COVID-19 as 'Game Changer' for the Physical Activity and Mental Well-Being of Augmented Reality Game Players During the Pandemic: Mixed Methods Survey Study

XR and mental wellbeing: state of the art and future research directions for the Metaverse

Introduction

The purpose of this study is to provide an overview of extant research regarding XR technology and its effect on consumer wellbeing. With the hopes of informing marketing practitioners on XR consumer psychology, in preparation for the Metaverse.

Methods

To achieve the above aim, two types of analysis took place. Firstly, a bibliometric analysis was conducted which was then followed by a framework-based structured literature review. The latter entailed an analysis of 81 articles evaluated from a positive psychological approach.

Findings

Following the TCCM framework, the analysis revealed the most common psychological theories demonstrating potential avenues for XR to impact consumer wellbeing. Moreover, researchers found preliminary links between, theory, characteristics, and contexts. Giving a preliminary description of how theory manifests into reality. Finally, the overview of extant literature was used to propose new avenues for future research pertaining to marketing, the Metaverse, and consumer effects.

Conclusion

In conclusion, the paper provides stakeholder insights which can ensure minimal consumer risk and sustainable use of the XR technology and Metaverse. While addressing the need for more research that uncovers the psychological effects of emerging technologies, so to prepare for the Metaverse. This is especially important when considering the current upsurge of these technologies and the uncertainties associated with their novelty and the idea of an 'always on' consumer.

Effects of a Rice-Farming Simulation Video Game on Nature Relatedness, Nutritional Status, and Psychological State in Urban-Dwelling Adults During the COVID-19 Pandemic: Randomized Waitlist Controlled Trial

BACKGROUND

During the COVID-19 pandemic, urban inhabitants faced significant challenges in maintaining connections with nature, adhering to nutritional guidelines, and managing mental well-being.

OBJECTIVE

Recognizing the urgent need for innovative approaches, this study was designed to explore the potential benefits of a specific digital intervention, the rice-farming simulation game Sakuna: Of Rice and Ruin, for nature relatedness, nutritional behaviors, and psychological well-being.

METHODS

A total of 66 adults without any prior major psychiatric disorders residing in an urban area were recruited for the study. They were randomly assigned to 2 groups through block randomization: the immediate intervention group (IIG; 34/66, 52%) and the waitlist group (32/66, 48%). Participants in the IIG were instructed to play the game for at least 4 days per week for 3 weeks, with each session lasting from 30 minutes to 3 hours. Assessments were performed at baseline, week 1, and week 3. The Nature Relatedness Scale (NR) and Nutrition Quotient Scale were used to evaluate nature relatedness and nutritional state, respectively. Furthermore, psychological state was assessed using the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), Brief Fear of Negative Evaluation Scale, Social Avoidance and Distress Scale, Toronto Alexithymia Scale, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale Revised, and Korean Resilience Quotient.

RESULTS

This study's results revealed significant time interactions between the IIG and waitlist group for both the total NR score (P=.001) and the score of the self subdomain of NR (P<.001), indicating an impact of the game on nature relatedness. No group×time interactions were found for the total Nutrition Quotient Scale and subdomain scores, although both groups showed increases from baseline. For psychological state, a significant group×time interaction was observed in the total WHOQOL-BREF score (P=.049), suggesting an impact of the game on quality of life. The psychological (P=.01), social (P=.003), and environmental (P=.04) subdomains of the WHOQOL-BREF showed only a significant time effect. Other psychological scales did not display any significant changes (all P>.05).

CONCLUSIONS

Our findings suggest that the rice-farming game intervention might have positive effects on nature relatedness, nature-friendly dietary behaviors, quality of life, anxiety, depression, interpersonal relationships, and resilience among urban adults during the COVID-19 pandemic. The impact of pronature games in confined urban environments provides valuable evidence of how digital technologies can be used to enhance urban residents' affinity for nature and psychological well-being. This understanding can be extended in the future to other digital platforms, such as metaverses.

TRIAL REGISTRATION

Clinical Research Information Service (CRIS) KCT0007657; http://tinyurl.com/yck7zxp7.

A Systematic Review of Health Management Mobile Applications in COVID-19 Pandemic: Features, Advantages, and Disadvantages

Introduction

With the increasing accessibility of smartphones, their use has been considered in healthcare services. Mobile applications have played a pivotal role in providing health services during COVID-19. This study is aimed at identifying the features, advantages, and disadvantages of health management mobile applications during COVID-19.

Methods

This systematic review was conducted in PubMed, Scopus, and Web of Science using the related keywords up to November 2021. The original articles in English about the health management mobile applications in COVID-19 were selected. The study selection was done by two researchers independently according to inclusion and exclusion criteria. Data extraction was done using a data extraction form, and the results were summarized and reported in related tables and figures.

Results

Finally, 12 articles were included based on the criteria. The benefits of mobile health applications for health management during COVID-19 were in four themes and 19 subthemes, and the most advantages of the application were in disease management and the possibility of recording information by users, digital tracking of calls, and data confidentiality. Furthermore, the disadvantages of them have been presented in two themes and 14 subthemes. The most common disadvantages are reduced adherence to daily symptom reports, personal interpretation of questions, and result bias.

Conclusion

The study results showed that mobile applications have been effective in controlling the prevalence of COVID-19 by identifying virus-infested environments, identifying and monitoring infected people, controlling social distancing, and maintaining quarantine. It is suggested that usability, ethical and security considerations, protection of personal information, and privacy of users be considered in application design and development.

