Healthier by Design:

A Multimethod Approach to Creating a Game-Design Framework

Pertaining to Players’ Mental Health

Daniel Tõevälja, Yo'Av Dar

Department of Computer
and Systems Sciences
Degree project 30 HE credits
Computer and Systems Sciences
Degree project at the master level
Spring term 2022
Supervisor: Mirjam Palosaari Eladhari
Abstract
The gaming industry has grown to be part and parcel of modern-day society. Many video games are
played by tens of millions of people. Video game development has a rich history starting from the 1950s.
At first, the industry was explored merely by few; however, it has grown with the technological
advancements and mass adoption of the field.
This study explores the specific area where game design and mental health overlap. The field is relatively
new in academia and has not seen many publications. Furthermore, this study builds a framework that
could be used to design various types of games with a focus on players’ mental wellbeing (which due
to the vast overlap in definitions, this study will use mental health and wellbeing interchangeably).
The research question of this project is, What important success factors are there in a framework for
designing games focusing on mental wellbeing? It aims to solve the problem of a research gap in
addressing game development for positive effects on the players’ mental health, and conversely, how to
avoid adverse effects.
In the process of the study, two data gathering methods were used. Firstly, semi-structured interviews
with designers of video games. This was the primary source of data to build the proposed frameworks.
Secondly, document research was used to gather data from existing frameworks. These two methods
have produced an interesting combination of findings that were later combined into the f ramework.
The framework proposed in this study supports players’ mental wellbeing, while helping design games
in a more sustainable way for the developer.
There are three parts to the frameworks: At the top, the connection is drawn to existing frameworks; at
the bottom, goals are described – both aspirational, as well as ones which should be avoided; and the
core contains different steps and other elements to achieve designers’ aim and have a positive and
meaningful impact on players’ mental health.

Keywords: design framework, mental health, video game, game designers, players wellbeing
Synopsis
BACKGROUND This thesis looks at the field of video games. More precisely, this study
focuses on the emerging field within game design that looks at
connections between games and players’ mental wellbeing.
There are different frameworks in game design field; however, there has
not been much focus thus far on players’ wellbeing and mental health.
PROBLEM The problem arises from the limited research in the field with a focus on
video-game design aspects related to players’ mental health.
RESEARCH What important success factors are there in a framework for designing
QUESTION games focusing on mental wellbeing? This question is relevant to the
problem in multiple ways. Firstly, solving it provides a new study in the
specific field. Secondly, building a framework makes it easier for other
studies to continue the development or build on it in another way.
STRATEGY AND The research strategy used in the study is a multimethod qualitative
METHOD approach. The following data collection methods were deployed:
• document analysis;
• semi-structured interviews.
RESULT The result is presented in the form of the new framework, Healthier by
Design (HbD), as outlined and explained in chapter 5. In this framework
there many aspects including, but are not limited to different steps
(Design, Prototype, Test, and Analyze), various questions (Does this
game impact player in a meaningful way? Does this game achieve the aim
of the developer?), and goals to strive for and pitfalls to avoid.
DISCUSSION The study only looks at the perspective of game designer and therefore
limiting the scope of the study. Furthermore, this study approaches the
subject only to the side of computer science, and not that of psychology.
This thesis is valuable as it builds on established routes of game design,
while focusing on a subject that is not yet well explored in the field.
The proposed framework in this thesis could be used by game designers
that care about players mental wellbeing.
Acknowledgements
The authors would like to thank the following people and organizations for their support and
contributions to this research:
The Department of Computer and Systems Sciences at Stockholm University, and in particular: our
supervisor, Dr. Mirjam Palosaari Eladhari, for broadening our horizons and for consistently providing
quality guidance along the way; our reviewer, Dr. Jakob Tholander, for steering us in the right direction;
and our program director, Dr. Erik Perjons, for exploring various ideas with us to determine which could
amount to feasible and valuable research projects.
We would also like to thank Aron Podavka of Drivhuset for taking an active interest in our work, and
for offering actionable leads for us to follow up on.
Last, but certainly not least, we would like to thank all participants in the research for their willingness
to coordinate across countries and timezones to share their wealth of experience and insight with us.
May your contribution to the research help lay the foundation for a new generation of game-
development!
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Table of Contents
1 Introduction ........................................................................................... 1
1.1 Background ...........................................................................................1
1.1.1 The research f ield .............................................................................1
1.1.2 Designing and evaluating video games .................................................1
1.1.3 Building f rameworks in the f ield of video games .....................................2
1.2 Introduction to research ..........................................................................2
1.2.1 The problem ....................................................................................2
1.2.2 The research question .......................................................................3
1.2.3 Delimitations ....................................................................................4
2 Earlier research ...................................................................................... 5
2.1 Designing video games ............................................................................5
2.2 Mental health and wellbeing .....................................................................8
2.2.1 Designing games with mental health in f ocus .........................................8
2.2.2 Video games in therapy .....................................................................9
2.2.3 Video game playing and mental health .................................................9
2.3 Mechanics, Dynamics, and Aesthetics (MDA) ............................................. 10
2.3.1 Mechanics ..................................................................................... 11
2.3.2 Dynamics ...................................................................................... 11
2.3.3 Aesthetics...................................................................................... 12
2.3.4 Complete MDA ............................................................................... 13
2.4 Design, Dynamics, Exper ience (DDE) ....................................................... 13
2.4.1 Design .......................................................................................... 14
2.4.2 Dynamics ...................................................................................... 14
2.4.3 Experience ..................................................................................... 14
2.4.4 Conclusion of DDE........................................................................... 14
2.5 Additional relevant f rameworks ............................................................... 16
2.5.1 The 6-11 f ramework ........................................................................ 16
2.5.2 SGDA Framework............................................................................ 18
2.5.3 The Design, Play, and Experience Framework (DPE) .............................. 20
2.5.4 The 4 Fs of Game Design ................................................................. 22
3 Method .................................................................................................. 23
3.1 Overview............................................................................................. 23
3.2 Research strategy ................................................................................. 23
3.2.1 Alternative research strategies .......................................................... 24
3.3 Data collection methods ......................................................................... 24
3.3.1 Interviews ..................................................................................... 25
3.3.2 Documents .................................................................................... 25

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 3.3.3 Alternative data collection methods .................................................... 26
3.4 Data collection in practice ...................................................................... 26
3.5 Data analysis ....................................................................................... 27
3.5.1 Alternative data analysis methods ...................................................... 28
3.6 Data gather ing challenges ...................................................................... 29
3.7 Ethical concerns ................................................................................... 29
4 Findings ................................................................................................ 30
5 Results and discussion......................................................................... 37
5.1 Results ............................................................................................... 37
5.2 Framework .......................................................................................... 37
5.2.1 Upper part of the f ramework - Connection ........................................... 38
5.2.2 Core of the f ramework ..................................................................... 39
5.2.3 Lower part of the f ramework - Goals .................................................. 40
5.2.4 Other results .................................................................................. 40
5.2.5 Contribution to the f ield of game development ..................................... 41
5.3 Discussion ........................................................................................... 41
5.4 Future research .................................................................................... 42
5.5 Conclusion........................................................................................... 43
References ................................................................................................. 44
Appendix A – Informed Consent Form...................................................... 47
Appendix B – Interview Questions ........................................................... 48
Appendix C – Reflection Document - Daniel ............................................. 49
Appendix D – Reflection Document – Yo'Av ............................................. 50

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List of Figures
Figure 1 Depression among teenagers [10]...................................................................................... 3
Figure 2 Educational Game Design Using The 7 Steps for Designing Serious Games Method [16] ..... 6
Figure 3 A Game Design Method for Therapeutic Games [18] ......................................................... 8
Figure 4 Framework for games with mediators [4, pp. 588].............................................................. 9
Figure 5 Example of MDA [2] ..................................................................................................... 10
Figure 6 Example of MDA [23] ................................................................................................... 11
Figure 7 Probability of die rolls for two dies [6] ............................................................................ 12
Figure 8 Theory behind MDA [6]................................................................................................. 12
Figure 9 example of vocabalary for fun in games [6, pp. 2] ............................................................ 13
Figure 10 MDA with designer and player perspective [6, pp. 2] ..................................................... 13
Figure 11The complete DDE framework [5, pp. 40] ...................................................................... 15
Figure 12 Example of The 6-11 framework in use [25, pp. 3]......................................................... 18
Figure 13 SGDA Framework [26, pp. 126] ................................................................................... 19
Figure 14 SGDA Framework version 3 [3, pp. 7] .......................................................................... 20
Figure 15 DPE framework [27, pp. 1014] ..................................................................................... 21
Figure 16 Flow Channel [27, pp. 1017]......................................................................................... 21
Figure 17 The 4 Fs of Game Design framework based on [28, 30] and most common visualizations. 22
Figure 18 Complete list of codes applied across interviews ............................................................ 28
Figure 19 Some of the responses by interviewees regarding the definition of player wellbeing. ........ 31
Figure 20 Some of the responses by interviewees regarding desired effects. .................................... 32
Figure 21 Some of the responses by interviewees regarding undesired effects. ................................ 33
Figure 22 Some of the responses by interviewees regarding game-development models................... 34
Figure 23 Some of the responses by interviewees regarding game-development best practices. ........ 35
Figure 24 Some of the responses by interviewees regarding worst mistakes. ................................... 36
Figure 25 Proposed framework: HbD: Healthier by Design ............................................................ 38
Figure 26 13 UN sustainable development goals [37] .................................................................... 41

