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Gaming to Teach Health Literacy
by Jennifer McCabe

If you keep up with the news of higher education then you have probably noticed the rising popularity of games in colleges and universities.  Many institutions around the world are exploring both the characteristics of learners who play games and the uses of games as learning tools. The examination of the use of games in higher education is as varied as it is widespread.  Some social scientists are using virtual worlds, like Second Life, as “Petri dishes” in which to conduct research.  Case Western Reserve University recently invested $30,000 into their Second Life campus in an effort to recruit potential students.  Other universities are using Second Life to offer training and development, and in the case of Harvard, to teach credit classes.   But the study of games and their pedagogical potential goes far beyond Second Life.  The University of North Carolina-Greensboro recently developed a microeconomics class that consists entirely of an online game.  Students are thrust into an alien world and forced to make economic decisions to survive.  All activity in this three-credit course takes place within the context of the game.

Here at James Madison University the exploration of gaming is equally varied, as this podcast from the Center for Instructional Technology (CIT) reveals.  Jennifer McCabe and Kevin Hegg, of JMU Libraries and Educational Technologies, recently completed work on a game aimed at helping students understand the complex issue of health literacy.  Health literacy, according to the National Library of Medicine's bibliography on the subject, is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” (cite GET THIS)  It is a constellation of skills including information- seeking, communication, cultural competence.  Being health literate is an essential part of health care today as many decisions clinicians and patients are forced to make involve complex information presented in a variety of formats.  Anyone who may interact with others, either as a nurse, social worker, therapist, or in another capacity, has an obligation to understand health literacy.Screen shot of Face the Case game avatar

The game McCabe and Hegg created is called “Face the Case”.  It is an online role-playing game where players receive health and human services situations and must acquire the appropriate skills to resolve them.  It takes place in a small virtual world that will feel familiar to players in the JMU community.  The game begins like many online games by creating an avatar, an online character that represents the player in the game.  Players create their avatar by choosing physical characteristics like gender, hair color, and clothing.  This information is retained and each time the player logs in to the game their avatar will retain the characteristics they chose.    

Once the avatar is set up, the player receives a message within the game notifying them of a situation that requires their intervention.  These situations are called cases, and they all have one or more people who need some kind of help with a health crisis.  The cases are as varied as a cancer patient exploring alternative treatments, to people who need home health care, to a prison cell block where inmates suspect poisoning from the chemicals in their soap.  All cases are similar in that they involve compromised health literacy.  Each case requires the player to identify and acquire new skills to resolve it.  As of this writing, there are 30 cases within the game, and a total of 22 discrete skills.  Players must select the skills they think the current case requires, and then acquire them by answering questions about topics related to health literacy.  Some questions require players to calculate the number of syllables in a sentence while others ask players to identify key concepts in sentences.  

In addition to acquiring skills on their own, players have the option of teaming up with collaborators, characters in the game who have specialized skills. Among the collaborators are a dietician, a drug counselor, and a sign language interpreter.  These collaborators are present in one part of the game, and they present their credentials as business cards that players can collect and use to solve cases.  Upon successful completion of the case, the player is rewarded with “bling bucks”, an in-game currency that they can use to acquire bling-- clothing, hair styles, and other accessories for their avatar.  The object of “Face the Case” is to select and acquire the appropriate skills to help a diverse population face their healthcare needs. 

Screen shot from Face the Case game

Categories of games include casual games like ”Bookworm” and Solitaire, massively multiplayer online games like “World of Warcraft” and “EverQuest”, and serious games, like “Multi Casualty Incident Response.” “Face the Case” was designed to incorporate the essential elements of game-play (levels of play, new powers, and rewards), while retaining its value as a learning tool.  The levels of play are expressed in terms of the difficulty of the case that the player solves.  The new powers are the skills the player acquires by correctly answering questions, and the rewards are in the form of virtual bling.  There is also one section of the game, Duke St. Park, where players may view others who have played the game, and see their avatars and current scores. 

Writing, designing, and programming for “Face the Case” took a team of five people approximately 18 months.  But creating a new game from scratch is not the only way to get games into the classroom.  Other ways to use “Face the Case” (or other existing games) include evaluating them for learning, design, to identify biases, and to help with retention of new information, designing new interfaces, or even documenting the process of creating an online learning tool.  “Face the Case” has been designed to be extensible, meaning that additional case narratives and mini-challenge questions can be added over time. 

Casual games can be created for courses by using Studymate, a Blackboard plug-in that allows faculty to design their own quiz games and electronic flash cards.  These are then linked in a Blackboard course and used to help students prepare for class and exams.  Almost any classroom activity can incorporate game like elements to increase the engagement.  Levels can appeal to some students who are motivated by achievement and competition with their peers.  New powers can be as simple as mastering new search strategies or accessing elusive information.  And rewards need not be grade-based; they can be as simple as pleasing sounds and visuals and public recognition of achievement. 

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