A virtual reality exergame to engage adolescents in physical activity: Mixed methods study describing the formative intervention development process
Background: Early adolescence (13-17 years) is a key developmental stage for physical activity (PA) promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in PA. Objective: The vEngage project aimed to develop a PA intervention for adolescents involving VR exergaming. This paper describes the formative intervention development work and process of the academic-industry collaboration. Methods: The formative development was guided by Medical Research Council (MRC) Framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of augmented reality (AR) running app Zombies, Run! (ZR) and building and testing a prototype with our adolescent user group. Results: VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques (BCTS) that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of game-play difficulty, new challenges, in-game rewards, multi-player options and potential to link with ‘real-world’ aspects like PA trackers; and some potential barriers to use like cost, perceived discomfort of VR headsets and concerns about motion sickness. A prototype game was developed and user-tested with generally positive feedback. Conclusions: This was a world-first attempt to develop a VR exergame designed to engage adolescents in PA developed within a public health intervention development framework. Our formative work suggests this is a very promising avenue. The benefit of the design process was collaborative parallel work between academics and game designers, and involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors that would be important for future implementation (like parental support). This paper also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial.