A Systematic Review of Serious Games for Health Education: Technology, Challenges, and Future Directions

Introduction

The role of serious games in the health sector has attracted much attention in research in recent years (Wattanasoontorn et al., 2013). In the last decade, technological developments have driven significant changes in medical education, especially in the application of serious games (Tori et al., 2022). A game genre that combines entertainment and educational elements can provide unique opportunities for a challenging and interactive learning process (Arif et al., 2021). Serious games are an innovative approach that combines elements of games with the goals of education, training, or behavior change (Avila-Pesantez et al., 2019; (Hamari et al., 2016). In contrast to traditional games, which focus on entertainment, serious games are designed to provide an interactive and exciting learning experience (Arif et al., 2020). This approach has the potential to improve understanding and knowledge retention in a fun and dynamic way. With the right design, serious games can adapt a variety of subject matter and present it in a context that is interesting to users. This condition makes serious games a very flexible tool in education and training. Its use has spread to various sectors, from schools to professional training (Nurhayati & Arif, 2023).

The benefits of serious games are very diverse and significant, including increased learning motivation, increased knowledge retention, and a more active and interactive learning experience. Its implementation can be found in various fields, such as education (Arif & Nurhayati, 2022), health (Damaševičius et al., 2023), military (Mun et al., 2017), tourism (Arif et al., 2023), and business (Beranič & Heričko, 2022). In the military, for example, serious games can simulate realistic combat situations for training. In business, serious games can help in training management and leadership skills. Meanwhile, these games can be used in the health sector for patient education or medical training. The technology used in serious games is diverse and continues to develop, ranging from personal computer platforms and game consoles to mobile technology (Devraj et al., 2021). Virtual and augmented reality technology is also starting to become commonplace in creating serious games, providing a more immersive learning experience (Lu et al., 2022; Strada et al., 2023). This ability allows players to truly experience and interact with the learning material in a way impossible with traditional methods. This technology also allows developers to create highly realistic and detailed scenarios. This condition can help depict complex or abstract concepts in a form that is easier to understand. Overall, the technology used in serious games provides excellent potential for innovation in how we teach and learn.

Artificial intelligence (AI) is essential in developing serious games (Eun et al., 2023). AI can be used to make in-game characters and scenarios more realistic and provide challenges that suit the user's abilities and needs (Arif et al., 2023). For example, AI can adjust a game's difficulty level based on a player's progress, providing just the proper challenge to ensure an optimal learning experience. AI also enables the development of dynamic and responsive content to player actions so that each gaming experience is unique and personal (Arif et al., 2023). In an educational context, serious games offer an exciting alternative to traditional learning methods (Arias-Calderón et al., 2022). Students can not only gain new knowledge but can also interact directly with learning material. This ability can help them understand intricate and complex concepts better. In today's digital era, the younger generation is often more connected to technology and digital media. These conditions cause serious games in education to offer a more relevant and exciting approach (Arif et al., 2023). Additionally, using games in teaching also helps reduce the stress and anxiety often associated with formal learning, making the learning process more enjoyable. Thus, serious games can be a very effective tool in increasing student engagement and learning outcomes.

In health education, serious games can provide knowledge about various aspects of health, from nutrition to medical procedures (Andrew et al., 2023). Additionally, serious games can also be used to train clinical skills and change health behavior (D’Aprile et al., 2019). For example, through serious games, a nursing student can learn how to perform clinical procedures safely and effectively (Wong et al., 2022), while patients can learn about the importance of a healthy lifestyle and adherence to treatment. This theoretical implementation has become a reality in many educational and health institutions worldwide. Technology and game-based approaches allow health education to become more engaging, interactive, and effective, with real potential to influence behavior and health outcomes (Sipiyaruk et al., 2018). The use of serious games in health education is not only limited to professional training but can also be an effective tool in patient education (Gomes Lisboa de Souza et al., 2022). Games designed to teach about a particular disease or how to manage a health condition can be an invaluable tool for helping patients understand and manage their condition (Ingadottir et al., 2020). For example, games that teach about diabetes can help players as patients understand how diet and exercise affect their blood sugar levels. However, many challenges must be faced, such as system requirements, player acceptance, and learning effectiveness in specific educational environments. This systematic literature review aims to understand the technology, challenges, and prospects for further research in using serious games for medical education.

