Exploring In-Game Reward Mechanisms in Diaquarium – A Serious Game for Children with Type 1 Diabetes

  • Ida Charlotte Rønningen
  • Eirik Årsand
  • Gunnar HartvigsenEmail author
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 10814)


When developing serious games for health, the main goal is to use game mechanisms in a way that the users decide to extend their playing time, complete all levels within the game, and thereby gain progression and intended learning with regard to disease management. One major concern when developing games for health is, therefore, the possibility of users who withdraw from the game before completed. A game, with a rapid descending popularity and users quitting gameplay early, fails to provide medical education to patients and is thus useless. For that reason, motivational game elements, such as in-game rewards, have been heavily used when designing serious games. This paper identifies and suggests several reinforcement mechanisms within serious games and explores how they can be applied in diabetes. The game called Diaquarium, a serious game for children with Type 1 diabetes, provides knowledge regarding how nutrition, blood glucose levels, and insulin interplay for this patient group. A prototype has been developed to demonstrate its concept and some game mechanisms with help of Unity 3D game engine and the C# programming language. Game design, requirements and suggestions for the project, were gathered through literature review, attending workshops, meetings and discussions with experts, as well as feedback from a related user group through a questionnaire. The questionnaire was distributed to an elementary school class, involving nine 9-year-old children. The questionnaire examined and collected feedback regarding the game outline, usability, and preferred reward mechanisms in the Diaquarium game. Despite a short period of testing and a limited test group with non-diabetic children, the game was recognized as attractive and moderately difficult within the potential user group. The analysis suggests that rewards are highly a matter of preference. Simultaneously, there were indications that some of the rewards were more favorable than others. It appears that rewards serving a purpose within the game, e.g., potentially effect progression in the gameplay, are more favorable than the opposite rewards serving no purpose. The findings were highly valued and taken into consideration during the design process of exploring the in-game rewards of the Diaquarium.


Serious games Diabetes Learning Motivation Reward mechanisms 


  1. 1.
    JDRF: Teen Toolkit. JDFR, New York (2013). Accessed 12 Dec 2016
  2. 2.
    Mitgutsch, K., Alvarado, N.: Purposeful by design? A serious game design assessment framework. In: Proceedings of the International Conference on the Foundations of Digital Games (FDG 2012), pp. 121–128. ACM, New York (2012)Google Scholar
  3. 3.
    Lewis, M.W.: Analysis of the roles of “serious games” in helping teach health-related knowledge and skills and in changing behavior. J. Diabetes Sci. Technol. 1(6), 918–920 (2007)CrossRefGoogle Scholar
  4. 4.
    Göbel, S., Hugo, O., Kickmeier-Rust, M., Egenfeldt-Nielsen, S.: Serious games—economic and legal issues. In: Dörner, R., Göbel, S., Effelsberg, W., Wiemeyer, J. (eds.) Serious Games, pp. 303–318. Springer, Cham (2016). Scholar
  5. 5.
    Rønningen, I.C.: Exploring in-game rewards in the Diaquarium: a serious game for children with type 1 diabetes mellitus. Master’s thesis in Computer Science. University of Tromsø – The Arctic University of Norway, December 2016Google Scholar
  6. 6.
    McKernan, B., Martey, R.M., Stromer-Galley, J., et al.: We don’t need no stinkin’ badges: the impact of reward features and feeling rewarded in educational games. Comput. Hum. Behav. 45, 299–306 (2015)CrossRefGoogle Scholar
  7. 7.
    Phillips, C., Johnson, D., Wyeth, P.: Video game reward types. In: Proceedings of First International Conference on Gameful Design, Research, and Applications, pp. 103–106. ACM, New York (2013)Google Scholar
  8. 8.
    Schell, J.: The Art of Game Design: A Book of Lenses. Elsevier, Amsterdam (2008)CrossRefGoogle Scholar
  9. 9.
    Schultz, W.: Multiple reward signals in the brain. Nat. Rev. Neurosci. 1(3), 199–207 (2000)CrossRefGoogle Scholar
  10. 10.
    Schultz, W.: Neural coding of basis reward terms of animal learning theory, game theory, microeconomics and behavioral ecology. Curr. Opin. Neurobiol. 14(2), 139–147 (2004)CrossRefGoogle Scholar
  11. 11.
    Howard-Jones, P., Jay, T.: Reward, learning and games. Curr. Opin. Behav. Sci. 10, 65–72 (2016)CrossRefGoogle Scholar
  12. 12.
    Hallford, N., Hallford, J.: Swords and Circuitry: A Designer’s Guide to Computer Role Playing Games. Prime Publishing, Roseville (2001)Google Scholar
  13. 13.
    Oxland, K.: Gameplay and Design. Addison Wesley, Harlow (2004)Google Scholar
  14. 14.
    King, D.L., Delfabbro, P., Griffiths, M.D.: Video game structural characteristics: a new psychological taxonomy. Int. J. Mental Health Addict. 8(1), 90–106 (2009)CrossRefGoogle Scholar
  15. 15.
    Wang, H., Sun, C.-T.: Game reward systems: gaming experiences and social meanings. In: Proceedings of the 2011 DiGRA International Conference: Think Design Play. Utrecht School of the Arts (2011)Google Scholar
  16. 16.
    Chou, Y.: The Six Contextual Types of Rewards in Gamification (2013). Accessed 14 Dec 2016
  17. 17.
    Johnson, P.: Surprise in Game Design (2013). Accessed 15 Dec 2016
  18. 18.
    Sylvester, T.: Designing Games: A Guide to Engineering Experiences. O’Reilly Media, Sebastopol (2013)Google Scholar
  19. 19.
    Granic, I., Lobel, A., Engels, R.C.M.E.: The benefits of playing video games. Am. Psychol. 69(1), 66–78 (2014)CrossRefGoogle Scholar
  20. 20.
    Konert, J., Göbel, S., Steinmetz, R.: Towards social serious games. In: Connolly, T., Felicia, P., Neville, G., Tabirca, S. (eds.) Proceedings of the 6th European Conference in Game Based Learning (ECGBL), vol. 1, no. 1. Academic Bookshop, Cork, Ireland (2012)Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ida Charlotte Rønningen
    • 1
  • Eirik Årsand
    • 2
  • Gunnar Hartvigsen
    • 1
    Email author
  1. 1.Department of Computer ScienceUniversity of Tromsø - The Arctic University of NorwayTromsøNorway
  2. 2.Norwegian Centre for E-health ResearchUniversity Hospital of North NorwayTromsøNorway

Personalised recommendations