Repercussions of Pandemic and Preventive Measures on General Well-Being, Psychological Health, Physical Fitness, and Health Behavior: Mediating Role of Coping Behavior

Background

Pandemic prevention measures increased physical inactivity due to travel restrictions that led to negative physical fitness, health behavior, psychological health, and general well-being. The mediating role of coping behavior must be identified before developing interventional strategies for this pandemic.

Objective

The study investigates the mediating role of coping behavior to mitigate the Coronavirus disease impact on physical fitness, health behavior, psychological health, and general well-being.

Methods

A web-based survey was used under convenience sampling to collect the primary data. Smart-PLS 3.0 was used to analyze the collected data.

Results

All 14 direct correlations (H1-H14) were correct, and coping behavior's mediating impact was shown to be statistically significant (H9a- H14d).

Conclusion

Our study findings indicate that mediating role of coping behavior in mitigating the pandemic impacts was statistically significant. It is concluded that coping behavior is a healthy adaptation to protecting the barrier against COVID-19 adverse effects on health.

Generalised anxiety disorder, depressive symptoms and their subjective change after the first wave of COVID-19 among gamers in Poland

Previous studies have indicated that levels of emotional distress were considerably elevated during the COVID-19 pandemic; however, some longitudinal studies did not confirm these findings. There is a very limited number of studies on specific subpopulations, such as video gamers in this particular period. Playing video games may have either a beneficial influence on mental health by diminishing stress or a detrimental impact in terms of increasing depression and anxiety. It is, therefore, important to establish whether regular gamers differ from the general population in terms of symptoms of depression and anxiety during COVID-19. A total of 1023 participants (aged 18-50) participated in the study. The sample was composed of gamers and was representative of the Polish population. Participants completed a modified version of GAD-7, PHQ-9 online, addressing subjective change in anxiety and depressive symptoms. 25% of the sample reported clinically significant anxiety levels, and 35% mentioned depression. There were no differences in anxiety and depression levels between the investigated sample of gamers and the general population. However, up to 30% of individuals reported an increase in subjective change in anxiety or depressive symptoms during COVID-19. A further 30% reported a downward subjective change in anxiety or depressive symptoms during COVID-19. The remaining 40% declared a lack of change in the subjective change in anxiety or depressive symptoms during COVID-19. Those who reported an increase scored substantially higher in anxiety and depression than other groups. This indicates that the COVID-19 pandemic may have impacted people's mental health along a syndemic-syndaimonic continuum. COVID-19 might have been harmful to those with already poorer mental health and beneficial to those with good mental health. It is also important to plan interventions targeting vulnerable individuals who report clinically significant levels of anxiety and depression - women and younger adults and those who subjectively perceive their emotional condition to deteriorate during the COVID-19 lockdown.

Playing remotely: The COVID-19 pandemic and mobile locative gaming in Northeast Brazil

Mobile locative games consist of a subset of mobile games that encourage players to go outside, by promoting outdoor activities and physical meetings. Because of this, their gameplay breaks the core of social distancing strategies implemented since the beginning of the COVID-19 pandemic. However, developers implemented changes in their locative games supported by the mobile game revenue model, which enabled a strategy called "playing remotely" that encourages the players to spend their money with microtransactions. This study analyses the impacts of the COVID-19 pandemic in mobile locative gaming, by examining the preferences and behavior of players from the Northeast Brazil, a region with socioeconomic inequalities and urban violence, among other issues that shape mobility practices. Accordingly, we pose a research question: how do players living in Northeast Brazil manage the mobile game revenue model for playing remotely during the COVID-19 pandemic? With this in mind, we have conducted an online survey among communities of players located in Northeast Brazil, by sharing a questionnaire with 21 questions. Seventy-four players from the region responded to our survey. The sample's age was from 16 to 58 years old, and they lived in seven of the nine states that form Northeast Brazil. We have found that players' preference is to invest their time in gathering resources by playing the game, instead of spending their money in microtransactions for playing remotely. Moreover, we have found that mobile communication plays a significant role in keeping players in touch during the COVID-19 pandemic, allowing players to expand their networks to other cities and countries. We have concluded that playing remotely represents an important strategy to support the development of locative games and other location-based applications, which can help us to prepare for the next pandemic.

A comparison of physiological intensity and psychological perceptions during three different group exercise formats

Introduction

Past research highlighted that group fitness is an ideal format to meet exercise prescription guidelines. To add, a group enhances exertion, enjoyment, and satisfaction. In the last five years, streaming (live classes on screen with other participants visible) and on demand (pre-recorded classes on screen without other participants visible) formats have grown in popularity. Our goal is to compare the physiological intensity and psychological perceptions of live group, live streaming, and non-live on demand classes. We hypothesize that live classes will have the greatest cardiovascular intensity, enjoyment, and satisfaction followed by streaming and finally on demand.

Methods

Fifty-four adults between 18–63 years, who regularly participate in group fitness classes, recorded their heart rate with a chest transmitter during a mixed-martial arts cardiovascular class on consecutive weeks in random order. We calculated the mean, identified the max, and extracted the top 300 values (5 min) for comparison between conditions.

Results

Following each class, the participants completed an online survey to evaluate their rate of perceived exertion, enjoyment, and satisfaction. Confirming our hypothesis, mean class heart rate and mean heart rate for the five minutes at the highest intensity were 9% greater during the live group format compared to both live streaming and non-live on demand (all values, p &lt; 0.01). However, there was no difference in any heart rate variables between the streaming and on demand formats. Also, rate of perceived exertion, enjoyment, and satisfaction were all significantly greater during the live session compared to the home collections (all values, p &lt; 0.05).