Main Focus of the Chapter

In this chapter, we meticulously define our objectives and aims, setting out to interrogate the efficacy of serious games as pedagogical tools in medical education. We address fundamental questions regarding their role in enhancing learning outcomes, their integration into curricula, and the balance between educational utility and user engagement. The inquiry contributes a novel perspective by synthesizing cutting-edge AI technology (Kazi, 2024; Patibandla et al., 2024) with learning theory to elucidate the transformative potential of serious games. This chapter is designed for a varied audience, including educators, researchers, and developers, and aims to clarify complex concepts while maintaining scholarly thoroughness. We present a comprehensive methodological approach, employing a systematic literature review complemented by case studies to illustrate the real-world application of theory. Our discourse is circumscribed to the pedagogical implications of serious games, intentionally omitting a deep dive into the programming specifics or market analysis. The chapter is attuned to contemporary shifts towards digital pedagogies, situating our discussion within the vibrant mosaic of current educational innovations and contributing to the broadening discourse on the future of educational technologies.

By delineating the contours of the current educational landscape, the chapter recognizes the burgeoning trend of gamification in education (Mustafa et al., 2022; Valderama et al., 2022). It situates the analysis of serious games within the context of evolving pedagogical strategies. It aims to contribute to the dialogue on digital education, offering a critical examination of serious games' capacity to engage and educate the next generation of healthcare professionals. Through this exploration, the chapter aspires to provide actionable insights that will aid in the design of educational interventions that are both scientifically sound and pedagogically effective, resonating with the emerging needs of a digitally native student body.

Literature Review

Serious Games

Serious games refer to games that are specifically designed for educational or training purposes, not just for entertainment (Stofella & Fadel, 2022). Serious game designers target understanding specific concepts, developing new skills, or changing behavior through engaging goal-oriented interactions. This concept paves the way for innovative learning approaches, where players can learn while playing in an engaging and interactive environment (Arif et al., 2021). Various elements such as graphics, narrative, and engaging game mechanics are essential in keeping players motivated and engaged. In the context of health education, serious games have the potential to support the delivery of health information and clinical training (de Oliveira et al., 2021). As time goes by, the scenarios offered by serious games become more diverse and sophisticated, allowing for deeper learning and richer experiences. The concept of serious games combines entertainment with education, making conveying complex and sometimes dull information more interestingly easier. Applying the latest technology in serious games also allows for realistic simulation of real-world situations, which is a perfect transition to discussions about scenarios in serious games (Arif et al., 2023).

Scenarios in serious games offer replicas of real-world situations that allow players to explore and learn in a safe and controlled environment (Arif et al., 2023). These scenarios, especially in a medical context, can simulate clinical conditions, medical procedures, or medical emergencies, thereby assisting in improving understanding and retention of information. These scenarios can also be adapted to meet the specific needs of various target groups, thereby increasing the relevance and effectiveness of serious games. Through these scenarios, serious games are changing how medical education and training are delivered. Technological advances play an essential role in developing these scenarios, which brings us to the next topic regarding the application of serious games in the health sector (Schulz et al., 2020). Effective scenario development requires a deep understanding of learning objectives and how best to integrate these objectives into an engaging game experience. Additionally, player feedback and performance evaluation are essential to improve scenario design and ensure the achievement of educational goals.

Serious games have various uses in healthcare. They help teach patients, train medical staff, and simulate medical scenarios, making it easier for users to grasp health-related concepts interactively (Georgieva-Tsaneva, 2019; Wong et al., 2022). This capability allows for deeper learning and more realistic training experiences, leading to better patient care. These applications are feasible due to ongoing technological progress, which enhances the design and development of serious games. These advancements enable more effective medical training and the simulation of intricate clinical situations (de Oliveira et al., 2021). Furthermore, using serious games for patient education aids in understanding health conditions and improving patient compliance and treatment outcomes. These technological strides pave the way for a discussion on how technology boosts the creation of advanced serious games.

