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by Jim Gearhart

In The Paper Kingdom: Fight Dragons, Conquer Fear

Using gamification to educate children about clinical trials

This is the third and final blog in a series about gamification in clinical research.

Here we take a closer look at  The Paper Kingdom, a video game that teaches kids about clinical trials. In earlier blogs we’ve looked at gamification and how it is starting to appear in clinical research. Gamification expert Professor Kevin Werbach describes the idea as using game design to “find the fun in what you have to do.”  With The Paper Kingdom, the National Institutes of Health teamed up with the New England Research Institutes and others to create an innovative way of addressing concerns youth have about participating in research.

The Paper Kingdom project fits in with a larger effort called Children and Clinical Studies.  Clinical trials with children are as important as they are sensitive and difficult. Trial results with adults cannot predict reliably how children might respond to medicines, but conducting trials on children presents a host of ethical questions and questions about children’s safety. The Clinical Trials and Kids web page has collected an array of materials to take these challenges on, with information and videos aimed both at kids and parents. The Paper Kingdom contributes to the project as an adventure with lessons to share.

Lisa Marceau was the Principal Investigator for the program at NERI Science and the Executive Producer for the online programs. In an email she said that the Paper Kingdom:

Lisa Marceau Image
Lisa Marceau, MPH takes content — which has otherwise not been provided to this age group, particularly in a format that “meets them where they are” — and delivers it in a way that kids can interact with it. Serious gaming is relatively new in the industry, and there remains a gap in knowledge about clinical trials. This game uses an innovative method to educate kids about this important topic.

Paper Kingdom AvatarThe theme of The Paper Kingdom is a high fantasy quest. Our hero follows his/her missing brother into a magic book, and there must battle a dragon’s minions. The player chooses an avatar, an animal assistant, weapons, armor, and color schemes before setting off through labyrinths on five different “worlds” to reach the dragon. Along the way, each of the five worlds reflects a fear about joining a clinical trial, and the worlds’ bad guys spread false rumors about what will happen in a clinical trial. Defeating the bad guys brings out the “Revealed Truth” that refutes each fear.

Here are some of the rumors the bad guys spread:

  • Sharp, shiny needles everywhere. They’ll stick you twenty times before you can blink!
  • Doctors test new and strange things on people just to see what will happen. You might grow a third arm when they’re done with you!
  • The study won’t help you. You’ll suffer for no reason at all!

The game designers chose these themes carefully. They reviewed studies about kids’ fears, conducted focus groups, and consulted with researchers as well as advisers to understand why children or teens might resist joining a clinical trial. What the designers learned fed into the fears that the dragons’ denizens spread through the kingdom.

My kids have  enjoyed The Paper Kingdom. At 10-, 11-, and 14-years old, my small test group fit right within the game’s demographic of 8 to 14-year olds. Each of my kids selected a unique combination of character, weapon, armor, color scheme, and animal assistant before setting out. They worked through the levels of the game, and compared with each other the highlights of which worlds they liked and which they didn’t.

During a “Truth Revealed” segment one daughter asked, “Why do they talk about these things all the time?” But then she remembered  those ‘things’ were the point of the game. Still, that made me wonder how well the game was delivering its lessons. In the midst of dragons, mazes, and elaborate scenery, how much information about clinical trials was getting through?

For us, the answer turned out to be, “Quite a bit.” When I quizzed my kids about what they remembered from the game, they came up with at least six of the fifteen fears without much prompting. And together we recalled more as we talked. So from this one example, the gamification strategy seemed a success, and the designers of Paper Kingdom are working on a more thorough review of the same question. They expect to publish the results soon, and I for one expect to see that this this innovative use of having fun is serving a worthy purpose.

Download The Paper Kingdom here:

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