Race Against Diabetes: development and validation of a serious game prototype for school-based health education
DOI:
https://doi.org/10.17398/1695-288X.24.2.179Keywords:
diabetes mellitus, educational technologies, digital games, school, diabetes educationAbstract
The global rise in the incidence of diabetes mellitus, particularly among children and adolescents, highlights the need for innovative educational strategies in school settings. Serious games have proven promising for improving self-care and preventing complications by combining playfulness with evidence-based content. This methodological study was conducted in two phases: the development of the digital prototype Race Against Diabetes and its validation with experts (n = 6) and the target population (n = 20, aged 11–14). The content adhered to the ADCES7 guidelines and those of the Brazilian Diabetes Society and was assessed using the CVC, I-CVI, S‑CVI/AVE, binomial test, and a Likert-based usability scale. The game is a 2D title developed in Unity/C++, featuring five levels focused on collecting healthy foods and learning about self-care. It achieved an S-CVI/AVE of 0.87, with some items showing a minimum I-CVI of 0.66 (p > 0.05). Usability was rated as satisfactory (mean score: 9.3 ± 2.65), with participants highlighting motivation, clarity, and learning. Race Against Diabetes shows strong potential as a pedagogical tool in health education, promoting knowledge and self-care skills through interactive gameplay. The pixel art design, chosen by students, further enhances engagement. Expansion to other platforms and long-term clinical impact studies are recommended.
Downloads
References
Abt, C. C. (1987). Serious games. University Press of America
Aleksić, V., & Simeunović, V. (2024). The Pixel Art as Computer Graphics Artistic Expression in Digital Games. 10th International Scientific Conference Technics, Informatics and Education, 2024.
Ancona, A., Corea, F., Lombardo, C., Gentili, D., & Mistretta, A. (2024). Serious games in child and adolescent health education campaigns: a systematic review. Annali dell'Istituto superiore di sanita, 60(4), 274–282. https://doi.org/10.4415/ANN_24_04_06
Bao, S. (2022). Visualizing situations: comparing pixel and vector art style in a dining situation sketch. In: 9th International Conference on Kansei Engineering and Emotion Research. KEER 2022.
Castro, F. S. F., Dias, D. M. V., Higarashi, I. H., Scochi, C. G. S., Fonseca, L. M. M. (2015). Avaliação da interação estudante-tecnologia educacional digital em enfermagem neonatal. Revista da Escola de Enfermagem da USP, 49(1),114-21. 10.1590/S0080-623420150000100015.
Celestini, A. (2020). Serious Games in Higher Distance Education. Canadian Journal of Learning and Technology, 46(1): 1-12.
Chandler, H. M. (2012). Manual de produção de jogos digitais. Bookman, 2012.
Cobas, R., Rodacki, M., Giacaglia, L., Calliari, L. E. P., Noronha, R. M., Valerio, C., Custórdio, J., Scharf, M., Barcellos, C. R. G., Tomarchio,
M. P., Silva, M. E. R. Santos, R. F., Zajdenverg, L., Gabbay, M. (2023). Diagnóstico do diabetes e rastreamento do diabetes tipo 2: Diretriz Oficial da Sociedade Brasileira de Diabetes. 10.29327/557753.2022-2.
Cruz-Cunha, M. M. (2012). Handbook of research on serious games as educational, business and research tools. IGI Global.
Dabbs, A. V., Myers, B. A., Curry, K. R., Jacob, J. D., Hawkins, R. P., Begey, A., Dew, M. A. (2009). User-centered design and interactive health technologies for patients. Computers, informatics, nursing: CIN, 27(3), 175-82. 10.1097/NCN.0b013e31819f7c7c.
Francisco, M. M. (2019). Construção e validação de um jogo da memória sobre hanseníase para adolescentes. Universidade Federal de Pernambuco.
Gazis, A., & Katsiri, E. (2023). Serious Games in Digital Gaming: A Comprehensive Review of Applications, Game Engines and Advancements. Wseas Transactions on Computer Research, 1(11): 1-13.
International Diabetes Federation (2022). Annual report 2022. IDF. https://idf.org/media/uploads/2023/07/IDF_Annual_Report_2022_Final.pdf
Jasper, M. A. (1994). Expert: a discussion of the implications of the concept as used in nursing. J. Adv. Nurs., 20(4), 769-76. 10.1046/j.1365-2648.1994.20040769.x
Kohli, D., Khurana, D., Singh, B., Kaur, A., & Sachdeva, P. (2024). Exploring the Capabilities of Unity 3D Gaming Software. In: 2024 OPJU International Technology Conference (OTCON) on Smart Computing for Innovation and Advancement in Industry 4.0.
Kolb, L. (2021). An effective model of diabetes care and education: the ADCES7 Self-Care Behaviors™. Sci Diabetes Self Manag Care., 47(1), 30-53. 10.1177/0145721720978154.
Lee, A. et al. (2020). Escolas promotoras de saúde: uma atualização. Economia da saúde aplicada e política de saúde, 18(1), 605-623.
Lima, S. M., & Otero, P. (2024). Serious games are more than just games. Los serious games son más que juegos. Archivos argentinos de pediatria, 122(6), e202310218. https://doi.org/10.5546/aap.2023-10218.eng
Liu, M., Guan, X., Guo, X., He, Y., Liu, Z., Ni, S., & Wu, Y. (2024). Impact of Serious Games on Body Composition, Physical Activity, and Dietary Change in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled
Trials. Nutrients, 16(9), 1290. https://doi.org/10.3390/nu16091290
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing research, 35(6), 382-6.