The latest technology supports the development of more sophisticated serious games. More realistic graphics, motion tracking technology, and virtual reality (VR) enable the creation of more immersive and realistic simulations, which can add valuable learning experiences (Nurhayati & Arif, 2023). These advances improve the quality and realism of simulations and open opportunities for new and more complex types of interactions in virtual environments. This potential leads us to discuss how this technology can be applied to take medical learning to the next level. Technologies like VR and augmented reality (AR) open opportunities for impressive immersive learning, allowing players to explore and interact in 3D environments (Altan et al., 2022; Garcia, 2020; Miller et al., 2024; Strada et al., 2023). Additionally, analytics and AI technology can customize learning experiences based on individual progress and needs, increasing learning effectiveness (Garcia et al., 2024). This technology also enables real-time evaluation and feedback, which is essential for continuous improvement (Arif et al., 2023). Through this potential, serious games have the way for further medical education and training innovation, which is a perfect transition to the next topic, Health Education Media. The potential integration between serious games and the latest technology opens opportunities to create a more comprehensive and effective health education platform.

Health Educational Media

Health education media refers to the tools or platforms used to convey health information and promotion to the public or individuals (Hayes et al., 2023; Stellefson et al., 2020). This media aims to increase public awareness and knowledge about health issues and support positive health behavior. The role of health education media is significant in building health literacy (Miranda, 2024; Ramos, 2024; Tomé et al., 2024) and helping people make better health decisions (De Jesus, 2013; Lowry et al., 2022). The transition from serious games to health education media is a logical step because both have the same goal: increasing health education and awareness (Sharifzadeh et al., 2020). This media can complement serious games in creating a comprehensive health education ecosystem. Health education media can also serve as a platform to convey the latest information about health and disease to the public. Examples of health education media applications cover a variety of formats and platforms. Printed materials such as brochures and posters (Mackert et al., 2014), educational videos (Garcia & Yousef, 2022; Weidmann et al., 2023), mobile applications (Çalış et al., 2023), and online platforms such as websites (Penedo et al., 2021), social media (Thapliyal et al., 2024), or health portals are some examples of media used to convey health information. Each of these media has advantages and disadvantages in reaching audiences and effectively conveying health information. The availability of these platforms allows for broader and easier access to health information, which is an essential foundation for promoting health awareness (Ofosu-Ampong et al., 2024; Panja, 2024). Integrating these platforms and serious games can also create a more comprehensive and interactive health education experience.

The latest technology allows the development of more innovative health education media. AR and VR offer new ways to present health information in an interactive and immersive way (Gandedkar et al., 2021). This technology opens up opportunities for more engaging and immersive learning experiences, which can help understand complex health concepts. This progress also creates opportunities for further integration with serious games, creating a more holistic health education ecosystem (Damaševičius et al., 2023). Additionally, advances in AI and analytics can help personalize educational content, making the learning experience more relevant and engaging for everyone. This technology enables real-time evaluation and feedback, which is essential for continuous adaptation and improvement in health education strategies. Online platforms and mobile applications make access to health information easier (Mohammadzadeh et al., 2023) and can be customized to suit user needs and preferences (Ramaswamy et al., 2023). Features such as easy search, access to extensive health databases, and the ability to track and manage personal health data make this medium a powerful tool for health education. This ease of access and customization is a significant step in shaping health education to be more inclusive and personalized. Additionally, using big data and analytics can help present more accurate and timely information to users, thereby improving the quality and effectiveness of health education (Garcia et al., 2024).

Methods and Data Collection

The methodology chosen in this study is the systematic literature review method. This approach was chosen because it allows structured and in-depth research into relevant literature (Linnenluecke et al., 2019). This method aims to systematically collect, evaluate, and analyze current research, providing comprehensive insight into the research (Ahn & Kang, 2018). In the context of this research, the main focus is how serious games are used in health education, specifically on the use of technology, implementation challenges, and further research directions. To ensure the highest standard of transparency and reporting completeness, we adhered strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines throughout our research process. This adherence is demonstrated through the application of the PRISMA checklist and the inclusion of a flow diagram that delineates the study selection process. The PRISMA checklist was meticulously followed, outlining each step of the literature review and selection process. We documented the flow of information through different phases of the systematic review. We provided a PRISMA flow diagram to map out the number of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage. This rigorous approach not only enhances the credibility of our systematic review but also provides a clear and replicable methodology for future research endeavors in this domain.