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List of Tables
Table 1 A Survey of Frameworks and Game Engines for Serious Game Development [17] ................ 7

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List of Abbreviations
ADHD – Attention Deficit Hyperactivity Disorder
APA – American Psychiatry Association
DDE – Design, Dynamic, Experience
DPE – Design, Play, and Experience
DSM-IV-TR – Diagnostical and Statistical Manual of Mental Disorders (version 4)
DSM-V – Diagnostical and Statistical Manual of Mental Disorders (version 5)
HbD – Healtier by Design
IGD – Internet Gaming Disorder
MDA – Mechanics, Dynamics, Aesthetics
MIT – Massachusetts Institute of Technology
RPG – Role Playing Games
SGDA – Serious Game Design Assessment
UN – United Nations

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1 Introduction
1.1 Background

1.1.1 The research field

Video-game popularity has skyrocketed in the last decade, and in the process has been tremendously
impactful on society [1]. Gaming has become mainstream in the last couple of decades, and nowadays
it is impossible to walk around a major metropolitan area and not have any exposure to video games.
Accessibility of video games has grown dramatically with widespread adoption of personal computers
and smartphones. Such prevalence is not free of consequence, and further research is needed to suggest
how the field can continue to grow responsibly and with a positive impact on society.
The area of video-game research is a fairly recent field of interest, and much still remains unknown. The
field is also quite flexible as video games and related topics change rapidly. For example, streaming
video-game gameplay.
The critique of video games runs the gamut from their negative attributes to the potential the technology
holds for improving various aspects of players’ lives.
Overall, journals that focus on games are filled with interesting new research. Some of that research has,
for example, built different models to describe connection between video games and culture as well as
physical health. There is, however, one field that is not that often represented in major publications and
that is research on mental wellbeing and gaming. This, in its core, connects computer science and
psychology.

1.1.2 Designing and evaluating video games

There are multiple frameworks that help creators design their games. These frameworks vary in
complexity and purpose. Some frameworks are complex and try to help designers to build their game in
the best way possible and to make sure that nothing is left unrefined. Such frameworks are usually
general-purpose ones and help with different steps and decisions to ensure a streamlined process for the
game designers.
Another type of framework is simple, multifunctional frameworks. They help both developers stay on
track, but are also aimed at academics to study and to evaluate games based on a simple framework.
One of the most established examples of this type of framework is the Mechanics, Dynamics, and
Aesthetics framework (MDA) [2]. This is one of the first frameworks developed, and there are many
research articles published using this framework to analyze existing or hypothetical video game.
The third type of frameworks in academic literature is specialized frameworks for designing and
analyzing games. Such frameworks are specialized to a single area that tackles a specific problem or

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focuses on a narrow field within the video-game world. Some of them are examples of frameworks that
support developing and designing educational games. There are also several frameworks that look at
health. These can be frameworks that support developing games that promote healthy habits, such as
walking and being active.

1.1.3 Building frameworks in the field of video games

Frameworks can be used to supplement different activities and processes. In the case of video games,
frameworks are often used to support development, and later, to analyze the game. Frameworks are
appreciated both by game designers and by academic researchers in the field [3, 4, 5, 6]. In the context
of this study, the term “framework” refers to a structure underlying a game-design system or concept in
order to achieve a desired result.
Often is the case that frameworks that get their start in academia stand on the shoulders of previously
established frameworks for developing a newer/specialized version, or to draw inspiration for their new
framework. Examples of these frameworks can be seen as Design, Dynamics, Experience (DDE) or
Serious Game Design Assessment (SGDA) version 3 [3, 4]. DDE was developed as a successor of MDA
[5], while SGDA version 3 is a newer and improved version of the original SGDA [3].

1.2 Introduction to research

1.2.1 The problem

The problem identified with these differing approaches to game development is a research gap in
addressing game development for positive effects on the players’ mental health, and conversely, how to
avoid adverse effects.
The problem arises from the limited research in the field with a focus on video-game design aspects
related to players’ mental health.
Some reliable research has been conducted in the field that has studied the connection between playing
video games and the players’ mental health; however, these studies have mostly focused on the effect
that a specific game has had on players’ mental wellbeing during and after playing the video game [7,
8, 9]. Such studies have not outlined specific design decisions that have led the game to have these
effects on end-user [7, 8]. Additionally, the studies in question have not been intended to be used by
game designers for the purpose of improving the gaming experience in a way that helps players to be in
a good mental state or to benefit their mental health [7, 8].
Conversely, some researchers have focused their work on helping game designers improve their craft to
make better games. Some of these studies have even resulted in various frameworks; however, the
studies that have had this focus have yet to center on helping the players’ mental wellbeing. There
appears to be a research gap surrounding the placement of players’ mental he alth at the forefront, to
design frameworks that would help players mentally, or assist in therapeutic treatments.

2
The problem is relevant because problems with mental health have been on the rise during the past
decade and it should not be ignored. This is illustrated in Figure 1. Meanwhile, we have seen a global
game industry gaining massive popularity. This is not to confuse correlation with causation, but rather
to highlight the potential for games to do good and even change the trend.

Figure 1 Depression among teenagers [10]

1.2.2 The research question

The research question of this project is, “What important success factors are there in a framework for
designing games focusing on mental wellbeing?”
The question arises from the problem and intends to address it directly, by proposing a framework that
could be used by all game designers that want to implement aspects into their game that would help
players’ mental wellbeing. Furthermore, the question seeks to find various success factors that have
worked in producing video games and have had a positive impact on players’ mental health.
In addition to finding the positives, the methodology (as will be discussed in later chapters) of the
research question also explores the factors that have had adverse effects on players’ wellbeing. These
are of importance for video-game designers to avoid while designing games that aim to put players in a
good mental state. It is just as important to avoid damaging aspects as it is to implement successful
aspects when designing this type of game.
In essence, the question seeks to solve the problem by producing a framework to conclude the study. It
does so by finding success factors in designing games with a focus on mental wellbeing, but also by
looking at things to avoid.

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1.2.3 Delimitations

As outlined in the literature, delimitations are critical for defining the borders of research projects, as it
is important to understand what a study is not about, just as it is important to understand what it is about
[2]. This research has several delimitations, which outline the scope of the study.
Firstly, this research takes the perspective of game developers and the way they perceive their own target
audience. Therefore player-perspective is excluded from the scope of the research in the delimitations.
Thus, this research will only focus on the side of the video-game designers and their view on the problem
and solution, while leaving out the viewpoint of video-game players. This defines and narrows the scope
of the data that this research will be based on, providing a more specialized view. This delimitation is
directly linked to the purpose of this study, and is meant to be used by video-game designers. For this
reason, excluding the players’ viewpoint from the data maintains the integrity of the scope of the study.
Therefore, the research takes on the perspective of game designers and developers, who are also the
primary audience to benefit from the resulting framework.
Similarly, views of psychologists have also been deemed to be beyond the scope of this research, as the
goal was to examine the views and practices of game developers, congruent with this study of computer
science.
Secondly, this research does not look at the success rates of games by designers, as this is deemed
beyond the scope of this thesis, due to lack of access to a large sample of established game designers to
observe and study the impact of their games on the players over time. This is a delimitation that emerges
from the researchers of this study and the form of this research. The authors do not have access to large
game development companies and their designers as well as the time necessary to conduct the study
with them. Furthermore, the research is designed to fit the scope suitable for a master’s thesis.
Other delimitations involve aspects that fall outside the realm of video-game design. These include
methods of developing video games and managerial decisions made that are not directly tied to video-
game design.

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2 Earlier research
This chapter examines the literature in the field of game design to connect the dots pertaining to mental
health. In addition, it introduces some topics relevant to this research in a suitable manner, and is
designed to support the research and methodology used in this study.
This chapter relies both on peer-reviewed work, as well as introduces professional books and auxiliary
materials as needed.
Emphasis is placed on existing frameworks that are relevant to building a new framework. Some of
these frameworks will be used later in the research for different purposes including data sources,
inspiration, and data analysis, among others.

