Articles - Dossier

Serious games for the empowerment of young diabetics: the case of “Tako Dojo”


This paper examines whether and how serious games for health can support patient empowerment and healthcare behaviors. This study examines the case of diabetes and tests the following hypotheses: 1) playing serious games increases the empowerment of diabetics; 2) this empowerment positively influences therapeutic adherence; 3) playing serious games can positively influence the health behaviors of diabetics. To test our hypotheses, a group of young diabetics from Puglia in Italy (N = 124; Mage = 14 years old, SD = 2.14) played a serious game dedicated to diabetes management that was developed in the Tako Dojo project. Following gameplay, the participants filled in a questionnaire on user experience, diabetes empowerment, therapeutic adherence and socio-demographics. The collected data were subjected to correlation and multiple regression analysis. The results confirmed our hypotheses and open the way for a reappraisal of the role of serious games in enhancing the self-management of healthcare behaviors.


Educational Technology; eHealth education; Serious game; Health; Diabetes; Patient Empowerment; Healthcare behaviors; Technology Enhanced Learning (TEL)

Full Text:

PDF (Italiano)



Anderson, R. M., Funnell, M. M., Fitzgerald, J. T., & Marrero, D. G. (2000). The Diabetes Empowerment Scale. A measure of psychosocial self-efficacy. Diabetes Care, 23(6), 739-743.

Anderson, B., & Rubin R. (2002). Practical psychology for diabetes clinicians. Alexandria, VA: American Diabetes Association.

Annetta, L.A. (2010). The “I’s” have it: A framework for serious educational game design. Review of General Psychology, 14(2), 105-112.

Arnab, S., Dunwell, I., & Debattista, K. (2012). Serious Games for Healthcare: Applications and Implications. Hershey, PA: IGI Global.

Bandura, A. (2005). The Primacy of Self- Regulation in Health Promotion. Applied Psychology: An International Review, 54(2), 245-254. doi: 10.1111/j.1464-0597.2005.00208.x

Baranowski, T., Buday, R., Thompson, D. I., & Baranowski, J. (2008). Playing for Real: Video Games and Stories for Health- Related Behavior Change. American Journal of Preventive Medicine, 34(1), 74-82.

Barbaranelli, C. (2006). Analisi dei dati con SPSS II. Le analisi multivariate. Milano, IT: LED.

Brooke, J. (1996). SUS: A quick and dirty usability scale. In P. W. Jordan, B. Thomas, B. A. Weerdmeester, & I. L. McClelland (Eds.), Usability evaluation in industry (pp. 189-194). London, UK: Taylor & Francis Ltd.

Brown, S. J., Lieberman, D. A., Gemeny, B. A., Fan, Y. C., Wilson, D. M., & Pasta, D. J. (1997). Educational video game for juvenile diabetes: Results of a controlled trial. Medical Informatics, 22, 77-89.

Bruscaglioni, M. (1994). Orizzonte empowerment: panorama sui significati e applicazioni dell’empowerment. Risorsa Uomo, 3, 325-342.

DeShazo, J., Harris, L., & Pratt, W. (2010). Effective intervention or child’s play? A review of video games for diabetes education. Diabetes Technologies & Therapeutics, 12(10), 815-822. doi: 10.1089/dia.2010.0030

Durkin, K. (2010). Video games and young people with developmental disorders. Review of General Psychology, 14, 122- 140.

Eysenbach, G. (2001). What is e-health? Journal of Medical Internet Research, 3(2):e20. doi: 10.2196/jmir.3.2.e20

Faiola, A., & Kharrazi, H. (2010). Diabetes education and Serious gaming: Teaching adolescents to cope with diabetes. In B. M. Hayes & W. Aspray (Eds.). Health Informatics. A patient centered approach to diabetes (pp. 151-177). Cambridge, MA: The MIT Press. doi:10.7551/ mitpress/9780262014328.003.0006

Fox, J. A., & Bailenson, J. N. (2009). Virtual self-modeling: the effects of vicarious reinforcement and identification on exercise behaviors. Media Psychology, 12(1), 1-25.

Funnell, M. M., & Anderson, R. M. (2004). Empowerment and self-management of diabetes. Clinical Diabetes, 22(3), 123- 127. doi: 10.2337/diaclin.22.3.123

Gee, J. (2004). Learning by design: Games as learning machines. Interactive Educational Multimedia, 8, 15-23.

Hoffman, H. G., Patterson, D. R., Seibel, E., Soltani, M., Jewett-Leahy, L., & Sharar, S. R. (2008). Virtual reality pain control during burn wound debridement in the hydrotank. Clinical Journal of Pain, 24, 299-304.

Istituto Superiore di Sanità (2014). OKkio alla salute: sintesi dei risultati 2014 [PDF document]. Retrieved from:

Kapp K. M. (2012). The gamification of learning and instruction: game-based methods and strategies for training and education. San Francisco, CA: Pfeiffer.