The criteria for selecting studies to be included in this review are articulated with precision and follow a predefined protocol to ensure relevance and rigor. We included randomized controlled trials, observational studies, and qualitative research that directly examine the application and impact of serious games in health education. The subjects were restricted to those involving specific health conditions or educational settings that utilize serious games as a primary intervention tool. Specific inclusion criteria were applied, such as the publication type, which encompassed peer-reviewed journal articles, conference proceedings, lecture notes, and book sections published between 2018 and 2023. Conversely, we excluded non-English publications, grey literature, and studies that did not focus on the defined scopes of technology application in serious games, their challenges, or future directions in health education. In the literature search process, we used the Scopus database and obtained 809 records related to research on serious games for health education. This research only uses a search period from 2018 to 2023. The aim is to ensure that this research covers the latest developments and trends in serious games and health education. The results of the subsequent selection process showed 481 research publication data with titles and abstracts related to discussing serious games for health education. This number includes a wide range of research from around the world and various scientific disciplines, showing how diverse this topic is. However, most references obtained still need to clearly show the actual relevance of proposals or research results regarding serious games for health education.

In synthesizing the data from the selected studies, we adopted a methodical approach that began with a thematic analysis to identify core concepts and patterns within the serious games literature. Each publication was meticulously coded for themes related to technology application, educational challenges, and future research directions in the context of medical education. This qualitative thematic synthesis enabled us to construct a narrative that encapsulates the multifaceted dimensions of serious game usage in health education. To complement the thematic analysis, we also employed a bibliometric analysis using the VOSviewer application, which allowed us to visualize and interpret the interrelationships among key terms extracted from the literature. This non-statistical method provided a macro-level overview of the field, highlighting the central topics and thematic clusters without the use of statistical meta-analysis techniques. The synthesized findings from both the thematic and bibliometric analyses offer a comprehensive perspective on the current state and emerging trends within the domain of serious games in health education.

Therefore, the selection process was repeated to ensure the publication's relevance and quality. The main selection criterion was that publications should show research material related to serious games used in medical education. One indicator is the presence of the keywords "serious game" and "health" or "medical" and "education" or "training" or "practice" in the title of the publication reference. After a rigorous selection process, we obtained 41 appropriate publication data that met these criteria. The next step is the publication selection process based on data duplication and research type. The selection process for the literature, depicted in Figure 1, details the progression from the initial stages to the final selection, resulting in 27 publications being chosen. All selected publications include 20 journals, 4 conferences, 3 lecture notes, and 1 book section, as shown in Figure 2.

On the other hand, Figure 3 shows the distribution of the number of publications from 2018 to 2023. After the publications were selected, we carried out a critical analysis of every article. This analysis process includes determining how the technology is applied, what challenges are faced in its application, and the prospects for future research. This analysis will provide an in-depth understanding of each study's context, methodology, findings, and implications.

In this research, we also tried to visualize the relationship between keywords and selected publication references using the VOSviewer application, as shown in Figure 4. Network visualization using VOSviewer revealed several key findings, where the central topics that dominated were "serious games", "medical education", and "video game learning". This signals a significant literature focus on linking serious games to medical education and video game-based learning technologies. The relationship between these words shows a significant link between the use of serious games in medical education and the learning approach through video games. In addition, the visualization also highlights thematic clusters, which indicate groups of keywords that frequently appear together. For example, "virtual simulation," "health care education," and "decision-making computing" were grouped in the same cluster, indicating a thematic connection between virtual simulation and health education. Demographic factors also are of concern in the literature, with words such as "human," "male," "female," "child," and "adolescent" emerging as relevant topics. These characteristics show consideration of individual characteristics in applying serious games in the health sector. Overall, this visualization provides a comprehensive picture of serious games' foundation and future direction in health education.

Results and Discussion

The implementation of serious games in various areas of health education, creating unique and immersive learning platforms for various sub-fields, has been highlighted in recent research. With the proliferation of diverse serious gaming applications, from primary medical education to industrial safety training, researchers and developers face challenges and opportunities in aligning technology, methodology, and educational needs. The various initiatives and approaches taken in developing and implementing serious games in various health fields show the dynamics and potential of this method in enriching the teaching and learning process. Table 1 shows the heterogeneity of information on the 27 serious game themes for health education discussed in this research.

Several researchers proposed a serious game system for medical education by creating a variety of new terms. One is "Virtual ER" introduced by Wong et al., (2022). This serious game system creates a learning bridge between medicine and nursing, showcasing the potential for serious games to support and stimulate interprofessional collaboration and improve communication skills among students from different fields of expertise. On the other hand, a study introduced "DECIDIX", a serious game that presents an innovative approach to sexual and reproductive education for teenagers. This research also discusses a pedagogical methodology rooted in Paulo Freire's principles, which provides access to accurate and relevant information in an exciting and interactive format (Monteiro et al., 2018). Meanwhile, the experience provided by research on "GridlockED" in medical education workshops shows that serious games can be an effective medium for conveying complex learning material.

The material is delivered in an accessible and engaging format while providing participants with an authentic learning experience (Hale et al., 2021). In another study, Gürer et al., (2023) propose "MINING-VIRTUAL" which expands the scope of implementation of serious games into the industrial sector by providing innovative and immersive OHS training in the mining context. The serious game, introduced in 2023, shows the successful integration of VR technology and the Unity3D game engine, opening up opportunities for similar applications in other high-risk industries (Gürer et al., 2023). Next, Khan and Kapralos, (2017) discussed a serious game that was introduced as "Fydlyty". They developed a serious game for developing cultural competency in medical education, introducing concepts and practices that support diversity and inclusivity in medicine and care.

In developing health education through serious games, Jaunay et al., (2019) through "Hygie" offer an insight into how continuing medical education can be realized in an engaging and interactive format. Serious games target general practitioners by exploiting the appeal of video games to convey learning material (Strada et al., 2023). Meanwhile, another serious game proposed by Brar et al., (2021) takes the concept of simulation to the next level by creating a virtual replica of a shift in an emergency department. They integrate crucial aspects such as prioritization in a multi-patient context and resource management. They offer a platform for risk-free practice and exploration of decisions in a busy and stressful environment.

Going further, de Oliveira et al., (2021) proposed "Mobile doc training" and explored the potential of mobile technology to support medical education. They provide a platform for medical students in Brazil to hone their skills in managing clinical cases through accessible and portable devices. Furthermore, research on serious games called "Tako Dojo" presents a unique approach to combining behavioral science with serious games. The concept bridges gaming experiences, patient empowerment, and health behaviors. Serious games introduced by D'Aprile et al. create a paradigm in which patients are passive recipients of health information and active participants in their health journey through play experiences designed to support the development of positive health-related knowledge and behavior (D’Aprile et al., 2019).

To enrich health education through serious games, Anders et al., (2023), through "Adventure Legal Medicine" have opened new horizons in forensic medical education. They present an independent learning platform that is not limited by space and time, providing easy access and flexibility to students. On the other hand, Al Kahf et al., (2023) proposed "Chatprogress" namely the serious integration of games and chatbots in medical education. The 2023 research provides incentives for further exploration of how technology can be effectively applied in learning strategies and raises questions about the potential for similar applications in other medical education contexts. Apart from that, "KidBreath" as an e-learning platform puts forward an innovative concept for health education for children with asthma. Serious games introduced by Delmas et al., (2018) integrate health education programs with digital learning technology and offer exciting solutions to common problems in children's health education.

In another study, Chon et al., (2019), via "EMERGE" displays a detailed emergency department simulation. This serious game creates a virtual platform that allows medical students to hone their declarative and procedural knowledge in a context close to reality, offering a breakthrough in practical learning approaches. The following serious game "Scenario Editor" provides an innovative and intuitive solution for mental health education through virtual simulations and serious games. The research discussed by Torres et al., (2021) allows educators to create and customize virtual learning experiences tailored to their specific needs, even with a limited computer or programming background. The variety and innovation in developing serious games for health education, as demonstrated by previous research examples, indicate great potential in various applications and contexts. From forensic medicine to pediatric patient education and emergency room simulations to mental health scenario development, serious gaming applications in health education have covered various fields and topics. These conditions create a varied and flexible framework where technology and pedagogical methods can complement and enrich each other, providing significant added value in learning and developing competencies in health and medical practice.

Innovation in medical education continues to develop along with technological advances (Erisen & Uludag, 2024; Tariq, 2024; Toit & Goosen, 2024), which is visible in the various implementations of serious games in various countries and educational contexts. In Bulgaria, medical education innovations involve using video materials and serious games as two main approaches to enhance the learning process. Algorithmic videos present detailed and didactic action sequences for medical manipulation, while serious games provide a simulated environment to strengthen mastery of the concepts (Georgieva-Tsaneva, 2019, 2019). In Canada, a serious game has been used in workshops to provide a rich and engaging learning experience for participants, showing how serious games can be integrated into more formal educational settings and structures (Hale et al., 2021). On the other hand, a serious game developed in Canada and the United States brings innovation to medical education by providing a web-based platform that includes scenario and dialogue editors. This serious game allows the creation of realistic conversations and interactions with virtual patients to increase cultural competency in medical practice (Khan & Kapralos, 2017). With advances in mobile technology, a serious game developed in Brazil integrates this technology to support medical education. Serious games visualize virtual learning environments that can accommodate clinical case training for medical students. This research also shows how the application of technology can be adapted to local needs and context (de Oliveira et al., 2021).

