Disengagement from games is challenging for children, and can lead to family conflict. While parental mediation is well-understood, the role of game design in supporting children’s disengagement remains underexplored. Our work addresses this gap through a qualitative study with 39 participants (22 children aged 4-11 and 17 parents), in which children played "Snarky’s Adventure", a prototype featuring disengagement-friendly mechanics supporting player understanding of progress, and the experience of satisfaction and closure at the end of play. Through Qualitative Content Analysis, we show that the features help children anticipate the end of play, but in some cases spark curiosity and the desire to re-engage. Additionally, while parents valued the mechanics to understand game progress, future work should explore how to actively engage them in children’s disengagement. Our work provides the first empirical exploration of disengagement-friendly game mechanics, and outlines challenges and opportunities for their future integration in children’s games.

When people play digital games together, their experiences are often influenced by the group. While prior research has focused on the individual player experience, we argue that a deeper understanding of group dynamics is required for designing digital games that effectively support complex social interactions. In this paper, we characterise the lived group experiences of fifteen long-term players, using qualitative content analysis of semi-structured interviews examining group lifecycles, their impact on play, and how games and platforms support or constrain them. Our findings show that gaming groups are diverse, often shifting between people- and task-orientation based on needs and motivations. They influence how games are experienced, establishing shared practices that persist across contexts. Yet, while games and tools support group play, they often lack flexibility to accommodate such evolving and nuanced social dynamics. We provide insight into how group-based play unfolds and examples of how games can better support it.

Embedding social robots in educational and/or childcare settings has potential to engage children while supporting caregivers. However, little is known about the practical, long-term integration of robots in such settings. Our work addresses this gap through an ethnographic study that adopts a year-long perspective toward a socially assistive robot in an inclusive daycare with a four-month robot deployment phase. Through Thematic Analysis, we highlight children's ability to develop a variety of self-determined interactions with the robot, while unveiling caregivers' need for its integration into structured routines such as meal times, as well as challenges for robustness of the robot in our research setting. On this basis, we make recommendations for the design of social robots for daycare environments.

Design workshops are often inaccessible to blind people due to a strong reliance on visual design methods. This paper presents an adapted low-fidelity prototyping method to enable blind persons to actively participate in the early design stages of developing assistive devices. We chose the development of a 2D tactile display as a case study. Therefore, we conducted four workshops with blind participants to develop a haptic toolkit and adapt the structure of prototyping workshops based on the preferences of the target group. The resulting toolkit and workshop structure were applied in six prototyping workshops with 12 blind participants to design a new 2D tactile display to test the new method. Our findings show that the participation of blind individuals is highly relevant for structuring accessible prototyping workshops, deciding group size, and developing accessible prototyping materials. Furthermore, our work lays the foundation for further investigation of the role of sighted assistants and the design of workshops that truly center blind persons as primary contributors.

Designing accessible lectures and lecture materials is crucial to promote inclusive higher education.We conducted need-finding interviews with 12 students who are blind or have low vision to learn their perspectives on how lectures and lecture material could become more accessible through Artificial Intelligence (AI) technologies.Key insights from the interviews reveal that students envision AI to automatically customize lecture material, connect disparate information sources, for example, to better keep track of the current lecture slide, and enhance interaction and engagement with lecture material.Based on these insights, we developed the LectureAssistant prototype, employing an iterative design process with visually impaired users that features AI-assisted video navigation and chatbot interaction.In a final evaluation with seven students, the participants expressed enthusiasm for features such as AI-powered video search and the possibility of asking questions about visual content in the current video frame.They provided valuable suggestions for future improvements, including notifications for lecture slide transitions and the provision of a short overview function for a slide.Insights from the study indicate great potential of the prototype to improve accessibility of lecture videos for students with visual impairments, although they also point to crucial areas for improvement, such as more reliable and personalized image descriptions.

Figure 1: Screenshots of the VR game (left) and quiet room (right).

Figure 1: With aVRness, users can choose between displaying real-world objects through fitting placeholders (Anchor Mode), or a faded view of the real world (Gradient Passthrough Mode) to increase their safety and avoid collisions during VR locomotion.

Virtual Reality (VR) promises to enable people to fully immerse themselves in virtual worlds.However, the body-centricity of VR results in accessibility concerns for people with physical disabilities.In our work, we build on existing research that focuses on physical accessibility and discuss the digital layer that includes the design of avatars and virtual worlds, and the experiential layer that addresses the experience that VR provides for people with physical disabilities.We present findings from a qualitative study (N=16) that combined semi-structured interviews with hands-on exploration of state-of-the-art VR hardware and applications.Leveraging Qualitative Content Analysis, our results show that physical, digital, and experiential accessibility concerns are often intertwined and must be seen in conjunction.Additionally, we show that application contexts (e.g., gaming or social VR) shape accessibility concerns and preferences.On this basis, we contribute a nuanced discussion of the complexity of VR accessibility and examine context-specific accessibility preferences using the examples of VR gaming and social VR that need to be accounted for to create accessible and enriching VR experiences.

Spectating sports matches or concerts is a popular activity, but these public live events have yet to become more accessible to people with disabilities. Inspecting the corresponding interactive seat plan before purchasing tickets online can be necessary to avoid or prepare for barriers at these venues. Unfortunately, these representations often lack valuable accessibility information. To explore how this can affect the disabled community, we leverage autoethnography to provide an in-depth introspective account through the lens of a person with a mobility disability. We apply Thematic Analysis to synthesise field notes from his research diary. The crafted themes showcase the lacking accessibility support in seat plans and illustrate the first author's adaptation strategies to facilitate accessible experiences. We further contextualise his social relationships as a key factor throughout this process. Grounded in these results, we reflect on the provision of accessibility information, the categorisation of seats, and interdependent relationships within and through these systems.

The positive effect of visual embellishments such as juiciness on player experience (PX) is well-recognized. However, little is known about non-interactive visual embellishments (e.g., decorative background images or game objects players cannot interact with) and their implications for PX. This paper introduces lushness, a novel concept referring to non-interactive visual elements in games that are leveraged for decorative purposes. We present results from a study with 31 participants who played four versions of a 2D platformer game with varying levels of lushness: (a) no lushness, (b) low lushness, (c) moderate lushness, and (d) extreme lushness. Results demonstrate positive effects of increased lushness on PX, in particular on audiovisual appeal and overall attractiveness of the game. However, we did not observe differences regarding other aspects of PX, e.g., player competence or cognitive load. Our findings suggest that lushness enhances PX on a surface-level, improving the visual appeal of games without significantly impacting other areas of PX. Designers and researchers can benefit from the informed use of lushness in the development of games to ensure visual appeal, an aspect which we critically appraise for appropriateness in different game genres and contexts of play.