Discussion

Streaming and on demand group fitness formats are viable options for meeting exercise prescription guidelines. But physiological intensity and psychological perceptions were greater during the live class format.

Exergaming Among Young Adults in Canada: Longitudinal Study

BACKGROUND

Exergaming may be an important option to support an active lifestyle, especially during pandemics.

OBJECTIVE

Our objectives were: (i) to explore whether exergaming status from before to during the COVID-19 pandemic (stopped, started, sustained exergaming, never-exergamed) related to changes in walking, moderate-to-vigorous physical activity (MVPA), or meeting MVPA guidelines; and (ii) among past-year exergamers, to describe change in minutes/week exergaming from before to during the pandemic.

METHODS

681 participants (M(SD) age=33.6(0.5), 41% male) from the 22-year NDIT study provided data on walking, MVPA, and exergaming before (2017-20) and during the COVID-19 pandemic (2021). Physical activity (PA) change scores were described by exergaming status.

RESULTS

62.4% of participants never exergamed, 8.2% started exergaming during the pandemic, 19.7% stopped, and 9.7% sustained exergaming. Declines were observed in all three PA indicators in all four groups. Among the more salient findings: (i) participants who started exergaming during COVID-19 reported the highest MVPA levels before and during the pandemic and declined the least (mean -35 minutes/week) (ii) sustained exergamers reported the lowest MVPA levels during the pandemic (median 66 minutes/week), and they declined the most in MVPA (mean change of -92 minutes/week) and in meeting MVPA guidelines (-23.6%). During the pandemic, starters reported 85 minutes of exergaming/week and sustained exergamers increased exergaming by a median 60 minutes/week.

CONCLUSIONS

Although starting and sustaining exergaming did not appear to help exergamers maintain pre-pandemic PA levels, exergaming can contribute a substantial proportion of total PA in young adults and may still represent a useful option to promote PA during pandemics.

CLINICALTRIAL

Not applicable.

Digital technologies for mental health improvements in the COVID-19 pandemic: a scoping review

Digital technologies have been used to support mental health services for two decades, but the COVID-19 pandemic created a particular opportunity for greater utilization and more data-driven assessment of these digital technologies. This research aims to offer a scoping review of the characteristics and effectiveness of digital interventions that were employed to improve mental health in the real context of COVID-19 pandemic. A combination of search terms was applied for automatic search of publications in the relevant databases. The key features of included studies were extracted, including the intervention, participant, and study details. A total of 20 eligible studies were included in the final review, which were conducted across different geographic regions and among diverse cultural groups. Among them, fourteen studies mainly reported the impact of digital technologies on general population, while only one published study developed specific interventions for the isolated COVID-19 depressed patients in hospitals. Digital technologies identified in this review were mainly developed via web-based and mobile-based platforms, such as social networking and video conferencing applications. But less than half of them were aligned with theoretical approaches from standardized psychological treatments. Most of the studies have reported positive effects of digital technologies, either on improving general mental and emotional well-being or addressing specific conditions (e.g., depression, stress, and anxiety). This scoping review suggests that digital technologies hold promise in bridging the mental health-care gap during and after the COVID-19 pandemic, and calls for more rigorous studies to identify pertinent features that are likely to achieve more effective mental health outcomes.

Use of augmented reality in mental health-related conditions: A systematic review

Objective

Augmented reality (AR) is a relatively new technology that merges virtual and physical environments, augmenting one's perception of reality. AR creates a computer-generated environment that evokes a unique perception of reality, where real and virtual objects are registered with one another, which operates interactively and in real time. Recently, the medical application of AR technology has dramatically increased with other assisted technologies, from training to clinical practice. The ability to manipulate the real environment extensively has given AR interventions an advantage over traditional approaches. In this study, we aim to conduct a systematic review of the use of AR to have a better understanding of how the use of AR may affect patients with mental health-related conditions when combined with gamification.

Method

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching Pubmed and Web of Science databases.

Results and Conclusion

We identified 48 relevant studies that fulfill the criteria. The studies were grouped into four categories: Neurodevelopmental disorders, anxiety and phobia, psychoeducation & well-being, and procedural & pain management. Our results revealed the effectiveness of AR in mental health-related conditions. However, the heterogeneity and small sample sizes demonstrate the need for further research with larger sample sizes and high-quality study designs.

The untapped potential of Games for Health in times of crises. A critical reflection

Given its promising role in public health to address hard to reach population groups, game-based interventions (i.e., Games for Health, G4H) have experienced growing interest in recent years. Therefore, it is surprising that they have played only a minor role during the COVID-19 pandemic. Hence, the aim of this paper is to reflect the opportunities and challenges of G4H especially during the pandemic but also with regard to future health crises. As commercial video games (i.e., those that primarily aim to entertain its users) were often used to deal with the containment measures during the COVID-19 pandemic, we call for greater cooperation with commercial game makers to distribute health-related messages via entertainment games. With regard to G4H we see a need to (i) strengthen the intervention theory underlying game-based applications, (ii) to enhance the appeal of games in order to maintain the interest of users in the long term, and (iii) to improve the evidence base using appropriate study designs. Finally, we argue for (iv) greater user involvement, both in terms of developing game-based approaches and as co-researchers in solving complex health problems.

Seeking virtual support: Digital technology use in adolescent and young adults with advanced cancer

BACKGROUND

A cancer diagnosis, especially advanced cancer, interferes with adolescent/young adult (AYA) peer relationships. AYAs increasingly use digital technologies (i.e., social media, video games) as a social instrument; little is known about the role of digital technologies in the AYA cancer experience. The objective of this analysis was to describe the use and impact of digital technologies among AYAs with advanced cancer.

PROCEDURE

As part of the "Exploring the Concept of a 'Good Death'" study, semi-structured interviews were conducted with 32 English-speaking AYAs (14-25 years) with advanced cancer (relapsed/refractory disease, estimated survival <50%). Interviews were audio recorded, deidentified, and transcribed verbatim. Questions focused on communication and sources of psychosocial support. Directed content analysis was used for codebook creation. Three reviewers completed transcript coding and reconciled discrepancies. Thematic analysis identified hierarchical themes. The present analysis focused on the specific theme of "digital technologies as a support mechanism."

RESULTS

When asked about sources of support, social media and multiplayer online games were most often recognized by AYAs. Three themes emerged regarding the role of digital technologies: distraction, maintaining existing peer support, and connecting with peers with cancer. Two AYAs acknowledged negative consequences of social media.

CONCLUSIONS

AYAs with advanced cancer cite digital technologies as a mechanism for maintaining and seeking peer support. Digital technologies may be leveraged to provide psychosocial support for AYAs with advanced cancer.

Personality profiles and engagement with the augmented reality game Pokémon GO: a cross-sectional study

Background: Since its release in 2016, Pokémon GO™ has achieved not only extensive popularity but has also accrued evidence that it helps to increase physical activity and sense of belonging. Personality traits may explain a differential engagement and fidelity with the game, hence potentially allowing for prediction of different patterns of game engagement as well as its health benefits. Our objective was to compare personality traits between Pokémon GO game players and non-players. Methods: We conducted a cross-sectional study in participants aged 18+ years through an online survey. The following categories of game engagement were defined: active players, occasional players, former players, and never players. Personality was measured with the NEO-FFI inventory that evaluates personality across five domains: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. ANOVA and MANOVA models were performed to test differences in personality traits’ scores. Multivariate regression models were also used to describe specific differences across groups of game engagement. Results: Data from 654 participants, average 28.6 years of age, 75% male, were included in the study. In the ANOVA analysis, we observed differences between the three players' subgroups in openness (p=0.015) and conscientiousness (p=0.032). In MANOVA and multivariate regression analyses, we found that active players presented higher scores in openness and agreeableness, but lower scores in conscientiousness compared to former or non-players. Conclusions: We found evidence that people that actively play Pokémon GO are more likely to be friendlier and more open to new experiences, but also scored less on conscientiousness which is related to discipline. This gives us better insight on how personality may help identification of people and their involvement with activities that demand fulfillment of tasks. These findings could help inform the engagement with health-related behaviors, including physical activity and medication adherence.

Using Telemedicine during the COVID-19 Pandemic: How Service Quality Affects Patients' Consultation

The COVID-19 epidemic put pressure on the traditional healthcare system and offline consultation methods. Telemedicine platforms provide a more convenient and safer channel for online health communication. Based on the signaling theory, our study explores the impacts of three dimensions of physicians' service quality (need fulfillment, security, and responsiveness) on online patient consultation on telemedicine platforms. A negative binomial model was used to test cross-sectional data of 2982 physicians obtained from Haodf.com. The results show the following: (1) the need fulfillment dimension variables positively affect online patient consultation; (2) the security dimension variables positively affect online patient consultation; (3) the responsiveness dimension variables positively affect online patient consultation. Our results contribute to the theoretical aspect of signaling theory and service quality in the context of telemedicine platforms and have several practical implications for telemedicine platform physicians and platform operators.

Developing a play-anywhere handheld AR storytelling app using remote data collection

Immersive story experiences like immersive theater productions and escape rooms have grown in popularity in recent years, offering the audience a more active role in the events portrayed. However, many of these activities were forced to close at the start of the COVID-19 pandemic, arising from restrictions placed on group activities and travel. This created an opportunity for a story experience that users could take part in around their local neighborhoods. Five mobile applications (apps) were developed toward this goal, aiming to make effective use of available local map data, alongside virtual content overlaid on users' surroundings through Augmented Reality (AR), to offer additional story features not present in the real environment. The first two apps investigated the feasibility of such an approach, including the remote field testing of the apps, where participants used their own devices across a variety of locations. Two follow-up apps further aimed to offer an improved user experience, also adopting a more standardized testing procedure, to better ensure each app was completed in an intended manner by those participating remotely. Participants rated their experience through immersion and engagement questionnaire factors that tested for their appropriateness to rate such experiences, in addition to providing their feedback. A final app applied the same AR story implementation to a curated site-specific study, once pandemic restrictions had eased. This combination of remote studies and subsequent curated study offered a reverse methodology to much previous research in this field, but was found to offer advantages in corroborating the results of the remote studies, and also in offering new insights to further improve such an AR story app, that is designed to be used at an outdoor location of the user's choosing. Such an app offers benefits to those who may prefer the opportunity to take part in such an activity solo or close to home, as well as for storytellers to develop an outside story for use at a variety of locations, making it available to a larger audience, without the challenges and costs in migrating it to different locations.