The diversity of countries in applying serious games in health education reflects the flexibility and adaptability of this method in various educational contexts and cultures. From Bulgaria to Brazil, these diverse implementations create a roadmap that shows how serious gaming technologies and methodologies can be adapted and applied in various educational settings and needs. This diversity also provides a foundation for sharing experiences and best practices between countries, enabling the further development of innovative educational strategies and applications worldwide.

Supporting Technology

The involvement of technology in the world of health education has brought fresh air and innovation through the development of serious games that aim to improve the understanding and skills of medical students and practitioners. Highlighting several case studies, this discussion will explore the use of various technologies, platforms, engines, and applications that have been integrated into developing serious games for health education. A list of references that discuss the use of technology to support serious health education games is shown in Table 2.

On the first point, mobile technology stands out as an effective tool in supporting the development and use of serious games in health education (de Oliveira et al., 2021; Kostenius et al., 2018). The main advantage of mobile technology lies in its accessibility and flexibility, allowing users to access learning materials anywhere and at any time, which can facilitate the achievement of educational goals in a wider context and the diversification of clinical scenarios that can be simulated in games. Furthermore, web-based applications also get a sufficient portion of serious game development. Studies conducted by Wong et al., (2022) and Khan and Kapralos, (2017) present a web-based approach that utilizes scenario and dialogue editors to create conversations and interactions with virtual patients, emphasizing educational enrichment through combining serious gaming elements with collaborative learning. The application of VR and game engines such as Unity3D, as illustrated by Gürer et al., (2023), opens up the potential for exploration of virtual environments that can facilitate users in identifying potential hazards and accessing critical information in the context of K3 education and training. On the other hand, Antoniou et al., (2020) reveal the role of biosensor technology and VR or mixed reality (MR) platforms, which can enrich the learning experience by presenting material interactively and integrating user emotional analysis to increase engagement and educational focus.

Adopting innovative technologies in medical education curricula, as discussed by (Georgieva-Tsaneva, 2019), can create a basis for developing and implementing serious games. Meanwhile, other approaches, such as the use of chatbots and Intelligent Tutoring System (ITS) applications (e.g., Garcia & Garcia, 2023; Garcia et al., 2022), show how integrating AI technology and chatbots (Garcia, 2023, 2023) can provide step-by-step answers and pedagogical comments and create learning experiences tailored to user needs (Al Kahf et al., 2023; Delmas et al., 2018). Technological advancements are significantly influencing the landscape of health education through the integration of AI, VR/AR, and mobile platforms into serious games. These technologies enhance the learning experience by offering immersive, interactive scenarios that cater to the evolving needs of medical students and professionals. Comparative analysis of various studies reveals a trend towards more user-centric educational tools, with some discrepancies in technology application and effectiveness, indicating areas for further research. Practical implications suggest that such insights could be applied to refine current educational practices, making them more engaging and accessible (Chauhan et al., 2024). Educators, developers, and health professionals could leverage the potential of serious games by incorporating these technologies into curricula, ensuring a more dynamic learning environment. These findings align with existing literature that recognizes the importance of innovative educational strategies, confirming and expanding upon the known benefits of serious games in health education.

Research Challenges

Serious games in health education have shown promising prospects in enhancing learning experiences and facilitating understanding of complex concepts. However, behind its potential are a series of challenges that educational developers and practitioners need to face and address. This discussion will involve an in-depth exploration of these challenges based on various related studies and studies. Collaboration between medical professionals and developers is becoming a necessity in the development of effective and medically accurate serious games. However, the challenge lies in creating an intersection between accurate medical information and engaging gameplay elements (Georgieva-Tsaneva, 2019). Furthermore, this condition creates a paradox where informative and educational content must be balanced with an entertaining and exciting user experience, especially in the context of sexual health education for young audiences (Sara & Guay, 2014). Further discussion on how to create this balance in various contexts and themes, such as cultural competency and education about occupational safety and health, would help define balanced and effective content development guidelines (Khan & Kapralos, 2017; Pietrafesa et al., 2021).