2.1 Designing video games

Video games first emerged in the 1950s [12]. At first, video games were not available to the masses,
and were only meant to be played at large universities that had state-of-the-art computers. These games
were designed by students at these universities. Video games did not take off until 1980s when arcade
video games started to gain popularity. The first arcade video games had strong ties to university
computer labs, but lacked meaningful academic research behind it. Developing arcade games was
something that few computer scientists did in their spare time [12].
Concurrently, console and personal computer gaming started gaining popularity and by the late 1990s,
gaming had had a major social impact of bringing young likeminded people together. Games also started
to have their own characteristics, and thus game genres were born.
Some games were labeled as Action, while others were considered to be Sports; however, to keep up
with the popularity of gaming, developers and development teams were needed, and thus game-
developing companies were born. Later on, differentiation among game developers was necessary and
distinct roles emerged: programmers, artists, designers, and producers, to name a few [12].
Presently, a common starting point for designing games is the one-sheet. It outlines the key factors such
as name, target players, and unique selling points. This is followed by the ten-pager, which details and
outlines the core of the game more in depth. This starts to include factors like game flow, characters,
gameplay, and game experience. Afterwards, games move to early development, where game
progression is designed [12].
Many considerations need to be accounted for when designing games. One such consideration is the
game world or space. This is a crucial area as often it takes up a lot of development resources and directly
impacts the gameplay time. It is important to provide a rich and varied experience for players while not
depleting all resources. Other crucial areas include player engagement, game performance and adaptive
difficulty. Researchers have thus proposed using modular design in games to support earlier mentioned
aspects [13].
Other researchers have focused on different factors of game design; for instance, some researchers have
focused on character design in video games [14]. They argue that the success of a game often relies on

5
character design and that character design should be more intimate and intense. They emphasize that
each character has to have its own identity and that players need to be able to present themselves in the
video game [14]
A sizable portion of the game design is focused on the game genre. An example of this is educational
games. A study from 2019 found that games are a great medium for education and knowledge [15].
They designed an investing game with gamification at the center of it. It was a short and casual game
that taught the principles of investing. They found that this type of game for education is both fun and
addictive [15]. There are also other approaches to educational game design. For example, a group of
researchers have developed a 7-step method for game design in education gender [16]. In Figure 2 these
steps are displayed. They have found that using this method to design games has resulted in entertaining
and addictive games for students. It has also lightened the workload on teachers and brought student-
satisfaction up [16].

Figure 2 Educational Game Design Using The 7 Steps for Designing Serious
Games Method [16]

Not all game design aspects are up to the developers. Nowadays, using game engines is exceedingly
popular in mainstream video games; however, game engines often have some limitations that influence
the design decisions of game developers. A paper from 2014 has looked at the use of game engines and
frameworks in serious game development [17]. In their work they have also published a small table that
connects game engines and frameworks. This table can be seen in Table 1 [17].

6
Table 1 A Survey of Frameworks and Game Engines for Serious Game
Development [17]

Researchers in the field of game design have also started looking at the potential of games being
beneficial for mental health or even having a therapeutic side to them. Group of researchers in 2016
have specified overall game design methods to build therapeutic games [18]. They have broadly divided
designing this type of game into three phases [18].
Phase 1: Investigating the problem with health experts
Phase 2: Designing the gameplay
– Step 2.1. Gameplay design and formalization
– Step 2.2. Gameplay prototyping
– Step 2.3. Playtest
Phase 3: Prototyping the therapeutic game
– Step 3.1. Game design
– Step 3.2. Game prototyping
– Step 3.3. Medical validation & playtests
Three phases (long quote) [18, page 4]
They have also tried to display the struggle of this specific type of game design. They have attempted
to map the proverbial sweet spot for gameplay in this field. Figure 3 shows that there is quite a small
gameplay area that needs to be achieved in order for therapeutic games to be successful [18].

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Figure 3 A Game Design Method for Therapeutic Games [18]

2.2 Mental health and wellbeing

There is still much ambiguity surrounding the definitions of wellbeing, mental health, and mental
disorders. This ambiguity is directly addressed in the Diagnostical and Statistical Manual of Mental
Disorders (DSM-IV-TR) [19], as older definitions rely on the juxtaposition of mental disorders as
opposed to physical ones, whereas the trend is to move towards a more holistic view of wellbeing that
encompasses both.
The DSM-IV-TR is the standard widely used by the American Psychiatry Association (APA) for
classifying mental disorders, used for study or treatment of these conditions [19]. It states that some of
the conditions that have been classified in the past as mental disorders have since been reclassified as
symptoms. It furthermore acknowledges, therefore, that even though the definitions are outdated,
surrounding terms are still used, merely because no suitable substitutions have been introduced and
accepted [19].
Due to the ambiguity in the definitions, for the purpose of this research, we will be looking at games
that either aim to improve aspects of the players’ wellbeing, or games that place the value of
entertainment at the forefront, but can also be used in therapeutic settings.

2.2.1 Designing games with mental health in focus

Designing video games with mental health in mind has become an area of interest growing in popularity
in academia. Numerous studies examine games and frameworks of design which aim to make the player
healthier in one way or another; however, there is one very basic framework that can be applied to games

8
for mental wellbeing as a common denominator. The Behavior Change Framework for video games can
be found in Figure 4 [4].

Figure 4 Framework for games with mediators [4, pp. 588]

2.2.2 Video games in therapy

Video games have been used in multiple ways in recent decades. One area in which video games have
become more prominent as a tool is therapy. “Video games can help to motivate patients, develop skills
and serve as a distractor” [20, page 94]. Video games have already been used in physiotherapy,
occupational therapy, and psychotherapy [20]. Another study has found that using certain online video
games could help with Attention Deficit Hyperactivity Disorder (ADHD), anxiety , and autism [21].
These are all profoundly serious areas and show just the potential that games have for alleviating some
of the conditions related to mental health.
An example of this has been the use of Wii sports games for therapeutic purposes [20]. This has been
described as a low-cost and commercially viable way of designing and developing games that support
wellbeing [20]. Xbox and PlayStation have yielded similar findings [20].

2.2.3 Video game playing and mental health

Several studies look at mental health and playing video games. One such study examines the effect of
intensity of video game playing and mental health in connection to sleeping quality [22]. They have
pointed out that video-game addiction is a relevant topic in modern academia. Furthermore, “DSM-V
added the Internet Gaming Disorder (IGD) as a non-substance addiction in its third section. It defined
the main symptoms and classified it as requiring further research ” [22, pp. 487]. This study also
mentions the importance of game design to society as 88% of American teenagers have indicated that
they play video games regularly; however, the study has found negative effects on players’ sleeping
patterns and quality when playing too much video games. More precisely, they state that “mental health

9
represents a protective factor for sleep quality, while intensity of video game playing represents a risk
factor” [22, pp. 491]. This shows how crucial some design factors, such as limiting addictiveness, could
be beneficial for a player’s mental health.

2.3 Mechanics, Dynamics, and Aesthetics

(MDA)

The MDA framework has been one of the most popular model used to design computer and video games
[5]. It was introduced in the early 2000s by Hunicke et al. [6]. The goal was to “clarify and strengthen
the iterative processes of developers, scholars and researchers alike, making it easier for all parties to
decompose, study and design a broad class of game designs and game artifacts” [6, pp. 1]. This approach
has focused on bringing out fundamental approaches to game design and how different parts work and
function together. MDA consists of three main sections: Mechanics, Dynamics, and Aesthetics [5].
There are two ways of looking at MDA. Firstly, looking at three parts that all need to be working in
perfect harmony [2]. This is where mechanics dictates most of the development and it can be visualized
in Figure 5. Secondly, MDA could be looked at as having three main sections that are dependent on
each other [23]. Different steps are taken in a certain order, and this can be seen in Figures 5 and 6.
Furthermore, different sections of the framework are associated with separate roles [23]: Mechanics is
mostly associated with programmers; Dynamics is mostly associated with game designers; and
Aesthetics are associated mostly with artists.

Figure 5 Example of MDA [2]

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Figure 6 Example of MDA [23]
Although MDA is a rather old framework, it is still in use. Nonetheless, as time has passed, different
interpolations of it have emerged. They all have similar basics, but the way they are applied is different.
Therefore, looking at the individual sections of the framework is necessary to understand the framework
and its intentions.