Competitive play in the multiplayer online battle arena game (MOBA) League of Legends (LoL) is a popular and engaging form of leisure.While it is well-understood what draws players into such games, less is known about the process of disengagement from play sessions in competitive multiplayer settings.However, disengagement is a necessary part of play, and one that has a significant impact on player experience.Our work addresses this knowledge gap through an exploratory interview study that examines the disengagement experiences of regular LoL players (n=8) and coaches (n=2).Leveraging grounded theory, our preliminary results identified four key contributors to the experience of disengagement: (1) satisfaction and frustration related to player performance, (2) team dynamics and social interaction, (3) individual and social aspirations, and (4) the role coaching in the structure of play sessions.These themes structure the complex dynamics of player experience at the end of play sessions.Building upon our initial findings, we propose a lens on disengagement in competitive online multiplayer games, adding nuance to the existing body of literature that has examined disengagement in single-player settings.

Non-verbal children are often provided with non-verbal communication cards (NVCCs) to share their needs. However, in busy spaces that prioritize verbal communication, for example, a daycare, this may place them at a disadvantage in comparison with verbal peers. In this work, we introduce the concept of a Socially Mediating Robot (SMR), acting as a communicational intermediary that verbalizes NVCC input. Thereby, we want to explore whether non-verbal children can be empowered by giving them an additional way of expressing themselves in a dynamic, buzzing environment. In an exploratory interview study with six participants professionally working with children, we then provide first insights on the feasibility of our concept from the perspective of caregiving staff. Thereby, we lay the groundwork for evaluating the concept in an ongoing field study in an inclusive daycare context.

This paper explores the adoption of a clinical decision support system (cDSS) utilizing game-based digital biomarkers for diagnosing mild cognitive impairment (MCI). Specifically, it investigates how different explanation methods, with a focus on data-centric explanations, impact perceived ease-of-use, perceived usefulness, and trust among healthcare professionals (HCPs). Through a qualitative study with 12 HCPs, we assess their interactions with an explainable AI (XAI)-enriched cDSS. The findings indicate that HCPs are open to adopting XAI-enriched cDSS to communicate the outcomes of game-based digital biomarkers. HCPs preferred to receive key diagnostic information in an easily digestible format. Both local explanations of intra-personal evolutionary data and global overview of normative data were found to be valuable for interpreting digital biomarkers. HCPs tended to trust the machine learning algorithms as a black box, but they considered the dataset used for training the model and the outcome prediction to be crucial. Therefore, presenting the uncertainty alongside the prediction was deemed important. These insights underscore the importance of designing cDSS tools that foster trust through clear, actionable explanations, paving the way for improved decision-making in clinical contexts.

Attending public sports events is a popular leisure activity that has yet to become more accessible for people with limited mobility. In our work, we address the role that technology, and especially, digital ticketing infrastructures play in the individual preparation for attending football matches and the experiences that disabled fans have at football stadia. Building on autoethnographic work on attending large public events with a disability, we report findings from semi-structured interviews with people with limited mobility (N=12). We apply Reflexive Thematic Analysis to craft four main themes, (1) showcasing the importance of familiarity with the processes, (2) illustrating the (in)voluntary separation of disabled and non-disabled people in current (ticketing) infrastructures, (3) highlighting social contacts as key contributor but dependency on other people also as obstruction of accessibility, and (4) contextualising the role of interactive seat plans for ticketing. Building upon these findings, we contribute an account on the experiences of people with limited mobility and the examination of current and prospective technology for this purpose with a focus on ticketing and seat plans, thereby also appraising previous findings from autoethnography.

• Disengagement is a multicausal player choice, not a design failure • Disengagement can be supported by various game design features • Internal, external, motivational, emotional factors influence dis(engagement) • (Dis)engagement triggers, supports and suppressors are identified Engagement is often viewed as the holy grail of digital experiences, particularly video games, while disengagement is seen as a consequence of poor design. This study attempts to flip the script, exploring disengagement as a natural part of the user journey rather than a failure of game design. Focusing on the popular open-world game Minecraft, the research investigates dynamics triggering engagement and disengagement in the multiplayer mode through the lenses of established frameworks like the Process Model of Engagement as well as the Mechanics, Dynamics, and Aesthetics model. Semi-structured focus-group interviews conducted with 15 participants analyzed using Mayring's content analysis revealed social connections, novelty, progression, goal-driven gameplay, and adrenaline-fueled combat as key drivers that keep players hooked. Yet, the very act of achieving goals, absence of friends, overplay, setbacks, skill gaps, negative interactions, and the demands of the real world can trigger a powerful urge to disengage. Far from a design flaw, this research expands the body of literature suggesting that disengagement is a vital component of user autonomy. By redefining success beyond mere engagement metrics, the study paves the way for responsible gaming practices that empower players to make informed choices about their level of involvement. It beckons us to embrace a holistic vision of genuinely sustainable, ethical, and meaningful digital experiences that respect user autonomy and cultivate healthy engagement patterns.

Disengagement from games can be challenging for players, and various attempts have been made to provide parents with the tools to limit children’s playing time. However, little is known about how children experience disengagement, and how children and parents jointly navigate the process of exiting a play session. To address this gap, we conducted semi-structured interviews with 25 participants, including 13 children (ages 4–9) and 12 parents. Through Thematic Analysis, we show that children – like adults – struggle to exit play if they have not yet reached a point of closure and are unsatisfied with their experience. At the same time, parents experience frustration when establishing limits, and many found it difficult to account for the state of a play session. On this basis, we highlight the relevance of disengagement-friendly game design and mediation strategies, and provide recommendations for children’s disengagement from play sessions while protecting their player experience.

Games for physical therapy can motivate patients, and HCI research has provided various recommendations for their design. However, such recommendations often remain at a high level: They are rarely reviewed with patients or appraised through application to game design and analysis. We address this gap by refining and operationalizing existing lessons for therapeutic games for young people. First, we report on semi-structured interviews with young people (aged 7–16) and parents, reviewing the lessons. Second, we operationalize them using an established collection of game design patterns to provide concrete guidance for game design and analysis. We critically appraise our approach through application to two games for physical therapy, Liberi and Wii Fit. Results show that high-level design implications can be made actionable using existing game design patterns, and we contribute a practical approach for the analysis and design of games for physical therapy.

Interactive technology and games provide promising methods for wheelchair skills training. This paper introduces RollAbility, a rehabilitative game for powered wheelchair skills training aimed at children and teenagers with complex movement disorders. The game combines clinical best practices and standardized training protocols with player experience goals. Developed through an iterative process with rehabilitation experts and game designers, RollAbility utilizes the Wheelchair Skills Training Program [Kirby et al. '23] and integrates key insights from Aufheimer's [CHI '23] motivation studies in physical therapy to ensure both therapeutic and engaging gameplay. Evaluated through exploratory sessions with children, therapists, and clinical experts, results show that RollAbility effectively merges clinical protocols with an engaging game format. However, balancing player autonomy and therapist guidance remains a critical consideration. This work offers a blueprint for designing therapeutic games that align clinical protocols with engaging player experiences.

