Player 2 Has Entered the Game: Extended Reality and Games for Health

Introduction

This issue of the Games for Health Journal provides an excellent example of how new technologies, such as extended reality (XR; virtual reality [VR], augmented reality, or mixed reality), have been embraced by the games for health community. The use of XR in clinical and health applications has exploded over the past decade, largely due to the creation of low-cost stand-alone head-mounted displays (HMDs) that can readily deploy health interventions and clinical applications within clinical settings, schools, and at home.

The use of XR to deliver immersive engaging experiences for skill-based learning, education, training, social support, and therapy has created unique opportunities for the games for health field to expand and explore new ways to engage its players. But beyond engagement, as we see in this current issue, the use of XR within health games has also been shown to have an important impact on health and behavioral outcomes.

When the journal was first launched in February 2012, Bill Ferguson, founding editor-in-chief of the Games for Health Journal, referenced the Pareto Principle in his editorial. ¹ This principle states that in any situation roughly 80% of the “work” will be done by 20% of the participants. He explained that the challenge for any new endeavor is amassing and aligning the 20% who are going to do the work that will ultimately result in the widespread adoption of new practices and thinking by the remaining 80%.

This current issue provides evidence of a paradigm shift, highlighting contributions from authors that are a part of that essential 20%—inspiring us to consider how XR might influence our own research while providing us with new models, frameworks, insights, hurdles, and methodologies to consider.

Reflecting on the inaugural 2012 issue of the Games for Health Journal, it is intriguing to see how many of the themes discussed within those first articles continue to be relevant a decade later, especially within XR research. For example, in that issue, the authors highlight the value of one's avatar as a tool for change and healing, cultural representation in digital environments, and encouragement of movement using immersion as a key to create impactful games.

Themes such as immersion, inclusion, and embodiment within games are not new and have been considered paramount in the design and implementation of games for health for decades. With the integration of XR into health interventions and applications, however, we have a new opportunity to explore how we might enhance and expand upon these ideas with the goal of creating even more engaging and impactful experiences.

For instance, even on a basic level, the donning of an HMD enhances immersion by blocking out the external world, ensuring the user is completely focused on the content presented, a feat challenging to do with web-based or mobile games. This is especially effective when working with adolescents, where the temptation to open a new tab on a computer, check a phone, or chat with someone else can all but completely break immersion and reduce engagement.

Furthermore, the use of XR has also increased opportunities for inclusion and embodiment through the creation and use of highly customizable avatars, allowing players to embody their true authentic selves. The embodiment of an avatar within an XR experience that is in sync with a player's head and hand movements also allows for an unparalleled sense of ownership of one's virtual actions, greatly enhancing the player's game experience.

In social VR experiences, personalized avatars can allow a player to see themselves and be seen by others in a safe and secure virtual space free from discrimination or stigmatization. For individuals such as transgender youth and those exploring their gender identity, avatar embodiment can be a powerful way to explore their gender identity within a supportive virtual community.

There is an abundance of potential yet untapped research within XR and games for health. It is a thrilling time to be involved in this evolving community. We can already envision how emergent technologies such as large language models, artificial intelligence, social VR, machine learning, spatial audio, and biometrics will expand our use of XR, inevitably adding new ideas and paradigms to the continuously growing field of games for health research.

Our gratitude extends to the 20% who have been—and will continue to be—the trailblazers forging new paths for us all to follow.