2.3.1 Mechanics

Mechanics is the core section of this framework. “Mechanics are the various actions, behaviors and
control mechanisms afforded to the player within a game context. Together with the game’s content
(levels, assets, etc.) the mechanics support overall gameplay dynamics” [6].
A good explanation for this is comparison to a typical card game: shuffling, trick-taking, and betting
can all be described as core mechanics of card games [6]; however, Mechanics in the MDA framework
are even more than that. This section gives the base to build on.

2.3.2 Dynamics
One way to look at Dynamic section is as “dynamics work to create aesthetic experiences. For example,
challenge is created by things like time pressure and opponent play” [6, pp. 3]. Notwithstanding, it
could be a section where Mechanics are refined by game designers [23]. Either way this section is a
bridge between the Mechanics section and the Aesthetic section. A simple example from real world
dynamics is die-rolls. A game can have one, two, or even more dice. This changes the game dynamics
greatly, Dice also bring in a dynamic by themselves. One die has 6 sides, which all have the same
likelihood of coming up when die is rolled. With two dice, the dynamic is different as can be seen in
Figure 7 [6].

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Figure 7 Probability of die rolls for two dies [6]

2.3.3 Aesthetics

Aesthetics are a vital part of any game development. It makes a vast difference to the player. It can be
argued that it is what makes game “fun” [6]. Mostly aesthetic section focuses on final development part
of game. It makes the game look ready and fully refined. This could be seen in Figure 8.

Figure 8 Theory behind MDA [6]

Some researchers have also pointed out “How do we know a specific type of fun when we see it? Talking
about games and play is hard because the vocabulary we use is relatively limited” [6, pp. 2]. They have
outlined the taxonomy in their study displayed in Figure 9 [6]. This, combined with designer and player
perspective from the MDA perspective in Figure 10, makes a good argument to focus a lot on aesthetics
on a game [6].

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Figure 9 example of vocabalary for fun in games [6, pp. 2]

Figure 10 MDA with designer and player perspective [6, pp. 2]

2.3.4 Complete MDA

“Mechanics describes the particular components of the game, at the level of data representation and
algorithms. Dynamics describes the run-time behavior of the mechanics acting on player inputs and each
other’s outputs over time. Aesthetics describes the desirable emotional responses evoked in the player,
when she interacts with the game system” [6]. There is an underlying connection between all three
sections that has kept this framework more or less relevant over twenty years. Many successful games
have been built with the help of MDA, most famously Minecraft [24].

2.4 Design, Dynamics, Experience (DDE)

The Design, Dynamics, Experience (DDE) framework was developed as an improvement of the MDA
framework [5]. DDE is aimed at establishing a framework for designing computer and video games. At
its core, it is similar to MDA and has three main parts: the Design section sets the blueprint; the
mechanics; and the interface [5]. It connects to the player by intellectual analysis and to the designer by
giving them full and direct control.
Secondly, the Dynamics section sets out connections between players and game in different
configurations. This step also gives full control to the designer, but does so indirectly by using rules.
Lastly, the Experience section combines senses, cerebellum, and cerebrum to end up with player-subject.
Furthermore, it introduces perception; arguably one of the most important parts of DDE. Due to the
informative nature of games, the designer loses full control in the experience section [5].

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2.4.1 Design

The Design section of DDE dissolved mechanics of MDA such as game code, game rules, and style into
three major parts with a new approach to them. Firstly, the blueprint has three parts to it, starting with
World Description. In a World Description game, world and interface rules are developed as well as
societies, characters, flora, and fauna [5].
Design is essentially the Mechanics portion of the MDA model, and it acknowledges that designers do
not have full control over all aspects of the end-result, but rather can commission changes that will affect
these assets [5].

2.4.2 Dynamics
The Dynamics portion of the DDE model refers to the way the individual parts respond to and interact
with each other. In theory, these are still affected by the designer’s will; however, the very name
“Dynamics” inherently accounts for some level of uncertainty [5].

2.4.3 Experience
The Experience is all-encompassing and concurrent with the Design and Dynamics of the game – it is
merely seen from the perspective of the player: from the moment of learning of the game, through the
contemplation of buying it, downloading/installing it, to the act of playing it [5].

2.4.4 Conclusion of DDE

Design, Dynamics, and Experience come together as an improved framework based on MDA. It
manages to “overcome several weaknesses of the well-established MDA framework. The subcategories
of the DDE framework, which in turn formed the three new main categories, are based on what needs
to be produced during the design and development of a computer or video game as well as what the role
of any produced asset will be during the production process or game experience” [5, page 42]. Detailed
below is the complete DDE framework in Figure 11.

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Figure 11The complete DDE framework [5, pp. 40]

15
2.5 Additional relevant frameworks

2.5.1 The 6-11 framework

The 6-11 framework is used for both analyzing games academically as well as to develop games. It is
rooted in MDA and was proposed in the early 2010s [25]. “The 6-11 Framework proposes that games
can be so engaging on a subconscious level because they successfully rely on a subset of basic emotions
and instincts which are common and deeply rooted into all of us. Specifically, the framework focuses
on six emotions and eleven instincts that are recurrent in psychology and widely analyzed in a number
of well-known treatises” [25, pp. 1].
Six emotions that are at the core of the framework according to R. Dillon [25] are:
• Fear: one of the most common emotions in games nowadays. Thanks to the newest
• technologies, it is now possible to represent realistic environments and situations where fear
can easily be triggered: think of all the recent survival horror games or dungeon explorations
in RPG games for plenty of examples.
• Anger: A powerful emotion that is often used as a motivational factor to play again or to
advance in the story to correct any wrongs that some bad guy did.
• Joy / Happiness: Arguably, one of the most relevant emotions for having a fun gaming
experience. Usually this is a consequence of the player succeeding in some task and being
rewarded by means of power ups, story advancements and so on.
• Pride: rewarding players and making them feel good for their achievements is an important
motivational factor for pushing them to improve further and advance in the game to face even
more difficult challenges.
• Sadness: Despite being an emotion that doesn’t seem to match with the concept of “fun”,
game designers have always been attracted by it as a way to reach new artistic heights and
touch more complex and mature themes.
• Excitement: most games worth playing should achieve this and it should happen naturally as a
consequence of successfully triggering other emotions and/or instincts.
List as a long quote [25, pp. 2]
Similarly, the eleven instincts are [25]:
• Survival (Fight or Flight): the most fundamental and primordial of all instincts, triggered
when we, like any other living being, are faced with a life threat. According to the situation,
our brain will instantly decide whether we should face the threat and fight for our life or try to
avoid it by finding a possible way of escaping. This is widely used in many modern video
games.
• Self Identification: people tend to admire successful individuals or smart fictional characters
and naturally start to imagine of being like their models.
• Collecting: a very strong instinct that can link to a variety of different emotions and it has
always been widely used in games.

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 • Greed: often we are prone to go beyond a simple “collection” and start amass much more
than actually needed just for the sake of it. Whether we are talking about real valuable items
or just goods and resources we need to build our virtual empire in a strategy game, a greedy
instinct is likely to surface very early in our gaming habits.
• Protection / Care / Nurture: arguably the “best” instinct of all: the one that pushes every
parent to love their children and every person to feel the impulse for caring and helping these
in need.
• Aggressiveness: the other side of the coin, usually leading to violence when coupled with
greed or anger. It is exploited in countless of games.
• Revenge: another powerful instinct that can act as a motivational force and is often used in
games to advance the storyline or justify why we need to annihilate some bad guy.
• Competition: deeply linked with the social aspects of our psyche and one of most important
instinct in relation to gaming, e.g. leaderboards. Without it, games would lose much of their
appeal.
• Communication: the need for expressing ideas, thoughts, or just gossip, was one of the most
influential for human evolution and it can be used to great effect in games too, while seeking
information by talking to a non-playing character (NPC) or while sharing experiences with
other players in chatrooms and forums.
• Exploration / Curiosity: all human discoveries, whether of a scientific or geographical nature,
have been made thanks to these instincts that always pushed us towards the unknown.
• Color Appreciation: scenes and environments full of vibrant colors naturally attract us,
including the more and more detailed and colorful graphics we see in modern games.
List as a long quote [25, pp. 2-3]
Sometimes it is difficult to analyze games from different perspectives; however, a useful way of
analyzing is also to combine different frameworks. This is displayed in Figure 12 [25]. In this case MDA
and 6-11 frameworks are combined to analyze hypothetical action-adventure game.