Equitable access to sport for disabled people remains challenging, and technology is often viewed as a way of addressing barriers. However, little is known about how disability is approached in such research and the purpose of sport that is afforded to disabled people. We address this issue in a review of 60 publications in the field of Human-Computer Interaction. We leverage Template Analysis in combination with Mueller and Young’s lenses on virtues of sport to also explore the experiential side of sports technology for disabled people. Our results are threefold: (1) We show that disability shifts the intended purpose of sports technology away from leisure to health, and that technologies such as exergames are viewed as an opportunity to replace real-world sport to address barriers and increase motivation. (2) We highlight that in(ter)dependence plays a strong role in technology development, but that disabled people are not extensively involved in research. (3) We show that virtues beyond health as per Mueller and Young do apply to existing work, but that value frameworks need to be re-worked in the context of disability, placing a stronger emphasis on sport as leisure, and the enriching role that technology can play.

Ending a gaming session can be challenging for children and parents/guardians. Although many tools exist to monitor and restrict playtime, many do not adequately communicate session progress to children, and do not effectively involve guardians in the process. This is a missed opportunity for families to develop media literacy, and can also lead to conflicts and fights about playtime. To open up conversation about playtime management as a shared responsibility between children and guardians, we present "Schlusslicht"’ – an ambient display that seeks to facilitate a shared awareness of progression of a gaming session and remaining time between guardians and children, and can be leveraged to further explore how we can best support children when disengaging from play sessions. Video link: https://www.youtube.com/watch?v=khEdN9C9Sgw

In this experience report, we report on the first author’s recent personal experience of relocation from Turkey to Germany as a postdoctoral researcher with a mobility disability. Here, we outline the details of the relocation process in three phases. In each phase, we share reflections on the relocation experience specifically outlining accessibility challenges. We focus on customizing existing and new access needs, dealing with language barriers as a blocker for interpersonal accessibility, but also discuss digital access, and visibility of access information in relation to connecting with local disabled communities. We refine our insights into lessons learnt from this process, outlining implications for policy makers, researchers and designers, academic community, as well as for the disabled community. Through this autoethnographic experience report, we aim to open a space to critically rethink accessibility on the move and the role of technology, specifically in the context of relocation.

‘Juicy’ or immediate abundant action feedback is widely held to make video games enjoyable and intrinsically motivating. Yet we do not know why it works: Which motives are mediating it? Which features afford it? In a pre-registered (n=1,699) online experiment, we tested three motives mapping prior practitioner discourse—effectance, competence, and curiosity—and connected design features. Using a dedicated action RPG and a 2x2+control design, we varied feedback amplification, success-dependence, and variability and recorded self-reported effectance, competence, curiosity, and enjoyment as well as free-choice playtime. Structural equation models show curiosity as the strongest enjoyment and only playtime predictor and support theorised competence pathways. Success dependence enhanced all motives, while amplification unexpectedly reduced them, possibly because the tested condition unintentionally impeded players’ sense of agency. Our study evidences uncertain success affording curiosity as an underappreciated moment-to-moment engagement driver, directly supports competence-related theory, and suggests that prior juicy game feel guidance ties to legible action-outcome bindings and graded success as preconditions of positive ‘low-level’ user experience.

Playing cooperative games is recognised as a positive social activity. Yet, we have limited means to rigorously define or communicate the structures that govern these experiences, hindering attempts at consolidating knowledge and limiting the potential of design efforts. In this work, we introduce the Living Framework for Cooperative Games (LFCG), a framework derived from a multi-step systematic analysis of 129 cooperative games with contributions of eleven researchers. We describe how LFCG can be used as a tool for analyses and ideation, and as a shared language for describing a game’s design. LFCG is published as a web application to facilitate use and appropriation. It supports the creation, dissemination and aggregation of game reports and specifications; and enables stakeholders to extend and publish custom versions. Lastly, we discuss using a research-driven approach for formalising game structures and the advantages of community contributions for consolidation and reach.

Utilizing a validated scale to assess player experience (PX) in video games can yield important findings. Nevertheless, insufficient quantitative data analysis expertise among games user research (GUR) self-taught practitioners, poses obstacles to effectively analyzing and interpreting the data obtained from various measurement scales. Hence, in this paper, we present a guided interface based web platform to support data analysis of the Player Experience Inventory (PXI), following a user-centered design (UCD) process, incorporating insights from Games User Research (GUR) specialists. The interface, extending a current platform for PXI data evaluation, aspires to enable data analysis with a high degree of flexibility, offering explanatory support for both, inexperienced and experienced analysts. The findings from user testing sessions indicated that the platform was perceived as user-friendly. However, findings also suggest that more accessible explanations of the statistical approaches are needed to aid in understanding data analysis and interpretation of outcomes.

The games research community has developed substantial knowledge on designing engaging experiences that draw players in. Surprisingly, less is known about player disengagement, with existing work predominantly addressing disengagement from the perspective of problematic play, and research exploring player disengagement from a constructive designer perspective is lacking. In this paper, we address this gap and argue that disengagement from games should be constructively designed, allowing players to exit play sessions in a self-determined way. Following a two-phase research approach that combines an interview study ( n =16) with a follow-up online survey ( n =111), we systematically analyze player perspectives on exiting play sessions. Our work expands the existing notion of disengagement through a characterization of exit experiences, a lens on disengagement as a process, and points for reflection for the design of games that seek to address player disengagement in a constructive way.

Repeated measurements of player experience are crucial in games user research, assessing how different designs evolve over time. However, this necessitates lightweight measurement instruments that are fit for the purpose. In this study, we conduct an examination of the test-retest reliability of the miniPXI -a short variant of the Player Experience Inventory (PXI) , an established measure for measuring player experience. We analyzed test-retest reliability by leveraging four games involving 100 participants, comparing it with four established multi-item measures and single-item indicators such as the Net Promoter Score ( NPS ) and overall enjoyment. The findings show mixed outcomes; the miniPXI demonstrated varying levels of test-retest reliability. Some constructs showed good to moderate reliability, while others were less consistent. On the other hand, multi-item measures exhibited moderate to good test-retest reliability, demonstrating their effectiveness in measuring player experiences over time. Additionally, the employed single-item indicators ( NPS and overall enjoyment) demonstrated good reliability. The results of our study highlight the complexity of player experience evaluations over time, utilizing single and multiple items per construct measures. We conclude that single-item measures may not be appropriate for long-term investigations of more complex PX dimensions and provide practical considerations for the applicability of such measures in repeated measurements.

While juiciness in games has previously been explored in the context of visual embellishments, less is known about whether and how the concept is leveraged in the context of audio and sound design. In our work, we address this issue through in-depth interviews with twelve audio designers working in the games industry. Through thematic analysis and content analysis, we show that principles of juicy design also apply to audio and sound design, and that it is applied intentionally to improve player feedback and experience. On this basis, our work contributes a conceptual foundation for juicy audio in its key factors of emphasis/augmentation, cohesion/coherence, and synesthesia. We identify associated attributes and provide implications for the design of games that seek to leverage juicy audio as a means of improving player experience.

We are excited to present PACM HCI's 2024 issue on games and play research, which contains 63 original and highly relevant articles covering the entire spectrum of HCI games research. As in the previous year, we used three recommendations ' 'Accept with Minor Revisions', 'Revise and Resubmit', and 'Reject.' For papers that were accepted with minor revisions, the second round of reviews was a 'light-touch' process in which the editorial board members checked the revisions, whereas papers that received Revise and Resubmit received another full round of external reviews with the same reviewers in most cases, and were also subjected to a final selection process. This second revision was treated as a real resubmission, which meant that it was given full consideration, but no guarantee or preferential treatment towards acceptance; a share of the revised papers was ultimately rejected. We would like to acknowledge the efforts that our community has made in adapting to this new process, working together with the submitting authors to achieve high-quality scholarship. The track editorial board consisted of 32 members and a total of 230 external reviewers from around the world ensured a high-quality review process. After the first round of submissions, each paper was handled by a primary track editorial board member who received reviews from a second track editorial board member and two external reviewers so that each submission received at least three high-quality reviews. After reviews were completed and checked for quality, the primary initiated discussion amongst the reviewers and came up with a preliminary recommendation (accept, between accept and revise and resubmit, revise and resubmit, between revise and resubmit and reject, reject). Papers that were in the middle three categories were then discussed in two synchronous virtual track editorial board meetings that took place over two consecutive days. The inclusion of the board meeting at this stage was a new addition to the review process last year. We included it to better calibrate decision making across the committee at this critical point in the review process, ensure consistency in outcomes, promote reflection and consideration at this stage in the process, and mentor newer editorial board members in the review process. We strove for a diverse program approaching games research from a variety of perspectives, including design, engineering, psychology, computer and data science while at the same time only accepting high-quality pieces of work. In this issue, we observe the following distribution of primary contributions: 42.9% of papers self-classify as using qualitative methods, 11.1% use quantitative methods, and 20.6% use mixed methods. Additionally, 3.2% of papers present design artifacts and 6.3% present technical artifacts. Finally, 4.8% of papers employ meta-research methods, 6.3% of papers present a new methodological approach, and 4.8% of papers contribute to the development and validation of theory. All articles in this issue were invited to present at the ACM CHI PLAY 2024 conference. We thank our dedicated team of track editorial board members, external reviewers, and paper authors, who continue to support the new review process and timeline, contributing to the maturation and growth of the PACM HCI games and play research community, and resulting in this issue of 63 exciting and highly relevant articles. This issue's 63 papers reflect the importance of play in our everyday lives, comment on recent trends and technical developments relevant to games and play, and also represent a significant effort of our community in coming together to produce a collection of research that highlights the multifaceted value of play.

For families, where abilities, motivations, and availability vary widely, opportunities for intergenerational play are limited. Designing games that cater to these differences remains an open challenge. In this paper, we first identify barriers related with time and expertise. Next, we propose asymmetric game design and asynchronous play to reconcile children's and adults' requirements; and interdependent gameplay mechanics to foster real-world interactions. Following this approach, we designed a testbed game and conducted a mixed-methods remote study with six pairs of adult-child family members. Our results showcase how asymmetric, asynchronous experiences can be leveraged to create novel gaming experiences that meet the requirements of family play. We discuss how interdependent progress can be designed to promote real-world interactions, creating pervasive conversational topics that permeate the family routine.

Representation of disability in games is important to facilitate inclusive experiences. In our work, we address this issue through an exploration of the representation of ADHD in games. First, we engage in interviews with 15 young people with ADHD to understand their lived experience of ADHD and their perspective on its integration in games. Second, we formulate considerations for the design of games that include ADHD in a way that aligns with their experience. Finally, we apply the guidelines to develop three game concepts and evaluate them with the initial group of young people to critically appraise our design considerations. The results show that nuanced representation of ADHD requires careful deliberation, that lived experience should be leveraged with care, and that game design must be mindful of the challenges associated with identifying the fine line between disability simulation and adequate representation.

Accessibility research strives to develop technology that is useful for disabled people, but the research processes that we engage in do not always center disabled people in a way that allows us to shape artifacts so that they benefit disabled communities. In this workshop, we want to address core questions that are relevant in this context: How can research questions be defined in a way that shares power between research teams and technology users? How should research processes be designed to be broadly accessible for disabled people? And what are equitable ways of summarizing and sharing research findings in a way that allows disabled communities to critically appraise findings with us? Through discussion among all attendees, we want to develop a practical guide in disability-centered research that will be made available and further developed as a community resource when engaging in accessibility research.

Wheelchair skills training is key for achieving greater personal mobility, and interactive solutions offer the potential for a more engaging training experience. In this paper, we examine the tensions between therapeutic requirements and player engagement, through the prototypical development of a wheelchair skills training game for children with Cerebral Palsy. Using an iterative and interdisciplinary design process, exercises from the Wheelchair Skills Program manual are implemented as interactive missions in an open-world, medieval-themed game. The game contains a custom input system that directly uses the player’s wheelchair input peripherals. In bridging the gap between clinical requirements and player engagement, we discuss the challenge of repetition and feedback in therapy, and implications for future work in game design.

While it is widely assumed that games can engage patients in therapy through their inherent ‘motivational pull’, relatively little attention has been paid to what HCI games research can learn from strategies employed by therapists. We address this gap by leveraging Self-Determination Theory (SDT) and its mini-theories Basic Psychological Needs Theory and Organismic Integration Theory as a theoretical lens on physical therapy for children and adolescents. Results from in-depth interviews with twelve therapists show that they carefully adjust sessions to allow patients to experience competence, making more comprehensive adjustments than currently offered by games. Additionally, we highlight how therapists leverage their relationship with patients to support motivation, but struggle to reconcile meaningful experiences of autonomy with therapeutic goals. On this basis, we reflect on implications for researchers and designers who create games for physical therapy, and the potential of SDT to provide a foundation for game design and therapeutic practice.

Fearing stigma, parents often hide their children's HIV diagnosis from them, and postpone disclosure, in turn negatively impacting children's well-being. Our work explores whether interactive technology can support disclosure. In the first study, we examine disclosure experiences and the role of interactive technology from the perspective of HIV-positive children and parents. Through Thematic Analysis, we highlight how disclosure is linked with parents’ own experience of HIV, and that disclosure needs to be viewed as a process. On this basis, we contribute an experience prototype that guides parents through an incremental disclosure process using interactive storytelling. In a second study, we evaluate the prototype through interviews with six parents. Leveraging Interpretative Phenomenological Analysis, we show that the prototype has potential to transform how parents understand and approach disclosure. Based on our results, we present further design directions, and discuss the (limitations of the) role that technology can play in this context.

Gamification is a popular technique to improve task engagement, and has broadly been deployed in health and education to a point where many users now expect gameful experiences in these settings. However, gamification has been criticised for being a potential obstacle to the experience of reflection. Motivated by this tension, our work examines how the addition of gamification to a Virtual Reality simulation of breastfeeding impacts player experience and reflection. Using a within-subjects design, we invited 34 participants to take part in a mixed-methods evaluation of a gamified and non-gamified variant of the simulation that included questionnaires and semi-structured interviews. Results show that gamification improved player experience and encouraged players to reflect on goal achievement and performance. However, it also diverted players’ attention from nuances within the act of nursing. Drawing on our findings, we contribute considerations for the application of gamification in personal and sensitive settings such as breastfeeding.