Eight Hypotheses on Technology Use and Psychosocial Wellbeing: A Bicultural Phenomenological Study of Gaming during the COVID-19 Pandemic

In this nonconfirmatory qualitative study, we pursued a range of hypotheses regarding how gaming operates in the lives and psychosocial wellbeing of those who actively play videogames during a crisis, such as the COVID-19 pandemic in 2020. Informed by an explorative survey (N = 793), interpretive phenomenological analysis was applied to interview data from actively gaming Chinese (n = 10) and Finnish (n = 10) participants. Our findings demonstrate how the general increase of pandemic-time gaming did not manifest in all player groups, but in some life contexts gaming activity rather decreased along with reformations in subjective meaning hierarchies and values. Ultimately, eight subordinate themes were refined into testable hypotheses. The study encourages policies that promote socially supportive gaming during pandemic-like situations to consider including personally meaningful solitary play in their recommendations and highlighting context-specificity over generalization. Finally, as almost all our data points echoing experiences of decreasing gaming activity came from China, we stress the importance of culturally diverse samples in the psychological study of global phenomena.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03586-x.

Moving towards the End of Gender Differences in the Habits of Use and Consumption of Mobile Video Games

The world of video games has become one of the most important entertainment niches for society. In the last decade it has surpassed in turnover audio-visual markets such as cinema and music, driving the development of a new form of communication. The increase in the number of female gamers has highlighted the need to discover differences and similarities between players, both in habits and motivations. We present a study based on a survey procedure for the completion of a questionnaire that aimed to cover the age range of 18 to 30 years of Spanish youngsters and that reached a total of 711 valid responses. The results showed that there were no significant differences in terms of hours spent playing video games between the two genders, although there were motivational differences in the reasons for playing, specifically in terms of competition and challenge. The discussion of the results was carried out by means of a comparative statistical analysis of means to confirm the hypotheses and meet the objectives. Despite the existence of significant differences between genders, these were not as notable as might be expected. When it comes to gaming, as we have detected in our study, there were some consumption habits with differentiated gender patterns; however, in relevant indicators such as hours of consumption, increase in lockdown consumption, and spending, there were no significant differences. The gender gap that existed a few years ago between video gamers is becoming progressively narrower.

Gambling and gaming during COVID-19: The role of mental health and social motives in gambling and gaming problems

BACKGROUND

The uncertain and stressful global situation caused by the COVID-19 pandemic has the potential to cause anxiety and impact people's mental health. Simultaneously, social distancing policies have isolated people from their normal social interactions. These societal changes have inevitably influenced gambling and gaming practices, and many people may have turned to betting or gaming as a means of social exchange. This study examined the influence of COVID-19 anxiety on increased mental health problems and their relationship to gambling and gaming problems. The mediating role of social motives for gambling and gaming was also investigated.

MATERIAL AND METHODS

Finnish adults (N = 1530; Mage = 46.67; 50.33% male) were recruited from a volunteer participant panel to participate in a survey study. COVID-19 anxiety was assessed using a scale adapted from the Spielberger State-Trait Anxiety Inventory. Mental health problems were evaluated with the five-item Mental Health Inventory. Gambling problems were measured using the Problem Gambling Severity Index, and gaming problems were measured with the Internet Gaming Disorder Test. Social motives for gaming were evaluated using a single-item measure. Analyses used generalised structural equation modelling.

RESULTS

COVID-19 anxiety predicted increased mental health problems, which were associated with heightened gambling and gaming problems. Social motives for gambling and gaming were a significant mediator, suggesting that gambling and gaming problems are emphasized markedly among those who are socially motivated by and involved in such games.

CONCLUSIONS

Mental health problems experienced during the pandemic and the social properties of games might accentuate gambling and gaming problems.

Comparing the Psychological Effects of Manikin-Based and Augmented Reality-Based Simulation Training: Within-Subjects Crossover Study

BACKGROUND

Patient simulators are an increasingly important part of medical training. They have been shown to be effective in teaching procedural skills, medical knowledge, and clinical decision-making. Recently, virtual and augmented reality simulators are being produced, but there is no research on whether these more realistic experiences cause problematic and greater stress responses as compared to standard manikin simulators.

OBJECTIVE

The purpose of this research is to examine the psychological and physiological effects of augmented reality (AR) in medical simulation training as compared to traditional manikin simulations.

METHODS

A within-subjects experimental design was used to assess the responses of medical students (N=89) as they completed simulated (using either manikin or AR) pediatric resuscitations. Baseline measures of psychological well-being, salivary cortisol, and galvanic skin response (GSR) were taken before the simulations began. Continuous GSR assessments throughout and after the simulations were captured along with follow-up measures of emotion and cortisol. Participants also wrote freely about their experience with each simulation, and narratives were coded for emotional word use.

RESULTS

Of the total 86 medical students who participated, 37 (43%) were male and 49 (57%) were female, with a mean age of 25.2 (SD 2.09, range 22-30) years and 24.7 (SD 2.08, range 23-36) years, respectively. GSR was higher in the manikin group adjusted for day, sex, and medications taken by the participants (AR-manikin: -0.11, 95% CI -0.18 to -0.03; P=.009). The difference in negative affect between simulation types was not statistically significant (AR-manikin: 0.41, 95% CI -0.72 to 1.53; P=.48). There was no statistically significant difference between simulation types in self-reported stress (AR-manikin: 0.53, 95% CI -2.35 to 3.42; P=.71) or simulation stress (AR-manikin: -2.17, 95% CI -6.94 to 2.59; P=.37). The difference in percentage of positive emotion words used to describe the experience was not statistically significant between simulation types, which were adjusted for day of experiment, sex of the participants, and total number of words used (AR-manikin: -4.0, 95% CI -0.91 to 0.10; P=.12). There was no statistically significant difference between simulation types in terms of the percentage of negative emotion words used to describe the experience (AR-manikin: -0.33, 95% CI -1.12 to 0.46; P=.41), simulation sickness (AR-manikin: 0.17, 95% CI -0.29 to 0.62; P=.47), or salivary cortisol (AR-manikin: 0.04, 95% CI -0.05 to 0.13; P=.41). Finally, preexisting levels of posttraumatic stress disorder, perceived stress, and reported depression were not tied to physiological responses to AR.