In the realm of technological accessibility and digital competence, there is a need for continuous initiatives to improve the digital capabilities of both teachers and students (Georgieva-Tsaneva, 2019; Kostenius et al., 2018). Implementing serious games in existing medical education curricula demands extensive adaptation from both a technological and a pedagogical perspective. Therefore, further exploration of how conventional teaching approaches and new technologies can complement each other in professional practice contexts, such as residency, would provide valuable insights (Busari et al., 2018). When integrating serious games in practical educational contexts, linking the concepts and strategies learned in games with actual clinical experience emerges as a significant challenge (Brar et al., 2021). Therefore, an in-depth understanding of how game experiences can be related to real situations in clinical practice will be essential (de Sena et al., 2019). Further research would be beneficial to identify and develop mechanisms to facilitate this integration.

As for challenges related to cultural and gender sensitivities, inclusive and participatory solutions in serious game development will ensure that the user experience is equitable and relevant for all users (D’Aprile et al., 2019; Khan & Kapralos, 2017). In other words, involving users from diverse backgrounds in the design and evaluation process can yield important insights for creating more inclusive and compelling learning experiences. The challenges of user information security and the development of realistic and relevant clinical scenarios demand a user-centered approach in serious game design (Bellemare et al., 2018; Sara & Guay, 2014; Tariq, 2024). Further research into how the user experience can be optimized to ensure that information security is guaranteed and how the developed scenarios can be as accurate and detailed as possible will help optimize the implementation of serious games in medical education (Chon et al., 2019; Revano et al., 2018; Yousef et al., 2023).

The review illuminates pivotal challenges such as the imperative for collaborative synergy between healthcare experts and game designers and the critical incorporation of cultural and gender sensitivities in game development. To surmount these challenges, fostering multidisciplinary teams and embracing inclusive design methodologies are key (Dollente et al., 2023; Garcia, 2020; Isles et al., 2023; Luluquisin et al., 2021). These teams should prioritize the integration of diverse perspectives from the early stages of development to ensure that serious games are both educationally sound and culturally competent. Additionally, implementing iterative design processes with continuous user feedback can enhance the relevance and efficacy of serious games. By addressing these challenges with strategic solutions, the field can advance toward creating serious games that are not only effective educational tools but also inclusive and reflective of a diverse user base.

Research Directions

Amid the digital transformation, serious games have emerged as a promising innovation in health education. With its ability to offer a more exciting and interactive learning approach, this technology seems ready to replace conventional learning methods. However, every innovation inevitably raises new challenges, and serious games are no exception. To maximize its potential, we need to identify and overcome these challenges. Based on the literature study, the following discussion outlines the challenges and directions for further research in the context of serious games for health education. Entering the era of AR/VR and AI technology, expectations for medical education are becoming increasingly higher (Antoniou et al., 2020; Darda & Matta, 2024). Integrating this technology into serious games offers deeper learning and personalization (Georgieva-Tsaneva, 2019). However, the challenge is combining technological innovation (Pilueta et al., 2022) with strict medical education standards so that graduates still meet the expected standards of professionalism. This condition is where further research is essential to ensure that serious games with AR/VR and AI technology provide optimal educational value.

As the gaming and information technology industries grow, games such as “MINING-VIRTUAL” are emerging as innovative educational solutions (Gürer et al., 2023). However, despite its potential, there is an urgent need to ensure the content's relevance to the field's realities. Therefore, collaboration between medical experts and game developers is crucial, providing guarantees that the games being developed are in line with health education needs. When developing a serious game, many considerations must be considered. Apart from content, other factors, such as learning methods and user interaction, are also essential (Antoniou et al., 2020; de Sena et al., 2019). Given the potential for integrating different learning methods in serious games, future research may focus on how the various methods complement each other and synergize, ensuring optimal learning outcomes.