Kato, P. (2010). Video Games in Health Care: Closing the Gap. Review of General Psychology, 14(2), 113-121. doi: 10.1037/a0019441

Kato, P. M., Cole, S. W., Bradlyn, A. S., & Pollock, B. (2008). A video game improves behavioral outcomes in adolescents and young adults with cancer: A randomized trial. Pediatrics, 122(2): e305–e317 doi: 10.1542/peds.2007-3134

Kayali, F., Peters, K., Kuczwara, J., Reithofer, A., Martinek, D., Wölfle, R., ... Hlavacs, H. (2015). Participatory Game Design for the INTERACCT Serious Game for Health. In Serious Games (pp. 13-25). Springer International Publishing.

Kharrazi, H., Faiola, A., & Defazio, J. (2009). Healthcare game design: behavioral modeling of serious gaming design for children with chronic diseases. In J. A. Jacko (Ed.), Human-Computer Interaction. Interacting in Various Application Domains. (pp. 335-344). Berlin, DE: Springer. doi: 10.1007/978-3-642-02583-9_37

Kristensen, L. J., Thastum, M., Mose, A. H., Birkebaek, N. H., & Danish Society for Diabetes in Childhood and Adolescence (2012). Psychometric evaluation of the adherence in diabetes questionnaire. Diabetes Care, 35(11), 2161-2166. doi: 10.2337/dc11-2342

Kühn, S., Gleich, T., Lorenz, R. C., Lindenberger, U., Gallinat, J. (2013). Playing Super Mario induces structural brain plasticity: gray matter changes resulting from training with a commercial video game. Molecular Psychiatry, 19: 265.271. doi: 10.1038/mp.2013.120

Michael, D., & Chen, S. (2006). Serious Games: Games That Educate, Train and Inform. Boston, MA: Thompson Course Technology PTR.

Patel, A., Schieble, T., Davidson, M., Tran, M. C. J., Schoenberg, C., Delphin, E., & Bennett, H. (2006). Distraction with a hand-held video game reduces pediatric preoperative anxiety. Pediatric Anesthesia, 16, 1019-1027.

Peters, K., Kayali, F., Reithofer, A., Wölfle, R., Mateus-Berr, R., Kuczwara, J., … Hlavacs, H. (2015). Serious Game Scores as Health Condition Indicator for Cancer Patients. In R. Cornet, L. Stoicu-Tivadar, A. Hörbst, C. L. Parra Calderón, S. K. Andersen, M. Hercigonja-Szekeres (Eds.), Digital Healthcare Empowering Europeans (pp. 892-896). doi:10.3233/978-1-61499-512-8-892

Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. Advances in Experimental Social Psychology, 19, 123-205.

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891.

Rinaldi, G., & Carnevali, L. (2011). Il ruolo dell’ICT nei moderni sistemi sanitari nazionali. L’introduzione dei concetti di e-health. Quali problematiche deve affrontare? Confronti, 15, 36-41.

Rappaport, J. (1981). In praise of paradox. A social policy of empowerment over prevention. American Journal of Community Psychology, 1, 1-25.

Salmon, P., & Hall, G. (2003). Patient empowerment and control: a psychological discourse in the service of medicine. Social Science and Medicine, 57, 1969-1980.

Santoro, E. (2007). Strumenti di rating al servizio pubblico: è vero empowerment? Ricerca & Pratica, 23, 189-191. doi 10.1707/300.3538

Seligman, M. (1990). Learned optimism. New York, NY: Knopf.

Tate, R., Haritatos, J., & Cole, S. (2009). HopeLab’s approach to re-mission. International Journal of Learning and Media, 1(1), 29-35. doi: 10.1162/ijlm.2009.0003

Thompson, D. (2012). Designing serious video games for health behavior change: Current status and future directions. Journal of Diabetes Science and Technology, 6(4), 807-811.

Thompson, D., Baranowski, T., Buday, R., Baranowski, J., Juliano, M., Frazior, M., … Jago, R. (2007). In pursuit of change: youth response to intensive goal setting embedded in a serious video game. Journal of Diabetes Science and Technology, 1(6), 907-917.

Thompson, D., Baranowski, T., Buday, R., Baranowski, J., Thompson, V., Jago, R., & Griffith, M. J. (2010). Serious video game for health: How behavioral science guided the development of a serious video game. Simulation & Gaming, 41(4), 587-606.

Yin, L., Ring, L., & Bickmore T. (2012). Using an Interactive Visual Novel to Promote Patient Empowerment through Engagement. In Proceeding of the International Conference on the Foundations of Digital Games, New York, ACM New York (pp. 41-48). doi: 10.1145/2282338.2282351

Zimmerman, M. (2000). Empowerment theory. In J. Rappaport, & E. Seidman (Eds.), Handbook of community psychology (pp. 43-63). New York, NY: Kluwer Academic/Plenum Press.

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


  • There are currently no refbacks.

Copyright (c) 2016 Gianvito D'Aprile, Antonio Ulloa Severino

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Italian Journal of Educational Technology (IJET) | ISSN (print) 2532-4632 | ISSN (online) 2532-7720