17
Figure 12 Example of The 6-11 framework in use [25, pp. 3]

2.5.2 SGDA Framework

This framework was developed in the Massachusetts Institute of Technology (MIT) and is focused on
six different areas [26]. The six areas can be seen in Figure 13 [26]. Firstly, purpose is at the center of
this framework. There is much emphasis on it. The authors of this framework have noted that analyzing
“game design starts with the investigation of the game’s purpose to impact its players” [26, pp. 126].
There are two main concepts behind the purpose: aim and impact. The other five areas of this framework
are content & information, game mechanics, fiction & narrative, aesthetics & graphics, framing,
coherence & cohesiveness of the game system.

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Figure 13 SGDA Framework [26, pp. 126]
This framework has also evolved and currently there are three versions of SGDA framework, this is
displayed on Figure 14 [3]. This is thanks to multiple research groups using it and adding their input to
the framework. This framework is useful mainly because of its core [3]. Purpose, aim, and impact are
often of interest to academic studies. Therefore, any version of this framework is a valuable tool for
analysis.

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Figure 14 SGDA Framework version 3 [3, pp. 7]

2.5.3 The Design, Play, and Experience Framework (DPE)

This is another framework inspired by MDA. Similarly, it has three sections to it. These are: design,
play, and experience [27]. It also has proposed interactive design process [27]. Both are displayed in
Figure 15. It seeks to connect designers and players [27]. It does so in an interactive way that sends
feedback from players to designers, who can implement changes based on the feedback in a process that
includes design and prototype.

20
Figure 15 DPE framework [27, pp. 1014]
One of the greatest advantages of using the DPE framework is to finetune different things related to the
game; for example, balancing the level of difficulty [27]. There needs to be a balance between level of
difficulty and player skill. Neither of these two is constant. Therefore, a flow channel needs to be formed
[27]. This process is displayed in Figure 16. Another example could be balancing the frequency of
rewards or progression [27].

Figure 16 Flow Channel [27, pp. 1017]

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2.5.4 The 4 Fs of Game Design

This framework, or method, represents a simple philosophy of game design. It suggests to fail faster and
follow the fun [28]. This is a framework that is not used in academia, but is referred to within the game
development industry itself. Its most notable advantage is its simplicity and focus on player. At its core,
it suggests three steps that are in a loop and between them are two philosophies [28]. This is represented
in Figure 17.

Figure 17 The 4 Fs of Game Design framework based on [28, 30] and most
common visualizations.
This framework has three steps; however, more importantly, it has two connections between steps that
are at the core of this method [28]. Fail Faster stands between Testing and Analyzing. It represents fast
development and testing. This is similar in nature to development practices and frequent playtesting
outlined in Tracy Fullerton’s book on game design [29]. There is no need to refine things that might not
even end up in the next version of the game. Similarly, Follow the Fun stands between Analyze and
Revise. This step is important to generate new ideas and to find what is considered “fun” and to represent
the goal of the game. The concept of fun is previously explained in the MDA chapter as a more complex
collection of terms representing the idea of fun [6].
This framework has also seen use in management case studies involving Ubisoft [30]. In this case the 4
Fs was able to solve many problems as “Ubisoft Montréal’s studio was able to respond to a major crisis:
the cancellation of the production of a blockbuster (a game with a sales potential of more than 5 million
units) due to a lack of originality and strategic differentiation” [30, pp. 95]. Ubisoft management was
able to bring in the simple framework and implement it in a game design progress that resulted in fast
development and a game that was judged to be “fun.”
Frameworks outlined in this chapter are used as data for document research as well as other parts of this
research. This is crucial to build a new framework with a focus on mental wellbeing.

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3 Method
3.1 Overview

In this chapter, we will explain the thought process (and elimination) that we have followed to arrive at
our chosen research strategy of multimethod qualitative research, and data collection methods of
document analysis and interview.
We will also walk through the selection criteria for a strategy and explain why some alternatives were
ruled out.
We will proceed to discuss the data analysis process itself, and ultimately address ethical concerns we
faced and the actions we took to mitigate them.

3.2 Research strategy

Choosing an appropriate research strategy is crucial for a high-quality study. A strategy is deemed
appropriate if it is suitable, feasible, and ethical regarding the subject matter of the study [31].
The authors of this study have chosen to use multimethod qualitative approach as primary research
strategy [32]. This strategy has afforded the authors the freedom needed to conduct this social science
research, while also setting necessary boundaries and clear objectives.
Multimethod qualitative approach is a lesser-known strategy that greatly helps to conduct certain studies.
Not to be confused with the mixed-method strategy, which will be elaborated on in the next section, the
main benefit of the multimethod strategy is that it allows the use of two or more qualitative methods
under one study. Most strategies only have room for one method of research apart from mixed methods;
however, none of them are so versatile as multimethod approach for a qualitative study.
Multimethod qualitative approach is described as appropriate strategy to be used when the study includes
two or more sources of qualitative data and does not include quantitative data [32]. A common practice
in using multimethod qualitative research is combining open-ended interviews with one or two other
sources of qualitative data [32]. This often includes either observation or document research [32].
Multimethod qualitative approach in many cases has a main method of collecting data and then another
method that compliments the main method [32]. For example, often interviews are the main source of
data, but they are complemented by document data in the form of pictures. This could be very useful as
oral and visual data often supplement each other to get the a broader overview. Another example of
combining interviews and documents is when documents bring the overall information to the study, but
interview provides the situational insight [32].
Suitability was met by the appropriateness of the data collected from the research-document review and
the interviews with game designers; feasibility was determined by the access to previously published
research and availability of relevant interview participants; and ethical considerations were addressed
by our comprehensive consent form, to accommodate for the needs of various participants and scenarios.

23
3.2.1 Alternative research strategies

Several strategies were considered for this study. All of them had some merit, but they were ultimately
ruled out for different reasons. Most of them did not offer research strategy that would be flexible enough
to incorporate planned research methods under the strategy.
A case-study approach [31] was initially considered. This would have allowed the researchers to track
the considerations that go into designing video game in real time. Although it would have offered an in-
depth view into the process, it would have been lacking in diversity of voices and opinions needed for
the desired outcome of this project, which is a new best-practices framework, thus adversely affecting
the generalizability of our findings [31]. Another aspect that was lacking was the flexibility to use data
from outside of the case-study. This would greatly limit the reach of this study to things that are relevant
pertaining to the study of success factors that could be in a framework for designing games focusing on
mental wellbeing. Therefore, this strategy was abandoned.
Next, a grounded theory strategy was considered, as it fits small-scale exploratory social research [31].
Although it is recognized as an appropriate approach for small-scale qualitative research, the notion of
positivism, meaning that if the theory flows from the data, it is not open to interpretation [31] seemed
too restrictive for a subject as layered and nuanced as players’ wellbeing. It would not have allowed for
the use all of the data-collection methods at our disposal, and would have forced a research method
deemed less than optimal.
To maintain a level of flexibility, a mixed-methods approach seemed tempting; however, it was not a
suitable fit for two main reasons: firstly, it required a combination of both quantitative and qualitative
methods, and secondly, it called for a distinctive link between two or more methods that would otherwise
collide [31]. This research could use mixed methods strategy if the study were comprised of other
components and brought in methods that supplied quantitative data; however, that was not the case.
Therefore, the strategy of mixed-methods was not used, since this research is solely based on qualitative
data, and does not rely on otherwise-clashing methods.

3.3 Data collection methods

Data collection method is of utmost importance to any social science study as it is at the core of the
study. Data quality and the amount of valuable data is often tied to the method used in the study. There
are not many different methods of collecting data in a social science study, but results can vary vastly,
as analysis of different methods can lead to different conclusions.

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3.3.1 Interviews

Interviews are a versatile method of collecting data. It offers flexibility in collecting different types of
answers and they rely on a simple, yet effective and established way of collecting data. Interviews can
be conducted in three formats: structured (with pre-determined questions), semi-structured (with some
pre-determined questions, leaving room for the interviewee to elaborate or propose their own
conversation topics), and unstructured (only presenting the overall topic to the interviewee before the
beginning of the conversation) [34].
Semi-structured interviews were ideal for this type of data collection, because we wanted to allow the
interviewees sufficient space to develop their answers and ideas, while also maintaining clear reference
points (in the form of the questions) that are identical in all interviews. The interview questions and a
sample informed consent form are included in appendices to this research.
Interviews were conducted remotely for several reasons: Firstly, it allowed for greater flexibility in
identifying potential participants in the research, eliminating the concern of their physical whereabouts.
Secondly, with Covid-19 remaining a threat, remote interviews allowed us to adhere to safety protocols
to protect the participants, as well as ourselves. Furthermore, some of the interviews were held via the
teleconferencing application Zoom, which allowed for screen recording during the session, while other
interviews were conducted via written correspondence. Both mediums lent themselves to data
processing and analysis, as will later be described.
For the purpose of this research, we have conducted interviews game-development professionals, and
gathered additional information from them about the types of models and frameworks they gravitated
towards, to examine whether and how theory and practice aligned.
An additional aspect considered for the interviews was to speak with professionals and academics in the
field of psychology; however, it was deemed beyond the scope and resources of the authors for the
purpose of this particular study, and therefore – unfeasible.