The current digital era demands fast and real-time interactions, such as those offered by chatbot-based games (Al Kahf et al., 2023). Although promising, the challenge is how to increase the effectiveness and relevance of chatbots in the context of medical education, as well as how further research can improve the quality and outcomes of learning through this medium. The adaptation and development of serious games across various medical specialties signal the need for more inclusive and adaptive game design (Anders et al., 2023; Chon et al., 2019; Georgieva-Tsaneva, 2019). Addressing these challenges, further research could focus on how serious games can be developed and adapted to the specific needs of various medical specialties, ensuring relevance and effectiveness in various contexts. Technologies such as Scenario Editor have opened up new opportunities in designing and implementing virtual learning experiences (Torres et al., 2021). With this tool, educators can create learning scenarios that suit their needs. However, the biggest challenge is ensuring that the scenarios are created to support the learning objectives, and this is an area where further research is urgently needed. Serious games have opened new possibilities in health education, promising a more interactive and engaging approach. However, as with all innovation, there are obstacles to overcome. Through this discussion, we have reviewed various crucial challenges and areas that require further attention. Then, we can exploit serious games' full potential in redefining how we educate future generations in health.

Conclusion

In advancing health education, serious games have emerged as a transformative learning medium, integrating educational principles with interactive gameplay to elevate learner engagement and comprehension. The application of cutting-edge technologies such as VR and AR in serious games offers highly immersive experiences that closely replicate real-world scenarios. Coupled with AI, these platforms are capable of tailoring learning experiences to individual needs. While the deployment of such advanced tools in health education is fraught with challenges, a collaborative synergy between medical experts and game designers is crucial to ensure the delivery of precise educational content in an engaging format. Future research avenues should explore new technologies, evaluate the enduring impacts of serious games on educational outcomes, and develop designs that are both inclusive and culturally sensitive. Investigating how the knowledge and skills acquired from serious games translate to clinical practice is another critical area of study. Ongoing assessment of the effectiveness of these educational tools will be essential. Despite the challenges, with sustained inquiry and cooperative efforts, serious games hold significant potential to reform the education and training of healthcare professionals, rendering them more adaptable, interactive, and attuned to the evolving demands of healthcare delivery.

Additional Reading

Almeida, R. P. (Ed.). (2022). Handbook of Research on Improving Allied Health Professions Education: Advancing Clinical Training and Interdisciplinary Translational Research. IGI Global. https://doi.org/10.4018/978-1-7998-9578-7

Arnab, S., Dunwell, I., & Debattista, K. (Eds.). (2013). Serious Games for Healthcare: Applications and Implications. IGI Global. https://doi.org/10.4018/978-1-4666-1903-6

Bredl, K. & Bösche, W. (Eds.). (2013). Serious Games and Virtual Worlds in Education, Professional Development, and Healthcare. IGI Global. https://doi.org/10.4018/978-1-4666-3673-6

Garcia, M. B. & de Almeida, R. P. (Eds.). (2024). Emerging Technologies for Health Literacy and Medical Practice. IGI Global. https://doi.org/10.4018/979-8-3693-1214-8

Garcia, M. B., Lopez Cabrera, M. V., & de Almeida, R. P. (Eds.). (2023). Handbook of Research on Instructional Technologies in Health Education and Allied Disciplines. IGI Global. https://doi.org/10.4018/978-1-6684-7164-7

Zheng, R. Z. & Gardner, M. K. (Eds.). (2017). Handbook of Research on Serious Games for Educational Applications. IGI Global. https://doi.org/10.4018/978-1-5225-0513-6

Key Terms and Definitions

Artificial Intelligence: A branch of computer science that deals with creating computers or computer systems capable of performing tasks that typically require human intelligence. This includes activities such as learning, reasoning, problem-solving, perception, and language understanding.

Clinical Skills Training: A specialized area of health education focused on developing skills required for clinical practice. This training can be enhanced through serious games that provide realistic simulations, aiding in the mastery of necessary clinical procedures.

Gamification: The incorporation of game elements and principles into non-gaming contexts. This approach is used to boost engagement, increase productivity in organizations, enhance learning experiences, and improve assessment methods.

Health Education: A discipline concerned with improving health knowledge, skills, and attitudes among individuals and communities. It often utilizes innovative methods, including serious games, to effectively convey health-related information.

Immersive Learning: An educational approach that employs virtual reality or other technologies to create a fully immersive and interactive learning environment. This method enhances the learning experience by making it more engaging and realistic.

Serious Games: Digital interactive applications with a primary purpose beyond mere entertainment. These games are designed to educate, train, or influence behavior by combining engaging gameplay with educational or training objectives.

User Interface: The part of a computer system or software that allows users to interact with it. This includes both the input devices used to control the system and the software that interprets and responds to user inputs.