CONCLUSIONS

AR simulators elicited similar stress responses to currently used manikin-based simulators, and we did not find any evidence of AR simulators causing excessive stress to participants. Therefore, AR simulators are a promising tool to be used in medical training, which can provide more emotionally realistic scenarios without the risk of additional harm.

School Nurses' Perceptions About Student's Wellbeing During the Covid-19 Pandemic in Sweden

The coronavirus 2019 (Covid-19) pandemic has affected both the private and public lives of people worldwide. Countries have chosen different strategies to reduce the spread of infection, including school closures and distance learning. This study aimed to describe school nurses' perceptions about the wellbeing of students during the Covid-19 pandemic in Sweden. Interviews in five focus groups and one individual were conducted with 17 school nurses in Sweden. The interviews were analyzed using a qualitative content analysis. According to the school nurses' perceptions, students were concerned about spreading infection, becoming infected themselves, their academic performances, and longing for socialization. The change in the school situation involved a slower pace and less anxiety for some students, more or less physical activity, and an increase in screen time.

The Impact of Pandemic-Related Life Stress on Internet Gaming: Social Cynicism and Gaming Motivation as Serial Mediators

A heightened interest in online gaming has emerged during COVID-19, and people have become increasingly vulnerable to internet gaming disorder (IGD). However, playing video games can also have a positive effect; gaming has been recognized as an efficient coping strategy. Currently, relatively little is understood about how online gaming can turn from an efficient coping strategy into an addiction disorder. This study investigated the mediating roles of social cynicism, escape and coping motives on the association between daily disruption during COVID-19 and IGD, seeking to reveal the underlying mechanism that influences the effects of gaming. A total of 203 participants in Hong Kong who reported having played electronic games during COVID-19 were surveyed. We conducted three hierarchical multiple regressions, then tested a serial mediation model using path analysis with structural equation modeling. The results revealed that escape motives significantly mediated the relationship between daily disruption related to COVID-19 and IGD, but no such effect was found for coping motives. Social cynicism alone was not a significant mediator, but social cynicism and escape motives in series mediated the relationship between daily disruption and IGD. These difference outcomes suggested different underlying mechanisms of escape and coping motives.

The Effects of Playing Video Games on Stress, Anxiety, Depression, Loneliness, and Gaming Disorder During the Early Stages of the COVID-19 Pandemic: PRISMA Systematic Review

During the initial phases of the COVID-19 pandemic, playing video games has been much more than just a pastime. Studies suggested that video games for many individuals have helped to cope with such difficult life experience. However, other research indicates that gaming may have had harmful effects. Within this context, this systematic review aimed to describe the literature on the effects of video games during the early stages of the COVID-19 crisis on stress, anxiety, depression, loneliness, and gaming disorder (GD), examining the study characteristics and outcomes. A systematic search of the literature was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. It was preregistered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY)-INPLASY202180053. The search databases were PsycINFO, Web of Science, and Medline. The search string was: [("video game*") OR ("computer game*") OR ("gaming")] AND [("COVID-19")]. Twenty-four studies met the inclusion criteria. Four research explored the effects of playing video games during the COVID-19 pandemic on stress, anxiety, and depression. Four studies investigated loneliness, while 18 research investigated game disorder. Video games, especially augmented reality and online multiplayer ones, mitigated stress, anxiety, depression, and loneliness among adolescents and young adults during stay-at-home restrictions. However, in the case of at-risk individuals (i.e., particularly male youths), playing video games had detrimental effects.

How can the potential harms of loot boxes be minimised?: Proposals for understanding and addressing issues at a national level

Background and aims

Loot boxes are in-game items which distribute rewards to players via random-number generation; many games require players to make in-game payments to access their contents. The combination of financial outlay and random rewards has raised concern about similarities to gambling. This debate paper presents a series of themes identified by an inter-institutional working group in Finland, alongside suggested actions, and are presented with the intention of stimulating debate among stakeholders.

Methods

This work uses an exploratory research approach to gather data from a range of sources, including state-of-the-art reports from several fields and qualitative content analysis of invited presentations from a range of stakeholders, including affected individuals, practitioners, and field-specific experts.

Results and Discussion

Several significant themes emerged from the work and are presented alongside a series of proposed action points. Based on this preliminary exploration we propose a series of, non-exhaustive, actions for both primary and secondary prevention. Furthermore, the group identified the potential for responsible gaming practices to be adopted which would help to minimize the harm from overspending in gaming activities. Finally, we identified the need for further research in the field, for example the use of player data and both longitudinal and qualitative studies.

Conclusions

The emergent themes are discussed in relation to both the views of the presenters and existing research in the field and are intended to promote discussion concerning the viability of context-specific approaches to an issue of global reach and significance.

Animal Crossing and COVID-19: A Qualitative Study Examining How Video Games Satisfy Basic Psychological Needs During the Pandemic

The COVID-19 pandemic has affected the way many people live their lives. The increasing amount of time spent indoors and isolated during periods of lockdown has been accompanied by an increase in the time people spend playing video games. One such game which soared in popularity during the early stages of the pandemic was Animal Crossing: New Horizons. Through semi-structured interviews with players, and using a theory-informed qualitative analysis, we document and examine players’ motivations and experiences playing Animal Crossing: New Horizons during the pandemic. Findings suggest that playing the game helped satisfy various psychological needs—autonomy, relatedness, and competence—as described by Self-Determination Theory. Conversely, players stopped playing the game when they found that their psychological needs were thwarted or better met through other activities. Our findings offer support that video games can offer psychological relief in stressful contexts by providing opportunities for people to satisfy key psychological needs. Theoretical and practical implications are discussed.