3.3.2 Documents

Documents can be overlooked as means of collecting data in a social science study. Documents come
in many different formats and can be analyzed in a multitude of ways. Documents have been used in
many studies with great success and are well established way of collecting data in the social sciences
field. Documents works well as a supplemental method, as it could be used either before or after other
methods to provide context and add depth to the study.
Therefore, in addition to interviews, and congruent with the multimethod approach, the complementary
method of this study is analysis of documents published in conferences and academic journals, to
combine the knowledge of what has been done in the field of game development with mental wellbeing;
to aggregate best practices and potential pitfalls; and to synthesize with real-world voices [11]
complemented by the interviews. This allows the researchers to approach the study from another angle
that is more meaningful and hopefully results in higher-quality research that opens the door to other
similar studies in the field.

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3.3.3 Alternative data collection methods

The first alternative data collection method that was eliminated was questionnaires. The main reason for
that was that it provided data that did not support the overall research of this study. Secondly,
questionnaires mostly provide quantitative data, which did not suit the multimethod qualitative strategy
used in this study [32]. There are ways that questionnaire could also provide qualitative data; however,
interviews could provide deeper and more detailed insights.
Another contender was the method of focus group [31], in which participants would have engaged in a
topical discussion in a manner similar to a natural conversation [33]. The benefit of using a focus group
is that much data can be collected with just one or two focus group meetings; however, it also has
downsides. Firstly, not all participants contribute much input in this setting. This could be for many
reasons, including participant personality and having other more senior experts present in the session.
Secondly, focus groups may have a slight peer pressure and this might influence the outcome of the
study, in that some participants may be reluctant to share views differing to the ones previously shared
by other, more dominant members of the group. Overall, the positives and negatives were closely
weighed when analyzing focus group compared to interviews. Ultimately, it was decided that the group
setting might cause participants to limit their answers if exposed to opposing opinions, therefore, one-
on-one interviews appeared more appropriate [31].
Another method considered was a combination of strategy and method that performs a deep-literature
analysis; however, as there was not much literature in this specific area of research interest, it was
deemed an unfeasible option.

3.4 Data collection in practice

The documents for this research were curated initially by searching the catalogs of the Stockholm
University Library and Google Scholar, and additions were made through the references listed in these
texts, as well as when a new concept would be introduced in the process of an interview, which require
further investigation.
The preliminary search queries consisted of various combinations of the following terms: “game
development,” “game design,” “wellness,” “mental wellbeing,” and “framework.” The objective was to
first find published texts that addressed both the game itself and the mental state of its target audience,
and then we could move to more targeted searches on either side; for example, as a commonly accepted
industry standard, citing the DSM for matters regarding mental wellbeing was a clear choice.
Additionally, several frameworks surfaced both in the context of academic discussions, as well as in
interviews, which meant we could narrow our search to find the proper citations for them.
The interviews took place over the course of March and April 2022. We used a multitude of platforms
to find appropriate participants: some were introduced to us via mutual acquaintances, while others we
sought by posting on social media, searching for developers on hubs such as Steam and Discord, and
emailing developers and gaming companies directly. Therefore, our sampling pool was initially one of
convenience – with by reaching out to developers within our network to make introductions [31], and
later purposive – by targeting participants based on criteria relevant to the study [31].

26
Ultimately, we interviewed thirteen game developers and designers hailing from the US and varied
countries across Europe. Their levels of education and experience differed, but their common
denominator was that their games were developed independently or in small teams.
Due to logistical constraints, some of the interviews were conducted via teleconferencing (Zoom calls),
and others via email.
When we presented our research to the participants, we broadened the scope to include both games
specifically designed to improve the wellbeing of the players, as well as games with mainstream appeal
that also contributed to players’ improved wellbeing.
Each participant was presented with a consent form, which they voluntarily signed and returned to us
ahead of their respective interview. The consent form can be found in Appendix A.
Teleconferencing interviews ranged from thirty to forty-five minutes each, and were guided by a script
through which we introduced the research and the fixed questions. The interviews took more of a
conversational tone during follow-up questions and other points the participants elaborated on; however,
the script served as a point of reference to the overall structure that was designed for all interviews. The
questions can be found in Appendix B.

3.5 Data analysis

Data analysis is an important part of any study. As this study was conducted over a fixed period of time,
and was intended to shine a light on game development in practice, the nature of this data analysis is
inductive – meaning, aiming to generalize conclusions from topical observations [19].
As mentioned in the previous section, the data sample consists of thirteen interviews, conducted over
the course of March-April 2022.
Some of the interviews were held virtually via the teleconferencing platform Zoom, and some were
conducted in writing alone.
As the interviews were semi-structured, each participant was afforded the option to go off-script if they
wanted to, while maintaining some identical themes across all interviews.
The analysis itself was done by means of the software ATLAS.ti for its interview-transcription
synchronization and data-labeling abilities.
To keep the original files safe, they were separated from the working copies. Video files were then
processed and transcribed in Word, and then linked and synchronized in ATLAS.ti.
Below are some of the codes (in alphabetical order) used to find common themes across all interviews,
corresponding with the interview questions:
• Approach – how mental health is addressed in the process of creating a game.
• Best practices – for creating a game, considering players’ wellbeing.
• Desired effects – to promote a healthier mindset in the players.

27
 • Game-design models – whether the developers used an academic or industry-standard model
for developing games.
• Undesired effects – things that should not be in the final product.
• Worst mistakes – teachable moments.
Although additional codes were applied, not all of them connected the thread among the interviews, so
the above-mentioned proved to be the most consistent.

Figure 18 Complete list of codes applied across interviews

3.5.1 Alternative data analysis methods

Alternative modes of data analysis mostly in the form of various software products. Software services
that focused on quantitative analysis were excluded immediately, and some qualitative software did not

28
meet our needs of synching video interviews with transcripts, into addition to combining written
interviews.
We had had positive experience with ATLAS.ti from previous research work, and opted to continue
using it for this study, as well.

3.6 Data gathering challenges

The main challenges of gathering data in this study are tied to the main method used for this research.
The interview method requires to have a selection domain experts participate in the study in order to
reach data saturation; however, many mainstream game development companies have a long and
bureaucratic process set out in order to participate in any academic study. Therefore, we sought
independent developers and smaller-scale gaming studios. Both groups got represented in this study.
Firstly, reaching out via social media and other readily accessible channels yielded some results, but
was not sufficient. As we progressed, we cast a wider net and reached out to developers via direct emails
and targeting designated developer hubs on Discord and Steam. While we got ultimately obtained the
response we had hoped for in the amount of time at our disposal, and even reached some data saturation,
this was no easy feat to accomplish.

3.7 Ethical concerns

This research was carefully designed to avoid ethical issues. For starters, it builds on and cites multiple
peer-reviewed studies that have been published and have been held to the same rigorous standards of
academic writing.
As for our own findings for this study, we have chosen to delimit the perspective of the players, which
inherently mitigates the risk of unduly exposing mental and other medical conditions of individuals.
Instead, we have opted to focus on game designers and how their experience has shaped their work-
practice. For this purpose, we have crafted an extensive consent form (attached as Appendix A), which
covers multiple scenarios and needs of each participant:
1. Participants’ contributions may be anonymized upon request, but it can appear in more detail (as
some developers may benefit from this platform to share their new findings and breakthroughs);
2. The interview will be recorded for purposes of data analysis and future reference;
3. In case any visual aspects of the interview become relevant in the final form of this thesis,
participants will be asked directly to approve the screenshot or video snippet.

29
4 Findings
The thirteen participants come from a variety of backgrounds, including countries (although all
participants interviewed from Europe or the United States), level of education, and specialty in video-
game design.
In order to align with the interviewees, after a short series of introductory questions, we wanted to get
their own perspective of player-wellbeing. Results overlapped to an extent, but were rarely identical:
• The game should not be too addictive.
• The game should be experienced like a piece of art.
• The game should be fun.
• Creating a sense of escapism.
• Lack of exposure to violence or discomfort.
Interestingly, one developer framed the caring for the player’s wellbeing in the form of the question,
“how much do we want to punish the player?” meaning, how much of a setback should the player
experience for not playing as expected?
Another developer offered a broader definition of wellbeing, as the “absence of anxiety, depression, or
fear, and often the inclusion of enjoyment and engagement. If not pure joy, at least contentment or
interest.”