Wearable activity trackers are inaccessible to older adults who use mobility aids (e.g., walker, wheelchair), because the accuracy of trackers drops considerably for such movement modalities (MMs). As an initial step to address this problem, we implemented and tested a minimum distance classifier to automatically identify the used MM out of seven modalities, including movement with or without a mobility aid, and no movement. Depending on the test setup, our classifier achieves accuracies between 82 % and 100 %. These findings can be leveraged in future work to combine the classifier with algorithms tailored to each mobility aid to make activity trackers accessible to users with limited mobility.

Adolescents in sub-Saharan Africa are at the epicenter of the global HIV epidemic. Yet, technology to support HIV management overwhelmingly focuses on adult medication adherence, neglecting the complex lives of adolescents in low-income regions. We present findings from interviews and focus groups that included twelve HIV-positive adolescents in Ethiopia, and eleven adults from their care circles. We leverage the Integrated Behavioral Model to examine the lived experience of HIV and the space for technology. Additionally, we present an inductive thematic analysis, which highlights non-disclosure as a central theme, i.e., adolescents remaining unaware of their HIV status. Drawing from these findings, we discuss how to account for (the lack of) disclosure in the design of technology to support HIV management, and reflect on whether technology could (and should) support the process. We further highlight the risks that researchers and designers need to be aware of when designing HIV management technology for this audience.

Movement-based video games can provide engaging play experiences, and also have the potential to encourage physical activity. However, existing design guidelines for such games overwhelmingly focus on non-disabled players. Here, we explore wheelchair users’ perspectives on movement-based games as an enjoyable play activity. We created eight game concepts as discussion points for semi-structured interviews (N=6) with wheelchair users, and used Interpretative Phenomenological Analysis to understand their perspectives on physical activity and play. Themes focus on independent access, challenges in social settings, and the need for comprehensive adaptation. We also conducted an online survey (N=21) using the same game concepts, and thematic analysis highlighted the importance of adequate challenge, and considerations around multiplayer experiences. Based on these findings, we re-contextualize and expand guidelines for movement-based games previously established by Mueller and Isbister to include disabled players, and suggest design strategies that take into account their perspectives on play.

In this paper we present Immersive Speculative Enactments (ISEs), a novel concept that extends conventional Speculative Enactments to Virtual Reality. Through ISEs, participants are immersed in a speculative world depicted by the designers and can engage with it in its truest envisioned form. We explore this concept via four scenarios with increasing technological uncertainty: a glimpse in the daily life of the parent of a newborn baby; a Mixed Reality experience supporting hybrid classrooms; two wearable devices that present a pet’s emotional state and needs; and an enactment on the effect of communication delay across interplanetary distances. We discuss the concept of ISEs and contrast them to other forms of speculation, provide guidelines on how to design them, as well as reflecting on the challenges, limitations, and potential associated with the role of ISEs in the HCI discourse.

Breastfeeding can be challenging, but it is difficult for antenatal education to convey issues associated with the lived experience of breastfeeding. In our work, we explore the potential of interactive simulations to support antenatal education, and present Virtual Feed, a Virtual Reality breastfeeding simulation for parents-to-be developed following a three-step process. (1) We created an experience prototype that features basic VR scenarios and a tangible baby, (2) we engaged in design sessions with 19 parents and parents-to-be to derive design implications to further refine the simulation, and (3) we evaluated the system through case studies to examine the perspectives of parents and parents-to-be on the simulation. Our results show that the simulation successfully engaged users and sparked curiosity, while also encouraging reflection about the challenges of breastfeeding. On this basis, we discuss challenges for the design of simulations with the purpose of supplementing antenatal education.

Maker culture encourages do-it-yourself practices to create, repair, and repurpose technology. In Human-Computer Interaction (HCI) research, it is seen as a means of empowering people, providing affordable and customisable technology with potential to enrich areas such as education or assistive technology. To investigate this alleged potential, we performed an anthropological inquiry at an elementary school for disabled children that lasted one year, participating in everyday activities with students, teachers, and therapists. We observed ‘heterogeneity in a fluid environment’ and ‘creativity in the moment’ in an ‘endemically underfunded’ setting. We saw how technology is ‘injecting dependencies’, ‘reinforcing disability’, and ‘occupying time and space’, changing our view on the role that making can have. Leveraging Empowerment Theory, we highlight how (making) technology risks ignoring the intertwined dynamics between the individual, the organisational, and the community, and articulate points for reflection for technology in schools for disabled children for the HCI research community.

Virtual Reality (VR) has become a mainstream opportunity to develop immersive environments where people are exposed to relevant stimuli in a systematic but safe way. Besides the controlled exposure to stimuli, VR systems enable a more efficient and unbiased gathering of information with practical applications in diagnosis, intervention, and health monitoring processes. Nonetheless, scientific literature has demonstrated that interacting with VR technology and its peripherals can be challenging, especially in populations less familiar with technology (e.g., older adults) or with clinical conditions that are not adequately accommodated by the technology, such as cognitive (e.g., dementia) or physical impairments (e.g., blindness). This workshop will focus on systems, technological approaches, and theoretical frameworks to develop user/patient-centred VR tools for diagnosis, intervention, and monitoring of health and wellbeing outcomes. Moreover, we welcome work focused on accessibility issues, aiming to promote equal access and opportunity to use VR tools by people with diverse abilities.

Questionnaires are vital in games user research (GUR) to assess player experience (PX). However, having too many questions in surveys prevents wider uptake among GUR professionals because of games' rapid production cycles. To address this issue, we present the miniPXI---an eleven-item measure of the popular Player Experience Inventory (PXI)---providing single items for each of its eleven constructs. To develop the scale and examine its reliability and validity, we present three studies, conducted with 15 experts and 628 digital game players across continents. In the first survey study (n=366, 15 experts), single items were selected. In a second survey study (n=232), we explored reliability and validity of the single-item scale. Participants completed both full and single-item (SI) variants in three days. In the last study (n=30), we established the validity and sensitivity via an experimental evaluation of two games. The results are nuanced; SI reliability estimates for PXI constructs range from .51 to .83 with an average of .68, we could confirm the validity for nine constructs. We conclude that the miniPXI can be a valuable tool for PX evaluations where a longer measure is not feasible, and provide practical considerations for its use.

The use of virtual reality (VR) to simulate confrontational human behaviour has significant potential for use in training, where the recreation of uncomfortable feelings may help users to prepare for challenging real-life situations. In this paper we present a user study (n=68) in which participants experienced simulated confrontational behaviour performed by a virtual character either in immersive VR, or on a 2D display. Participants reported a higher elevation in anxiety in VR, which correlated positively with a perceived sense of physical space. Character believability was influenced negatively by visual elements of the simulation, and positively by behavioural elements, which complements findings from previous work. We recommend the use of VR for simulations of confrontational behaviour, where a realistic emotional response is part of the intended experience. We also discuss incorporation of domain knowledge of human behaviours, and carefully crafted motion-captured sequences, to increase users’ sense of believability.