Augmented Reality Games and Presence: A Systematic Review

The sense of presence in augmented reality (AR) has been studied by multiple researchers through diverse applications and strategies. In addition to the valuable information provided to the scientific community, new questions keep being raised. These approaches vary from following the standards from virtual reality to ascertaining the presence of users’ experiences and new proposals for evaluating presence that specifically target AR environments. It is undeniable that the idea of evaluating presence across AR may be overwhelming due to the different scenarios that may be possible, whether this regards technological devices—from immersive AR headsets to the small screens of smartphones—or the amount of virtual information that is being added to the real scenario. Taking into account the recent literature that has addressed the sense of presence in AR as a true challenge given the diversity of ways that AR can be experienced, this study proposes a specific scope to address presence and other related forms of dimensions such as immersion, engagement, embodiment, or telepresence, when AR is used in games. This systematic review was conducted following the PRISMA methodology, carefully analysing all studies that reported visual games that include AR activities and somehow included presence data—or related dimensions that may be referred to as immersion-related feelings, analysis or results. This study clarifies what dimensions of presence are being considered and evaluated in AR games, how presence-related variables have been evaluated, and what the major research findings are. For a better understanding of these approaches, this study takes note of what devices are being used for the AR experience when immersion-related feelings are one of the behaviours that are considered in their evaluations, and discusses to what extent these feelings in AR games affect the player’s other behaviours.

Innovate or game over? Examining effects of product innovativeness on video game success

In recent years, the video game industry has invested significant amounts in the development of innovative elements for its products. However, it is still subject to debate whether these R&D investments always pay off. While prior research has confirmed that enhancing product innovativeness increases business performance in certain industries, corresponding findings for the video game market are lacking. This might be a result of missing theoretical conceptualizations and adequate empirical operationalizations of game innovativeness. Addressing this research gap, this study provides the first conceptualization and operationalization of game innovativeness, shedding first light on its performance effects. Based on longitudinal data on 351 computer games, our findings confirm that innovations in the game's presentation and principle enhance short-term success, whereas innovations in a game's storyline can be more of a hindrance than a godsend for companies. However, our results also show that performance effects of game innovativeness diminish over time.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12525-022-00521-7.

A longitudinal comparison of college student mental health under the COVID-19 self-restraint policy in Japan

Background

The coronavirus-19 (COVID-19) pandemic has resulted in substantial mental health problems. In addition to the fear of infection, prevention policies that result in isolation such as lockdowns or, in Japan, “self-restraint,” are associated with psychological symptoms. University students are vulnerable to emotional disorders because of the psychological challenges associated with the transition to adulthood. Therefore, we investigated changes in the mental health of university students before and during the COVID-19 pandemic.

Methods

We used data from depression screening conducted by the University of Tsukuba, Japan, during student health examinations. Students completed the Patient Health Questionnaire-9 (PHQ-9) and an open-ended question on stress self-coping.

Results

In 2020, 9.6% of students were depressed, approximately twice as many as in previous years. The paired samples Wilcoxon test showed that PHQ-9 scores were significantly higher in 2020 than in 2019; the largest effect size was for sleep difficulties. Analysis of the open-ended responses for stress coping strategies showed that physical activity and online communication were most frequently used.

Limitations

The 2020 survey was web-based, whereas the surveys in previous years were completed in person. Only approximately one-sixth of participants answered the open-ended question.

Conclusions

The percentage of students with mental health problems has doubled, and more attention to student mental health is needed. However, many students seem to be using appropriate coping measures. Education about best practices and raising awareness about establishing and maintaining sleep–wake rhythms may be useful.

Promoting Sports Engagement during the COVID-19 Pandemic via Virtual Reality Games

Objective

To examine sports engagement and health changes of young adults when utilizing a VR sports game and investigate the relationship between sports engagement and health.

Method

This study used a single-group design with 20 participants, aged 19–29 years, with no preexisting health conditions. The VR game “Sports Scramble” was used thrice within a span of one week. Outcomes sought include sports engagement and health, measured through the Sports Engagement Scale (SES) and Short Form 36 (SF-36), respectively.

Results

A significant difference (p < 0.001) was found between the pre-posttest scores of the SES. Moreover, a positive trend was observed in terms of health with a significant difference (p < 0.05) between pre-posttest scores of the SF-36's vitality dimension. There were positive correlations among the dedication and vigor subscales of the SES with the dimensions of health.

Conclusion

This study showed the potential of VR sports games in positively influencing sports engagement and health among participants with the vigor and dedication positively influencing health. Future studies may involve the exploration of the effectiveness of VR to promote engagement and health through a randomized controlled trial with a longer timeframe and across various populations.

Perceived barriers to physical activity during the 2nd lockdown in a northeastern state of Brazil

Background

The practice of physical activity has been recommended during the pandemic period of COVID-19 as a way of preventing the worsening of physical and mental health. After the increase in COVID-19 cases in Brazil and the new lockdown decrees, many people have reported that they are unable to engage in physical activity during the lockdown.

Aims

The present study aimed to investigate the barriers to physical activity in the 2nd lockdown in the state of Ceará, Northeast Brazil.

