Playful PHI: Using Cognitive Behavioral Game Design (CBGD) to Create a COVID-19 Prevention Game, Vaccine Nation

"Playful PHI" presents Vaccine Nation, a tower-defense game designed to promote COVID-19 prevention behaviors including hand hygiene, masking, social distancing, isolation, and vaccination. The work is grounded in Cognitive Behavioral Game Design (CBGD), a model that pairs social cognitive goals such as behavior change, awareness, and self-efficacy, drawn from Social Cognitive Theory, with mechanics that engage multiple forms of intelligence, including graphics, narrative, relationships and role models, and humor. The authors motivate this approach by pointing to the pandemic's public health demands, the CDC's reliance on non-pharmaceutical interventions, and the spread of misinformation, with one cited study finding that up to 40 percent of COVID-19 social media posts originated from unreliable sources. Playful public health precedents, such as handwashing songs, the Vaccination Game, and the board game Pandemic, provide the rationale for using play to connect individual actions with community-level health outcomes.

The game's design translates these goals into concrete mechanics. Intervention costs are represented as research points rather than money, and stronger measures, with vaccination the most powerful, yield higher survival rates. Outbreaks are introduced at 80 to 100 day intervals to sustain persistence, and humor-driven achievements reinforce engagement. The intended player experience follows a progression of engagement, challenge, flow, persistence, and mastery, and the game is aimed at players aged 14 and older.

The scope of the work is primarily design-theoretical. It offers no empirical testing of player attitudes, knowledge, or behavior, and it reports no measured effectiveness for the game's prevention messaging. Its contribution lies in demonstrating how a established behavioral framework can be operationalized in a playable public health tool, with the reference section supplying the supporting literature on game design, behavioral psychology, and COVID-19 guidance from the CDC and WHO.