Digital Games and the Communication of Health Problems: A Review of Games Against the Concept of Procedural Rhetoric

This review examines serious digital games as a tool for communicating health problems to teenagers, using Ian Bogost's theory of procedural rhetoric as its analytical framework. Its central question is which game genres and mechanics are capable of influencing real-world behavior, and its core argument is that persuasion in games operates through rules and processes rather than through narrative or content alone. The authors distinguish serious games from gamification, acknowledging criticisms of the latter while calling for more critical engagement with both approaches.

The review evaluates a range of titles, praising examples such as Food Force, ICED!, Eco Warriors, and WolfQuest for mechanics that effectively convey their messages. Among the examples considered, the only quantitative effectiveness evidence cited is ICED!'s pre- and post-game evaluation, in which 56 percent of respondents reported changed attitudes. Browser games receive particular attention as a cost-effective option for reaching broad adult audiences, and titles such as Pos or Not, The Great Flu, and Climate Challenge are identified as successful because their mechanics embody the behaviors they aim to teach. By contrast, Love Bugs Battle, Rizk, and Power of Research are judged to fail at procedural persuasion, either because their mechanics are unrelated to their intended behaviors or because they are too simple or too complex to sustain engagement.

The authors' analysis of sixteen serious games, mapped against procedural rhetoric criteria, yields a central conclusion: effective health-communication games must align winning conditions and mechanics directly with the understanding or behavior they target. They caution that faithful simulations of off-game processes and oversimplified models can both undermine persuasion, and they recommend designing rhetorically persuasive models of unhealthy behaviors instead. Grounded in serious games, gamification, and game-based learning literature, the review offers a framework for designers and researchers, though its evidence of behavioral effectiveness remains limited.