Virtual Reality (VR) holds the promise of immersing people in virtual worlds. However, initial work on the relationship between VR and disability suggests that VR is a body-centric technology that poses barriers for disabled users. We supplement this work with a theoretical analysis of immersive VR through the lens of Surrogate Body theory, a concept from media theory for the structured examination of interactive media in use. Leveraging Critical Disability Studies, particularly the theory of the Minority Body, we explore the assumptions about bodies inherent in VR, and we reflect on implications of these assumptions when disabled people engage with the technology. Our findings show that VR is an inherently ableist technology that assumes a ‘corporeal standard’ (i.e., an ‘ideal’, non-disabled human body), and fails to adequately accommodate disabled people. We conclude with implications for HCI research on VR, and discuss design approaches that foster inclusive technology development.

Breastfeeding brings benefits for newborns and parents, but can be a challenging process. In this paper, we leverage a mixed-methods approach that builds on the Integrated Behavioural Model (IBM) to explore parents’ perspectives toward breastfeeding along with their lived experiences, and examine the role of technology in this setting. Results of twelve semi-structured interviews and 175 online survey responses suggest generally positive attitudes toward breastfeeding and good theoretical knowledge. This is combined with a complex lived experience of breastfeeding where main challenges are situated in practical, emotional, and environmental/societal aspects, which are currently not sufficiently recognised by technology that seeks to support breastfeeding. Building upon our findings, we present points for reflection for the design of technology to support breastfeeding, focusing on the importance of drawing from the lived experience of parents, and ensuring that technology not only casts breastfeeding as an individual but also as a collective effort.

Immersive experiences – enabled by technologies such as VR, AR, 360° video and other highly immersive multimedia applications – have the potential to make interacting with various activities more inclusive for many people. This can be achieved by applying the principles of inclusive design. This panel will discuss the current challenges in designing inclusive immersive technologies, and how they should be addressed.

Researchers and developers have suggested that the use of diegetic interfaces can enhance users' sense of presence and immersion in virtual reality (VR) applications. While concepts of diegetic interfaces in VR are analogous to those seen on 2D displays, little work has considered how they might integrate with the movement-based controllers commonly used in consumer VR systems, to create higher fidelity interactions. In this paper we present a study (N = 58) in which we compare participants' experiences of diegetic and non-diegetic tool management interfaces, in a prototype VR crime scene investigation (CSI) training application. Contrary to expectations, we do not find evidence that participants' sense of presence is elevated when using the diegetic interface; however, we suggest that this may be due to reported higher levels of perceived workload, which can act to degrade user experience and engagement. We conclude by discussing the relationship between diegetic interface design and interaction fidelity, and highlighting trade-offs between fidelity, engagement, and learning outcomes in VR training applications.

Since its inaugural edition in 2014, the ACM SIGCHI Annual Symposium on Computer-Human Interaction in Play (CHI PLAY) has grown to become the premier ACM SIGCHI venue for playercomputer interaction, bringing together researchers and professionals across all areas of play, games, and human-computer interaction. This year, CHI PLAY has moved its publications to a journal-based model, and we are pleased to present the first issue of the Proceedings of the ACM on Human-Computer Interaction that contains full paper contributions from the CHI PLAY community. This issue has 64 papers that were accepted in the 2021 cycle of the CHI PLAY conference. Over two rounds, a total of 250 papers were submitted for review and our acceptance rate is 25.6%. Thework published in this volume represents the contributions from the 2021 program committee, including external reviewers, associate chairs, and editors. Together, we have engaged in a revised reviewing process that saw several major changes. First, we moved to a revise and resubmit process to address existing inequities in submission and review, improve the quality of the review process, and increase the reach of our community's research. Second, we made major changes to our review form to improve the review process, while also easing the burden of review, along with explicitlywelcoming different contribution types and managing the complexities of interdisciplinary evaluation. We would like to acknowledge the efforts that our community has made in adapting to this new process, ensuring rigorous review during a global pandemic, and working together with the submitting authors to achieve high-quality scholarship. In this issue, the majority of contributions are empirical in nature, with fifteen papers classified by the authors as using qualitative methods, fifteen using quantitative methods, and nine using mixed methods. We also publish seven papers presenting design artefacts and three presenting technical artefacts. Finally, we include four papers employing meta-research methods, two papers that present new methodological approaches, and nine papers that contribute to the development and validation of theory.

Play presents a popular pastime for all humans, though not all humans play alike. Subsequently, Human–Computer Interaction Games research is increasingly concerned with the development of games that serve neurodivergent 1 players. In a critical review of 66 publications informed by Disability Studies and Self-Determination Theory, we analyse which populations , research methods, kinds of play and overall purpose goals existing games address. We find that games are largely developed for children, in a top-down approach. They tend to focus on educational and medical settings and are driven by factors extrinsic to neurodivergent interests. Existing work predominantly follows a medical model of disability, which fails to support self-determination of neurodivergent players and marginalises their opportunities for immersion. Our contribution comprises a large-scale investigation into a budding area of research gaining traction with the intent to capture a status quo and identify opportunities for future work attending to differences without articulating them as deficit.

Virtual Reality (VR) holds the promise of providing engaging embodied experiences, but little is known about how people with disabilities engage with it. We explore challenges and opportunities of VR gaming for wheelchair users. First, we present findings from a survey that received 25 responses and gives insights into wheelchair users' motives to (non-) engage with VR and their experiences. Drawing from this survey, we derive design implications which we tested through implementation and qualitative evaluation of three full-body VR game prototypes with 18 participants. Our results show that VR gaming engages wheelchair users, though nuanced consideration is required for the design of embodied immersive experiences for minority bodies, and we illustrate how designers can create meaningful, positive experiences.

Physical activity (PA) positively impacts the quality of life of older adults, with technology as a promising factor in maintaining motivation. Within Computer Science and Engineering, research investigates how to track PA of older adults for various purposes. We present a systematic review of 204 papers and discuss wearable tracking systems according to their purpose, technological context, and target audience, as well as design and evaluation processes with particular attention to the meaningful involvement of older adults. Our results show that most systems focus on supervising older adults in the context of disease and frailty management. Only few systems focus on supporting older adults by promoting rehabilitation and respecting agency of older adults via self-monitoring PA, or encouraging PA to maintain healthy levels of activity. Moreover, systems are often narrowly limited to walking, although older adults may enjoy a broader range of activities. Likewise, the involvement of older adults in design processes is scarce, and their experience with a given technology is rarely considered relevant for evaluation. In sum, we contribute an overview of wearable technology for tracking older adults’ PA, contextualize our findings within recommendations provided by Sports and Rehabilitation Science, and illustrate opportunities for future work.