Methods

1036 (55.6% women) residents of the state of Ceará, Northeastern Brazil participated in the study. For data collection, a questionnaire was used including sample characterization questions, physical activity, and barriers to physical activity during the 2nd lockdown in the state of Ceará. This instrument was made available by Google Forms, between March 8th and 19th, 2021. Descriptive statistics and logistic regression were used for data analysis.

Results

The three most relevant barriers were: Lack of motivation (7.3%), lack of space at home (5.9%) professional instructions (2.8%). The lack of space at home barrier was associated with age (OR = 2.56; CI 95% 1.05-6.02) and living in the capital (OR = 2.53; CI 95% 1.26-5.33). The barriers, taking care of children (OR = 3.75; CI 95% 1.37-10.2) and increased time spent on daily activities (OR = 2.20; CI 95% 1.02-4.74) were associated with living in the metropolitan region.

Conclusion

The lack of motivation, space at home, and professional instruction showed as being limiting factors to physical activity during the lockdown, indicating plans of action aimed at encouraging the practice of physical activity during a pandemic period.

Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review

BACKGROUND

Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games.

OBJECTIVE

The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play).

METHODS

A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [("video game*") OR ("computer game*")] AND [("stress") OR ("anxiety") OR ("relaxation")] AND [("study") OR ("trial") OR ("training")].

RESULTS

A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety.

CONCLUSIONS

Efficacy in reducing stress and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081.

Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint

The COVID-19 pandemic caused widespread challenges and revealed vulnerabilities across global health care systems. In response, many health care providers turned to telehealth solutions, which have been widely embraced and are likely to become standard for modern care. Immersive extended reality (XR) technologies have the potential to enhance telehealth with greater acceptability, engagement, and presence. However, numerous technical, logistic, and clinical barriers remain to the incorporation of XR technology into telehealth practice. COVID-19 may accelerate the union of XR and telehealth as researchers explore novel solutions to close social distances. In this viewpoint, we highlight research demonstrations of XR telehealth during the COVID-19 pandemic and discuss future directions to make XR the next evolution of remote health care.

Effectiveness of Interactive Tools in Online Health Care Communities: Social Exchange Theory Perspective

Background

Although the COVID-19 pandemic will have a negative effect on China’s economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms increased by 10, and the number of new users’ daily consultations increased by 9 during the pandemic. The continuous participation of physicians is a major factor in the success of the platform, and economic return is an important reason for physicians to provide internet-based services. However, no study has provided the effectiveness of interactive tools in online health care communities to influence physicians’ returns.

Objective

The effect of internet-based effort on the benefits and effectiveness of interactive effort tools in internet-based health care areas remains unclear. Thus, the goals of this study are to examine the effect of doctors’ internet-based service quality on their economic returns during COVID-19 social restrictions, to examine the effect of mutual help groups on doctors’ economic returns during COVID-19 social restrictions, and to explore the moderating effect of disease privacy on doctors’ efforts and economic returns during COVID-19 social restrictions.

Methods

On the basis of the social exchange theory, this study establishes an internet-based effort exchange model for doctors. We used a crawler to download information automatically from Haodf website. From March 5 to 7, 2020, which occurred during the COVID-19 pandemic in China, cross-sectional information of 2530 doctors were collected.

Results

Hierarchical linear regression showed that disease privacy (β=.481; P<.001), reputation (β=.584; P<.001), and service quality (β=.560; P<.001) had a significant positive effect on the economic returns of the physicians. The influence of mutual help groups on earnings increases with an increase in the degree of disease privacy (β=.189; P<.001), indicating that mutual help groups have a stronger effect on earnings when patients ask questions about diseases regarding which they desire privacy.

Conclusions

For platform operators, the results of this study can help the platform understand how to improve doctors’ economic returns, especially regarding helping a specific doctor group improve its income to retain good doctors. For physicians on the platform, this study will help doctors spend their limited energy and time on tools that can improve internet-based consultation incomes. Patients who receive internet-based health care services extract information about a doctor based on the doctor’s internet-based efforts to understand the doctor’s level of professionalism and personality to choose the doctor they like the most. The data used in this study may be biased or not representative of all medical platforms, as they were collected from a single website.

Problematic Use of Alcohol and Online Gaming as Coping Strategies During the COVID-19 Pandemic: A Mini Review

The COVID-19 (coronavirus disease 2019) pandemic has dramatically changed our daily lives and activities, including those originally intended to serve for leisure and pleasure. Drinking and online gaming became coping behaviors used to rescue ourselves from the stress and restricted lifestyle during the COVID-19 pandemic. However, frequent drinking and gaming can result in the pathological consequences of addiction. Those affected use the stimuli not to obtain pleasure, but rather to avoid the displeasure induced by stress and previous use, often unsuccessfully. This review aims to provide an overview of recent longitudinal cohort studies on alcohol and gaming use during the COVID-19 pandemic, as well as to analyze how the pandemic has affected alcohol and gaming use. There was a substantial risk of alcohol and online gaming overuse during the lockdown, which may depend on the pandemic's duration or overuse patterns. Previous studies have shown that increased alcohol consumption and online gaming are associated with heightened stress and anxiety levels caused by social isolation/quarantine. Over time, frequent or excessive alcohol consumption and gaming could lead to an increased risk of more serious mental health problems. Every effort should be made to mitigate mental health problems and ensure adequate adaptation to these exceptional circumstances. Therefore, it would be helpful to encourage physical activity, social interaction, and collaboration to facilitate psychological and physical health.