30
Figure 19 Some of the responses by interviewees regarding the definition of
player wellbeing.

Flowing from that, we discussed desired and undesired effects games on players’ wellbeing in order to
see what the perception in the previous question could look like in practice. The responses regarding the
desired effects began overlap and saturate more:
• The game should be fun.
• The game should be entertaining.
• The game should create a cinematic experience.
• The game should provide a social experience when playing with a friend.
One developer emphasized the importance of the game creating a unique experience for the player
through setting and storytelling, while another aimed for the player to recognize the humanity of the
characters in the game, to strengthen empathy.

31
Figure 20 Some of the responses by interviewees regarding desired effects.

The undesired effects virtually serve as a mirror image of the previous question:
• The game should not offend or traumatize the player.
• The player should not feel like their actions do not matter.
• The player should not feel helpless.
• The player should not feel confused or frustrated.
• The player should not get bored or be ahead of the plot.

32
Figure 21 Some of the responses by interviewees regarding undesired
effects.

The question about game-design models yielded three main approaches:

• Developers that studied game development, but without much emphasis on player wellbeing,
were either not aware of existing models, or tried to emulate what they liked about other games.
• One developer described his approach as playing the game himself to see if it had achieved the
desired effect.
• Developers that considered both the game and players’ wellbeing, used more technical terms in
their responses, as well:
o One developer described her approach as eudemonic hedonic, in that “the gameplay
makes you feel good, but something else about the game helps you either cope with
negative emotion or helps you feel like you can handle it better.” The game is meant to
make the player feel better, but not because of instant-gratification entertainment, but
through completing tasks within the game that serve a larger purpose.
o Another developer referred to Follow the Fun [28] as his guiding principle.

33
Figure 22 Some of the responses by interviewees regarding game-
development models.

Next, we gathered some of the best practices they could volunteer about their work process:
• Care about and prioritize the player.
• Research and documentation.
• Maintain communication with team/collaborators.
• Solicit feedback along the way.
• Constantly conduct testing.
To highlight importance, it interesting to see how many times some of the keywords or concepts were
used:
Communication (2); Meetings (2); Team (3); and Feedback (4).
One developer even pointed out that to avoid the negative impact in -app purchases may have on the
target audience (young players, as well as their parents that pay for the game), they prefer to p rice their
game lower, but ensuring the player does not have to pay for anything extra once the game has been
purchased.

34
Figure 23 Some of the responses by interviewees regarding game-
development best practices.

Lastly, we asked about which are the worst mistakes that they have either made or witnessed. The
purpose of this question was to turn these events to teachable moments and help developers avoid such
mistakes in the future:
• Miscommunication and misalignment with the team.
• Poor planning.
• Copying other games.
• Not providing added-value to the player.
• Forcing the user to make in-app purchases for rig the game with a “pay-to-win" mentality.
• Bombarding the player with ads and banners.
One developer shared an anecdote about a mistake regarding giving a character a name of the opposite
gender, to highlight the importance of being culturally of the audience of the game. This can be achieved

35
by seeking multiple sources during the research, but also soliciting feedback from people from that
culture.

Similar concepts appear multiple times here:

Team (2) and Mis/communication (3)

Figure 24 Some of the responses by interviewees regarding worst mistakes.

In the next chapter we will tie these findings to the existing frameworks previously reviewed, and
propose our own.

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5 Results and discussion
5.1 Results

After gathering data from interviews and documents, data was analyzed in order to develop a framework
as the main answer to the research question; however, some results will be outlined in this subchapter
to provide more complete overview. This includes saturated results and quotes from participants.
Firstly, from outside the game design, different results linked to teamwork and management.
Communication within the team was mentioned multiple times, mainly from the aspect of
communicating often and between different design teams is crucial for successful game development.
Designers explained that poor communication can lead to inefficient and may hinder development. An
example of this is when a character designer spends weeks on designing a new character that the
narrative team has already eliminated from the game. Also, multiple participants noted that their teams
had not met as much as they would have liked to. From the management perspective, some participants
complained of hiring or having teammates who were not motivated or do not have the correct skills.
There were also results connected to defining mental wellbeing for player. Many participants outlined
the need for positive feelings. Some of the examples of that are enjoyment, fun, and inclusion. Some
designers also pointed out the feelings to avoid in order to have a positive effect on the player, these are
for example avoiding confusion and helplessness.
Other findings are outlined in greater detail in the proposed framework and can be found in the
framework subchapter.

5.2 Framework
The research question, “What important success factors are there in a framework for designing games
focusing on mental wellbeing?” lends itself to the following proposed framework, which the authors
present as Healthier by Design (HbD).
The answer to the research question is thus combined with other relevant findings to form the HbD
framework that is displayed and explained in this chapter
Data collected and analyzed in this paper combined with previous research in the field were combined
to form the new framework, which is displayed the Figure 25. HbD is built on an established route of
forming new frameworks based on existing ones [3, 5, 25, 27].

37
Figure 25 Proposed framework: HbD: Healthier by Design

5.2.1 Upper part of the framework - Connection

The upper part of the HbD framework is tied to existing game design frameworks. The two that are most
compatible with this framework are MDA and DDE [5, 6]. The reason for choosing these two to be most
compatible is simple, these two are the most cited framework and they have been of inspiration for this
framework. They are also universally accepted for both designing games as well as to analy ze the games
[5, 6, 23].
Alternatively, any other framework could be used as a base framework to design the game, if it is
universal and follows an established route with steps or stages. One of these frameworks is for example
the DPE framework [27]. It uses simple steps that are compatible with proposed framework. It is also
somewhat established and known [35].

38
5.2.2 Core of the framework

This part sets out to define steps and loop between these steps as can be seen at the center of Figure 25.
It also has two entities: Designer and Player. For both entities there are also two questions that keep the
project on track to its goal. Additionally, it sets out an aim and impact.
Firstly, the Design step is set out to be where design decisions are made. This step is inspired by DDE
and DPE [5, 27]. In the case of DDE, it is more of a section of the framework rather than a standalone;
however, the parts of the section also applies to our proposed design step. Furthermore, DPE has inspired
us to make this a step in a loop rather than to have it as a full section of framework.
Secondly, the prototype step is where development of a new prototype takes place, it accounts for the
decisions made in the Design step and applies them to the prototype in a way that improves playing
experience. This occurs while the aim of the developers is kept in mind. This step is inspired by DPE
[27]. It is mainly because the Prototyping section or step is not popular among other frameworks that
have been analyzed; however, our gathered data shows that it is a step that many designers take.
Prototyping is important to get something ready for the next step.
Thirdly, Test step is crucial to collect data from player side. This step is of utmost importance for the
HbD framework to function properly. It can be implemented in multiple ways, the ones that were
outlined in our collected data are by conducting playtests, interviews, focus groups, and feedback
collection. This step is also linked to The 4 Fs of Game Design and DPE [27, 28, 30]. This is shown to
be an important step in both of these frameworks, and our data has also suggested that this is one of the
most crucial steps along the way. Designers often have different opinions compared to regular players,
and therefore might develop the game in a way that is not optimal for the player.
Lastly, analyzing the data from the Test step is the only way to get valuable information from the
previous step. In this step, the designer should look for data that can improve the playing experience,
and potentially eliminate negative experience triggers. The 4 Fs of Game Design is one of the
inspirations for this step, but it is universally accepted that testing games should be followed by
analyzing the data gathered [28, 30]. Otherwise, that same mistakes could be made, and improving the
game will be difficult. This step should be followed by another iteration of the Design step to keep the
loop going. This loop is important to constantly improve the game.
Then there are two things that fall under the overall purpose of the game. These are aim and impact,
both are inspired by SGDA Framework [3, 25]. Firstly, the aim of the HbD framework is to look at the
side of the developer and is connected to two questions: “Does this game achieve the aim of the
developer?” and “How can this game be improved in order to move closer to the aim?”
Developers and players might not always be on the same page, and therefore it is important to separate
a part to focus more on the developers’ aim. For example, developers’ aim could be to build a
commercially viable game; however, players might not benefit from it at all. On the other hand, the
impact is directly aimed at players and represents the impact that the game will have on a player.
Questions that rise are “Does this game impact player in a positive way?” and “How can this game be
improved to have a more meaningful impact?” Both questions are implemented in order to support the
game development in a direction that looks out for players wellbeing.
At the core part of the HbD framework are only two entities: Designer and Player. This is inspired by
MDA, DDE, and DPE [5, 6, 27]. This research is limited in its scope to the designer side; however, the

39
data and previous research have both shown how important it is to solicit input from the player side to
the development of a game.
Overall, the core part of the HbD framework includes the process of developing games while considering
players wellbeing. It is inspired by most popular frameworks and designed with the support of the data
collected over the course of this study from many game designers.