Games User Research (GUR) focuses on measuring, analysing and understanding player experiences to optimise game designs. Hence, GUR experts aim to understand how specific game design choices are experienced by players, and how these lead to specific emotional responses. An instrument, providing such actionable insight into player experience, specifically designed by and for GUR was thus far lacking. To address this gap, the Player Experience Inventory (PXI) was developed, drawing on Means-End theory and measuring player experience both at the level of Functional Consequences, (i.e., the immediate experiences as a direct result of game design choices, such as audiovisual appeal or ease-of-control) and at the level of Psychosocial Consequences, (i.e., the second-order emotional experiences, such as immersion or mastery). Initial construct and item development was conducted in two iterations with 64 GUR experts. Next, the scale was validated and evaluated over five studies and populations, totalling 529 participants. Results support the theorized structure of the scale and provide evidence for both discriminant and convergent validity. Results also show that the scale performs well over different sample sizes and studies, supporting configural invariance. Hence, the PXI provides a reliable and theoretically sound tool for researchers to measure player experience and investigate how game design choices are linked to emotional responses.

Access to wheelchair skills training is important for the mobility and independence of wheelchair users, but training rates are low - particularly among young people. In this paper, we present Geometry Wheels, a movement-based experience prototype to explore the potential of interactive technology to support basic wheelchair skills training for manual wheelchair users, designed with the support of occupational therapists. Results of an evaluation with 15 participants (10 young wheelchair users and 5 parents) show that interactive systems can deliver engaging and challenging activities that encourage wheelchair navigation and activity. However, the project also revealed challenges in designing for individual differences in physical abilities, in conflicts between children's and parents' perceptions of ability, and barriers to home use. We outline strategies for the design of rehabilitative technology to help young people with disabilities build physical abilities.

Recently, a shift from curative to preventive care is promoted, by which patients are expected to become active and use diverse forms of self-management health systems (SMHS), i.e., integrated solutions that present data from multiple sensors and/or self-reports, possibly enhanced with risk assessment and decision support, to perform health-related actions. This is promoted as contributing to living longer and healthier, assisting ageing-in-place. Hence, older adults have also become a potential target of SMHS. While studies are performed on uses and attitudes of specific patient groups towards SMHS, studies that focus on older, including the oldest, adults are scarce. Therefore, we report on a qualitative study with 20 older adults (mean age = 80). Through thematic analysis, we identified four themes (i.e., enforced use of technology; need for support in technology use; equivocal stance towards sharing data; hypothetical value of technology for healthy ageing) to provide a deeper understanding of older adults' attitudes and engagement with information- and communication technologies (ICT) in general and SMHS in particular. We also present four pitfalls, unified by a central concept "Ageing is not a disease'', along with design considerations for future SMHS.

Playful technology has the potential to support physical activity (PA) among wheelchair users, but little is known about design considerations for this audience, who experience significant access barriers. In this paper, we lever-age the Integrated Behavioural Model (IBM) to understand wheelchair users' perspectives on PA, technology, and play.First, we present findings from an interview study with eight physically active wheelchair users. Second, we build on the interviews in a survey that received 44 responses from a broader group of wheelchair users. Results show that the anticipation of positive experiences was the strongest predictor of engagement with PA, and that accessibility concerns act as barriers both in terms of PA participation and technology use. We present four design goals - emphasizing enjoyment,involving others, building knowledge and enabling flexibility - to make our findings actionable for researchers and designers wishing to create accessible playful technology to support PA.

Gamification is widely applied to increase user engagement and motivation, but empirical studies on effectiveness are inconclusive, and often limited to the integration of tangible elements such as leaderboards or badges. In this paper, we report findings from a study with 36 participants that uses the lens of Self-Determination Theory to compare traditional gamification elements, and the concept of juiciness (the provision of abundant audiovisual feedback) in the VR simulation Predator!. Results show that gamification and juiciness improve user experience, but that only juiciness fulfills all basic psychological needs that facilitate intrinsic motivation when applied in nongaming settings. User preferences favour the combination of both approaches, however, neither improved performance, and there is evidence of juicy elements influencing user behaviour. We discuss implications of these findings for the integration of gamification, reflect on the role of both approaches in the context of feedback, and outline challenges and opportunities for further research.

Squeeze interaction, defined as squeezing a soft object that affects computed feedback, is a promising interaction technique due to its expressive character. Skweezee for Processing is a Processing library that allows makers to implement squeeze interactions in a lightweight manner. The library offers a set of features based on data extraction algorithms and aims to preserve the dynamics of squeezes in the mapping from user action to system output. Distributing Skweezee for Processing as an open source library, we invite the community to further investigate the potential of squeeze interactions and to contribute to the extension and improvement of the library. We emphasize the potential for rich squeeze interaction by demonstrating a game that implements squeeze interaction as core mechanic. Additionally, we demonstrate the ease of implementing squeeze interactions in a variety of settings using the Skweezee for Processing library.

This article presents a qualitative driving simulator study designed to understand the experience of giving up control to automated processes in semiautonomous driving systems. The study employed an experience prototyping methodology, with 12 drivers (4 female) completing 2 sessions in a high-fidelity driving simulator. Condition A simulated a normally functioning car, while Condition B simulated a semiautonomous system that monitors driver behavior and takes evasive action when danger is detected. The simulator experience was used to ground wider discussion of automation and the experience of driving, which was explored through a semistructured interview. Results identify design challenges for autonomous driving systems; the loss of user agency and confidence, and handling the change between manual and automated control. Opportunities were identified; in augmenting rather than removing human abilities, and in providing new learning opportunities for drivers.

A myoelectric prosthesis (myo) is a dexterous artificial limb controlled by muscle contractions. Learning to use a myo can be challenging, so extensive training is often required to use a myo prosthesis effectively. Signal visualizations and simple muscle-controlled games are currently used to help patients train their muscles, but are boring and frustrating. Furthermore, current training systems require expensive medical equipment and clinician oversight, restricting training to infrequent clinical visits. To address these limitations, we developed a new game that promotes fun and success, and shows the viability of a low-cost myoelectric input device. We adapted a user-centered design (UCD) process to receive feedback from patients, clinicians, and family members as we iteratively addressed challenges to improve our game. Through this work, we introduce a free and open myo training game, provide new information about the design of myo training games, and reflect on an adapted UCD process for the practical iterative development of therapeutic games.

Young people using powered wheelchairs have limited access to engaging leisure activities. We address this issue through a two-stage project; 1) the participatory development of a set of wheelchair-controlled, movement-based games (with 9 participants at a school that provides education for young people who have special needs) and 2) three case studies (4 participants) exploring player perspectives on a set of three wheelchair-controlled casual games. Our results show that movement-based playful experiences are engaging for young people using powered wheelchairs. However, the participatory design process and case studies also reveal challenges for game accessibility regarding the integration of movement in games, diversity of abilities among young people using powered wheelchairs, and the representation of disability in games. In our paper, we explore how to address those challenges in the development of accessible, empowering movement-based games, which is crucial to the wider participation of young people using powered wheelchairs in play.

