From Clinical Theory to User Reality: A Multi-Phase Co-design protocol of an Analog Serious Game for Fall Prevention

Introduction: Developing serious games for geriatric rehabilitation requires bridging the gap between clinical guidelines and user engagement. This study presents a novel methodological protocol used in the co-development of an analog serious game for fall prevention in older adults. The objective was to validate a comprehensive co-design framework that integrates multidisciplinary stakeholder insights with end-user creativity through a sequential, participatory methodology, ensuring both clinical fidelity and high playability.

Methods: A multi-phase qualitative exploratory study was conducted in Southern Portugal using a participatory design approach. Phase 1 involved focus groups with a multidisciplinary panel of stakeholders. Narratives were analyzed using a dual-coding matrix combining the International Classification of Functioning(ICF) to define therapeutic targets and the Mechanics-Dynamics-Aesthetics (MDA) framework to translate them into game rules. Phase 2 applied these findings in collaborative workshops with community-dwelling older adults (≥65 years).  This phase followed a structured five-stage protocol: Literacy, Ideation, Prototyping, Testing, and Validation, designed to refine the game mechanics based on user interaction, motivation, and playfulness.

Results: The protocol successfully facilitated the translation of complex clinical constraints into accessible game mechanics. Phase 1 analysis mapped clinical needs to specific MDA components, establishing safety parameters for dual tasking. Phase 2 workshops demonstrated that the structured protocol empowered older adults to validate these mechanics while prioritizing "Aesthetics" (social interaction and fellowship) over competitive dynamics. The process culminated in a validated analog board game prototype that integrates essential training elements (strength, balance, attention) within a nature-themed narrative, confirming the protocol’s efficacy in aligning clinical requirements with user preferences.

Conclusion: This study validates a "translation protocol" for serious games development. By synergizing focus group perspective, (via ICF and MDA analysis) with a structured user co-creation pipeline, we established a blueprint that ensures the intervention is clinically grounded in fall risk factors yet intrinsically motivating.

(This work was supported by FCT - Fundação para a Ciência e Tecnologia, I.P. by projectreference "UID/05704/2025" and DOI identifierhttps://doi.org/10.54499/UID/05704/2025)