Machado, L. D. S., Moraes, R. M., Nunes, F. L. S. (2009). Serious games para saúde e treinamento imersivo: abordagens práticas de realidade virtual e aumentada. SBC.
Maheu-Cadotte, M. A., Cossette, S., Dubé, V., Fontaine, G., Lavallée, A., Lavoie, P., Mailhot, T., & Deschênes, M. F. (2021). Efficacy of Serious Games in Healthcare Professions Education: A Systematic Review and Meta-analysis. Simulation in healthcare : journal of the
Society for Simulation in Healthcare, 16(3), 199–212. https://doi.org/10.1097/SIH.0000000000000512
Makhlysheva, A. (2013). A mobile phone-based serious game for children with Type 1 diabetes. University of Tromso.
Maskeliūnas, R., Kulikajevas, A., Blažauskas, T., Damaševičius, R., Swacha, J. (2020). An interactive, serious mobile game for supporting the learning of programming in javascript in the context of eco-friendly city management. Computers, 9(4), 102-19. 10.3390/computers9040102.
Mondellini, M., Colombo, V., Mauri, M., Tizzoni, F., Tarabelloni, A., & Nobile, M. Evaluating the Usability of a Serious Game for Nutritional Education with Children with ADHD. 2023 IEEE 11th International Conference on Serious Games and Applications for Health (SeGAH), Athens, Greece, 2023, pp. 1-6, doi: 10.1109/SeGAH57547.2023.10253793.
Mourão, D. M., Melgaço, N. M., Frias, N. F. S., Silva, N. B. M., Silva, R. S., Sedlmaier, B. M. G., & Borges, G. F. (2023). (Des)conhecimento do diabetes nas escolas: percepção de crianças e adolescentes. Physis: Revista De Saúde Coletiva, 33, e33041. https://doi.org/10.1590/S0103-7331202333041
Novak D. (2024). A Serious Game (MyDiabetic) to Support Children's Education in Type 1 Diabetes Mellitus: Iterative Participatory Co-Design and Feasibility Study. JMIR serious games, 12, e49478. https://doi.org/10.2196/49478
Novak, J. (2012). Game Development Essentials: an introduction. Cengage Learning.
Oliveira, F. G. C. S. M. (2021). Jogos sérios na diabetes tipo 1: aumentar o conhecimento de adolescentes e jovens adultos através de ludificação. Universidade do Porto.
Papanastasiou, G., Drigas, A., & Skianis, C. (2021.) Serious Games for Sustainable Education in Emerging Countries: An Open-Source Pipeline and Methodology. Springer
Pasquali, L. (2013). Psicometria: teoria dos testes na psicologia e educação. 5 ed. Vozes.
Passos, K. G. Farias. (2012). O fluxo de informação no processo de desenvolvimento de jogos eletrônicos. Universidade Federal de Santa Catarina.
Polit, D. F., Beck, C. T. (2019). Fundamentos de pesquisa em enfermagem: avaliação de evidências para a prática da enfermagem. 9ª ed, Porto Alegre: Artmed.
Rehman, U., Abbasi A. Z., Shah M. U., Idrees, A., Ilahi, H., & Hlavacs, H. Analyzing and Prioritizing Usability Issues in Games. In: Fang, X. (eds) HCI in Games: Experience Design and Game Mechanics. HCII 2021. Lecture Notes in Computer Science(), vol 12789. Springer,
Cham. https://doi.org/10.1007/978-3-030-77277-2_9
Savi, R., Wangenheim, C. G., Ulbricht, V., Vanzin, T. (2010). Proposta de um modelo de avaliação de jogos educacionais. Renote. 8(3), 1-13. 10.22456/1679-1916.18043.
Silber, D. (2016). Pixel art for game developers. Routledge.
Singh, S., & Kaur, A. (2022). Game Development using Unity Game Engine. In: 2022 3rd International Conference on Computing, Analytics and Networks (ICAN).
Sociedade Brasileira de Diabetes. (2022). Diretrizes da sociedade brasileira de diabetes 2022. Clannad.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Natalia S. Costa, Dra. Karanini P. Oliveira, Mateus C. Avelar

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish in this journal accept the following conditions:
Authors retain copyright over their works and grant the journal the right of first publication. Articles are published under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows third parties to share, copy, distribute, publicly communicate, adapt, transform, and reuse the work in any medium or format, including for commercial purposes, provided that authorship is properly acknowledged, the original source is cited, a link to the license is included, and any changes made are indicated. Note: This license applies to articles published from Vol. 25, No. 2, 2026 onwards.
Authors may enter into separate and additional contractual arrangements for the non-exclusive distribution of the published version of the article —for example, its deposit in an institutional repository or its subsequent inclusion in a book—, provided that it is clearly stated that the work was first published in this journal.
Authors are permitted and encouraged to deposit and disseminate their work on the Internet, for example, in institutional repositories, institutional websites, or personal websites before, during, and after the review and publication process, as this may foster scholarly exchange, increase the visibility of the work, and enable broader and faster dissemination of the published research.





