Konstantinos C. Apostolakis

Researchers over the past 20 years have steered their attention towards examining whether video games have the potential to positively affect behavioral/emotional traits in players, recognizing their potential to offer not only enjoyable, but also meaningful experiences. Insight from studies has informed video game design, to achieve diverse outcomes, e.g., building empathy, shaping attitudes, raising awareness, or impacting how players (re)appreciate history. Utilizing the integrative review instrument, we examine the literature on video games as empathy/attitude change stimulants, alongside the methodological approaches, tools, evaluation studies, and outcomes comprising the current state of evidence. Through this process, we formulate future research directions, which (a) overview the interdisciplinary priorities of researchers in the aforementioned topics, (b) highlight their key insights/perspectives, (c) outline their methodological approaches, and (d) summarize the discussions, challenges, and outlook on future work toward realizing video games as digital spaces of conscience that foster empathy, critical reflection, and collective remembrance.

[This corrects the article DOI: 10.2196/54049.].

UNSTRUCTURED Patients undergoing surgery often experience stress and anxiety, which can increase complications and hinder recovery. Effective management of these psychological factors is key to improving outcomes. Preoperative anxiety is inversely correlated with the amount of information patients receive, but accessible, personalized support remains limited, especially in preoperative settings. Face-to-face education is often impractical due to resource constraints. Digital health (DH) interventions offer a promising alternative, enhancing patient engagement and empowerment. However, most current tools focus on providing information, overlooking the importance of personalization and psychological support. This study aimed to assess the viability of a DH intervention known as the Adhera CARINAE DH Program. This program is specifically designed to offer evidence-based and personalized stress- and anxiety-management techniques. It achieves this by using a comprehensive digital ecosystem that incorporates wearable devices, mobile apps, and virtual reality technologies. The intervention program also makes use of advanced data-driven techniques to deliver tailored patient education and lifestyle support. A total of 74 patients scheduled for surgery across 4 hospitals in 3 European countries were enrolled in this study from September 2021 to March 2022. Surgeries included cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacements, prostate or bladder cancer surgeries, hip and knee replacements, maxillofacial surgery, and scoliosis procedures. After assessment for eligibility, participants were randomized into 2 groups: the intervention group (n=23) received the Adhera CARINAE DH intervention in addition to standard care, while the control group (n=27) received standard care alone. Psychological metrics such as self-efficacy, self-management, and mental well-being were assessed before and after the intervention, alongside physiological markers of stress. The intervention group demonstrated significant improvements across several psychological outcomes. For example, Visual Analogue Scale Stress at the hospital improved at admission by 5% and at hospital discharge by 11.1% and Visual Analogue Scale Pain at admission improved by 31.2%. In addition, Hospital Anxiety and Depression Scale Anxiety after surgery improved by 15.6%, and Positive and Negative Affect Scale-Negative at hospital admission improved by 17.5%. Overall, patients in the intervention study spent 17.12% less days in the hospital. Besides these individual scores, the intervention group shows more positive relationships among the psychological dimensions of self-efficacy, self-management, and mental well-being, suggesting that the CARINAE solution could have a positive effect and impact on the reduction of stress and negative emotions. Our results provide an important first step toward a deeper understanding of optimizing DH solutions to support patients undergoing surgery and for potential applications in remote patient monitoring and communication. ClinicalTrials.gov NCT05184725; https://clinicaltrials.gov/study/NCT05184725.

Background: Patients undergoing surgery often experience stress and anxiety, which can increase complications and hinder recovery. Effective management of these psychological factors is key to improving outcomes. Preoperative anxiety is inversely correlated with the amount of information patients receive, but accessible, personalized support remains limited, especially in preoperative settings. Face-to-face education is often impractical due to resource constraints. Digital health (DH) interventions offer a promising alternative, enhancing patient engagement and empowerment. However, most current tools focus on providing information, overlooking the importance of personalization and psychological support. Objective: This study aimed to assess the viability of a DH intervention known as the Adhera CARINAE DH Program. This program is specifically designed to offer evidence-based and personalized stress- and anxiety-management techniques. It achieves this by using a comprehensive digital ecosystem that incorporates wearable devices, mobile apps, and virtual reality technologies. The intervention program also makes use of advanced data-driven techniques to deliver tailored patient education and lifestyle support. Methods: A total of 74 patients scheduled for surgery across 4 hospitals in 3 European countries were enrolled in this study from September 2021 to March 2022. Surgeries included cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacements, prostate or bladder cancer surgeries, hip and knee replacements, maxillofacial surgery, and scoliosis procedures. After assessment for eligibility, participants were randomized into 2 groups: the intervention group (n=23) received the Adhera CARINAE DH intervention in addition to standard care, while the control group (n=27) received standard care alone. Psychological metrics such as self-efficacy, self-management, and mental well-being were assessed before and after the intervention, alongside physiological markers of stress. Results: The intervention group demonstrated significant improvements across several psychological outcomes. For example, Visual Analogue Scale Stress at the hospital improved at admission by 5% and at hospital discharge by 11.1% and Visual Analogue Scale Pain at admission improved by 31.2%. In addition, Hospital Anxiety and Depression Scale Anxiety after surgery improved by 15.6%, and Positive and Negative Affect Scale-Negative at hospital admission improved by 17.5%. Overall, patients in the intervention study spent 17.12% less days in the hospital. Besides these individual scores, the intervention group shows more positive relationships among the psychological dimensions of self-efficacy, self-management, and mental well-being, suggesting that the CARINAE solution could have a positive effect and impact on the reduction of stress and negative emotions. Conclusions: Our results provide an important first step toward a deeper understanding of optimizing DH solutions to support patients undergoing surgery and for potential applications in remote patient monitoring and communication. Trial Registration: ClinicalTrials.gov NCT05184725; https://clinicaltrials.gov/study/NCT05184725 International Registered Report Identifier (IRRID): RR2-10.2196/38536

Serious games have emerged as a powerful tool for achieving targeted outcomes beyond entertainment, such as learning or raising awareness about a topic. Considering their pervasiveness and wide adoption in the educational domain, traditional assessment approaches of these games have predominantly focused on their entertainment value and achievement of learning objectives. This paper proposes a comprehensive evaluation framework that goes beyond traditional dimensions to include aspects relevant to empathy raising and attitude change. The proposed framework has been validated through three user studies, assessing entertainment, historical awareness, empathy raising, and attitude change for three games, involving in total 98 high school students. Results from the studies are presented, as well as implications and lessons learned regarding the overall methodological approach, the evaluation instruments used, and the procedures followed.

Video games are maturing as a medium to tell stories inspired by historical struggles and real-life experiences. In this regard, they could work as a mechanism in Transitional Justice pursuit. In this article, we argue that games can become agents for promoting education, reconciliation, and healing. We hence identify means by which museums and video games create empathy, reported in recent literature, and draw inceptive parallels between museum space design philosophies and design choices in modern video game experiences. Finally, we identify in the literature that there is a lack of a framework bringing together experts in memory and heritage studies with game developers, to derive guidelines for developing empathy-inducing games around sensitive topics. Thus, we propose a methodological approach to the creation of such a framework. This framework would instrument a collaborative effort to apply domain adaptation of the strategies and design philosophies for memory and Transitional Justice museum exhibitions to video game storytelling frameworks and mechanics.