5.2.3 Lower part of the framework - Goals

The Lower part of the framework is divided into two sections. This is something that falls outside of the
interest of other frameworks discussed in this paper; however, it is imperative to achieve great results in
developing a game that has a positive impact on players’ mental wellbeing. The left section is titled
“Strive for” and the right section is titled “Avoid”.
Firstly, on the left side there are positive things to achieve:
• Player having a meaningful experience.
• Gathering feedback from players.
• Player-oriented design.
• Good character development.
• Well-balanced flow channel.
On the right side there are pitfalls designers should avoid wherever possible:
• Player losing the feeling of fun.
• Player getting frustrated with the game.
• Player having to pay extra within the game.
• Problems with story structure and core emotional elements.
While these findings were deemed important, they were difficult to implement within the core part of
the framework.

5.2.4 Other results

There was a small category of findings that does not fit under the field of game design, which included
findings related to teamwork and communication. These are listed below:
• Strive for good teamwork and communication within the development team.
• Avoid large gaps between team meetings.
Both findings are suggestions to game development teams. It, therefore, flows that where there is a team,
communication is imperative, and where the work is done by a single developer – feedback should be
solicited wherever possible, including by playing the game from the perspective of the end-user.

40
Striving for good teamwork and communication is important according to the data collected in the
interviews. This is something that was not outlined in the earlier research as it is outside of the game
design framework; however, it is still important to include it. Similarly, avoiding large gaps between
team meetings is not outlined in Chapter 2; however, as it was mentioned in different ways on multiple
occasions in the interviews it is important to make it into a suggestion for development teams.

5.2.5 Contribution to the field of game development

This framework, and therefore, the study contributes towards more sustainable game development
practice as well as supports players wellbeing. The United Nations has set seventeen sustainable
development goals for a more sustainable society [36]. These goals are displayed in Figure 26. One of
these goals is good health and wellbeing (number 3). Developing games with mental wellbeing in mind
is one of the biggest goals of this framework besides making the game development more sustainable
by practice for game developers.

Figure 26 13 UN sustainable development goals [37]

5.3 Discussion

Previous academic research in the specific field of game development with emphasis on mental
wellbeing is scarce. Therefore, to compare to the previous research it is necessary to look at the overall
field of game design frameworks. This field is far more evolved and has many decades of research. The
most cited one of them is MDA framework. There have been other frameworks developed with the
inspiration of MDA. Most famous of these is DDE. This subchapter will compare the new proposed
framework to the other established frameworks and explain the biggest differences.
The MDA framework is in some ways similar to the proposed framework; however, MDA purpose is
completely different. It was designed about two decades ago and has been an important part of game

41
design and research area ever since. Firstly, HbD is designed to be used in conjunction with MDA. This
means that the designer could use MDA, and also implement the new framework from this study. The
biggest difference between these two is that MDA uses sections while HbD has steps and other
supporting elements. MDA is designed to support the complete design progress of the game, while the
other framework is designed to support the development of game with a focus on mental wellbeing.
The DDE framework was developed as an improvement to an existing established framework. This is
very similar to the approach taken with the proposed framework. The similarities continue with DDE.
Both frameworks have player and designer implemented in the framework. Furthermore, both place
emphasis on design step/section. This clearly shows that the field has evolved a bit and more emphasis
is placed on design part.
It is important to understand the way frameworks are currently developed in an academic context in the
field of video games. They are, to a great extent, inspired by other existing frameworks; this is a good
practice to help bring an existing concept to its next evolutionary stage.

5.4 Future research

Future research could take many routes. One way is to further develop this proposed framework, and
perhaps even make it a complete framework that could be commonly used in a game design. This
research route could take the HbD framework and integrate it into a full framework for developers. This
could be achieved by using a multitude of research strategies and methods.
Furthermore, it follows the established framework development route of drawing inspiration from
existing frameworks to build a new one or to refine newer versions of existing framework.
It is worth noting at this point that at its inception, the purpose of this study was to create a new game
that could improve the mental wellbeing of its players. From there, it morphed into the concept of
developing a new framework for game designers to be able to better incorporate the players’ wellbeing
into their game-design process (whether it is intended for that specific purpose, or whether it is meant
to have a broader, mainstream appeal).
Another viable route in this research area is to develop a holistic, multidisciplinary framework in
cooperation with a research team in the field of mental health. Options in this research area are vast, as
different frameworks could be developed or new finding could be discovered to that improve the mental
health of players around the world. This type of research could also be of interest to regulatory
institutions in order to better monitor public mental health.
An additional route is to modify the HbD framework in order for it to be useful in analyzing existing
games from the perspective of players’ mental health. This route could lead to interesting comparisons
between popular games and to analyze the gaming industry overall from the perspective of players’
wellbeing.
Overall, this is a small exploratory study, consisting of thirteen participants from different backgrounds,
countries, and age groups; however, a study with many more participants could contribute more to
generalizability by achieving greater saturation of data.

42
Lastly, it is possible to further the academic contribution of this research by conducting a study that has
a specialized framework for game design with a focus on mental health. This could be, for example, a
study conducted with environmental artists and players. This could lead to some interesting discoveries
that are specialized for a certain group of designers.

5.5 Conclusion

This study has explored the research question of “What important success factors are there in a
framework for designing games focusing on mental wellbeing?” This study was executed by conducting
a multimethod qualitative approach to the research. The two methods of data collection deployed were
semi-structured interviews and thematic document analysis. Both data collection methods were used for
arriving at an answer to the research question.
The authors have opted to formulate the findings of this research in the form of a new framework, which
is built for video game designers and acts as a support mechanism to develop games with mental
wellbeing in mind.
This framework that is developed is heavily inspired by existing frameworks, particularly the MDA and
DDE, and it is built on data gathered directly via interviews with developers in addition to previously
published research.
There are three main parts to the framework. Firstly, top part shows the connection necessary to the
successful implementation. The core of the framework developed has different steps and other parts in
it. Its objective is to support both the players’ mental wellbeing as well as doing it in a sustainable way
for developer. The last part of the framework is implemented to point out things to do and things to
avoid for designers. It is imperative to avoid problems and ensure that no bad influence comes from the
game to the players’ mental wellbeing.
While the initial plan was to create a framework that could work independently, a major finding on our
part was that it worked better in conjunction with existing frameworks as a starting point (such as MDA
and DDE), and not necessarily as a standalone framework. It is, therefore, our hope that our work may
serve future research as well, in the search for and creation of newer and more refined frameworks.

43
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Appendix A – Informed Consent
Form

Informed Consent Form

Hello,
We are MSc students at Stockholm University DSV (department of Computer and Systems Sciences).
We are working on our thesis project about the connection between game design and player wellbeing.
You are receiving this form because we have previously discussed our current research project, and
you have expressed interest in participating as an interviewee. Please read and sign this form below.
In this research:
● You will be asked to describe your thoughts, attitudes, and actions regarding the connection between
game development and players’ mental wellbeing.
● The interview will be conducted virtually via Zoom, with a screen recording for future reference and
processing.
● Should any visual aspects of the interview be deemed useful to incorporate in the final version of the
project, you will be contacted with the relevant screenshot(s) or video snippet(s) for final
authorization.

Participation in this research is voluntary.

Although the information is not inherently confidential, identifying details can be anonymized upon
request. You can withdraw your consent to the experiment and stop participation at any time.

If you have any questions after today, please contact us:

Yo’Av Dar at yoda0361@dsv.su.se
Daniel Tõevälja at dato7371@student.su.se

I have read and understood the information on this form and had all of my questions answered.
______________________________ _________________
Subject's Signature Date

47
Appendix B – Interview Questions
1. Please give a brief intro about your background and experience in the game industry, and what
your current role is.
2. Please describe the game/s you’re currently involved with.
3. How do you define players’ wellbeing, relating to game development?
4. When creating a game, do you place any emphasis on mental-health benefits to the players?
a. If so, is the emphasis noticeable in the design process or the final product?
b. In what ways?
5. What features of the design are intended to increase player wellbeing?
6. How do you gauge your target-audience’s needs and response to your game? (e.g., focus
groups pre-release, interviews post-release)
7. What are the desired effects you do you aim to achieve?
a. How do you ensure their place in the game design or development?
8. What effects do you wish to avoid?
a. What precautions do you take to exclude them from the final product?
9. Are there any game-design models that you follow?
a. What do you like about them?
b. Where do you find it’s better to stray from them?
10. What are some of your game-development best practices that you are most proud of?
11. What are some of the worst mistakes (made by you or others) that you always try to avoid?

48