Matching game difficulty to player ability is a crucial step toward a rewarding player experience, yet making difficulty adjustments that are effective yet unobtrusive can be challenging. This paper examines the impact of automatic and player-initiated difficulty adjustment on player experience through two studies. In the first study, 40 participants played the casual game THYFTHYF either in motion-based or sedentary mode, using menu-based, embedded, or automatic difficulty adjustment. In the second study, we created an adapted version of the commercially available game fl0w to allow us to carry out a more focused study of sedentary casual play. Results from both studies demonstrate that the type of difficulty adjustment has an impact on perceived autonomy, but other player experience measures were not affected as expected. Our findings suggest that most players express a preference for manual difficulty choices, but that overall game experience was not notably impacted by automated difficulty adjustments.

Recent research suggests that motion-based video games have the potential to provide both mental and physical stimulation for older adults in residential care. However, little research has explored the practical challenges and opportunities that arise from integrating these games within existing schedules of activities in these contexts. In our work, we report on a qualitative enquiry that was conducted over a three month period at two long-term care facilities. Findings suggest that older adults enjoyed playing video games, and that games can be a valuable means of re-introducing challenge in late life, but that the impact of age-related changes and impairment can influence people's ability to engage with games in a group setting. We outline core challenges in the design for care context and discuss implications of our work regarding the suitability of games as a self-directed leisure activity.

Neurological Vision Impairment (NVI) detrimentally impacts upon quality of life, as daily activities such as reading and crossing the road often become significantly impaired. Therapy strategies for NVI based on visual scanning of on-screen stimuli have recently been demonstrated as effective at improving functional vision. However, these strategies are repetitive, monotonous and unsuitable for use with children and young adults. This project explores the design of a game-based therapy programme that aims to support participant engagement and adherence. We first outline requirements for this software, before reporting on the iterative design process undertaken in collaboration with young people, therapists and teachers at a centre for vision impairment. Our work provides insights into the participatory design of games in collaboration with young people with special needs, and reflects upon the tension of balancing game challenge, therapy goals, and accessibility. Furthermore, it highlights the potential of games to empower special populations by providing a medium through which to communicate the subjective experience of specific impairments.

People using wheelchairs face barriers in their daily lives, many of which are created by people who surround them. Promoting positive attitudes towards persons with disabilities is an integral step in removing these barriers and improving their quality of life. In this context, persuasive games offer an opportunity of encouraging attitude change. We created a wheelchair-controlled persuasive game to study how embodied interaction can be applied to influence player attitudes over time. Our results show that the game intervention successfully raised awareness for challenges that people using wheelchairs face, and that embodied interaction is a more effective approach than traditional input in terms of retaining attitude change over time. Based on these findings, we provide design strategies for embodied interaction in persuasive games, and outline how our findings can be leveraged to help designers create effective persuasive experiences beyond games.

Game balancing can help players with different skill levels play multiplayer games together; however, little is known about how the balancing approach affects performance, experience, and self-esteem'especially when differences in player strength result from given abilities, rather than learned skill. We explore three balancing approaches in a dance game and show that the explicit approach commonly used in commercial games reduces self-esteem and feelings of relatedness in dyads, whereas hidden balancing improves self-esteem and reduces score differential without affecting game outcome. We apply our results in a second study with dyads where one player had a mobility disability and used a wheelchair. By making motion-based games accessible for people with different physical abilities, and by enabling people with mobility disabilities to compete on a par with able-bodied peers, we show how to provide empowering experiences through enjoyable games that have the potential to increase physical activity and self-esteem.

Few leisure activities are accessible to institutionalized older adults using wheelchairs; in consequence, they experience lower levels of perceived health than able-bodied peers. Video games have been shown to be an engaging leisure activity for older adults. In our work, we address the design of wheelchair-accessible motion-based games. We present KINECTWheels, a toolkit designed to integrate wheelchair movements into motion-based games, and Cupcake Heaven, a wheelchair-based video game designed for older adults using wheelchairs. Results of two studies show that KINECTWheels can be applied to make motion-based games wheelchair-accessible, and that wheelchair-based games engage older adults. Through the application of the wheelchair as an enabling technology in play, our work has the potential of encouraging older adults to develop a positive relationship with their wheelchair.

Motion-based video games can have a variety of benefits for the players and are increasingly applied in physical therapy, rehabilitation and prevention for older adults. However, little is known about how this audience experiences playing such games, how the player experience affects the way older adults interact with motion-based games, and how this can relate to therapy goals. In our work, we decompose the player experience of older adults engaging with motion-based games, focusing on the effects of manipulations of the game representation through the visual channel (visual complexity), since it is the primary interaction modality of most games and since vision impairments are common amongst older adults. We examine the effects of different levels of visual complexity on player experience, performance, and exertion in a study with fifteen participants. Our results show that visual complexity affects the way games are perceived in two ways: First, while older adults do have preferences in terms of visual complexity of video games, notable effects were only measurable following drastic variations. Second, perceived exertion shifts depending on the degree of visual complexity. These findings can help inform the design of motion-based games for therapy and rehabilitation for older adults.

Persuasive games are an effective approach for motivating health behavior, and recent years have seen an increase in games designed for changing human behaviors or attitudes. However, these games are limited in two major ways: first, they are not based on theories of what motivates healthy behavior change. This makes it difficult to evaluate why a persuasive approach works. Second, most persuasive games treat players as a monolithic group. As an attempt to resolve these weaknesses, we conducted a large-scale survey of 642 gamers' eating habits and their associated determinants of healthy behavior to understand how health behavior relates to gamer type. We developed seven different models of healthy eating behavior for the gamer types identified by BrainHex. We then explored the differences between the models and created two approaches for effective persuasive game design based on our results. The first is a one-size-fits-all approach that will motivate the majority of the population, while not demotivating any players. The second is a personalized approach that will best motivate a particular type of gamer. Finally, to make our approaches actionable in persuasive game design, we map common game mechanics to the determinants of healthy behavior.

Older adults in nursing homes often lead sedentary lifestyles, which reduces their life expectancy. Full-body motion-control games provide an opportunity for these adults to remain active and engaged; these games are not designed with age-related impairments in mind, which prevents the games from being leveraged to increase the activity levels of older adults. In this paper, we present two studies aimed at developing game design guidelines for full-body motion controls for older adults experiencing age-related changes and impairments. Our studies also demonstrate how full-body motion-control games can accommodate a variety of user abilities, have a positive effect on mood and, by extension, the emotional well-being of older adults. Based on our studies, we present seven guidelines for the design of full-body interaction in games. The guidelines are designed to foster safe physical activity among older adults, thereby increasing their quality of life.

Although several casual gaming systems have been developed during the past years, little research examining the impact of human factors on the design and use of digital games has been carried out, and commercially available games are only partially suitable for audiences with special needs. The research project described within this paper aims to analyze and explore design guidelines for diverse audiences and results of focus group gaming sessions to develop a research toolbox allowing for the easy creation of adaptable and accessible game scenarios. Thereby, a controllable environment for the detailed evaluation of the interrelations between human factors and entertainment systems is provided. Results obtained by further testing will be integrated in the toolbox, and may foster the development of accessible games, thus opening up new opportunities for diverse audiences and allowing them to further engage in digital games.