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The Influence of Visual Recognition and Preference in Serious Game Development: A Mixed-Method Study in Nepal
University of Skövde, School of Informatics. University of Skövde, Informatics Research Environment. (GAME Research Group (GAME))ORCID iD: 0000-0003-0977-1285
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden ; Department of Nursing, Kathmandu Medical College, Nepal.ORCID iD: 0009-0000-0457-5977
University of Skövde, School of Informatics. University of Skövde, Informatics Research Environment. (GAME Research Group (GAME))ORCID iD: 0000-0001-5617-9984
University of Skövde, School of Informatics. University of Skövde, Informatics Research Environment. (GAME Research Group (GAME))ORCID iD: 0009-0003-3037-1953
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2025 (English)In: INTERNATIONAL JOURNAL OF SERIOUS GAMES, E-ISSN 2384-8766, Vol. 12, no 3, p. 47-68Article in journal (Refereed) Published
Abstract [en]

Understanding players’ diverse visual recognition and visual preferences, especially in cross-cultural contexts, is critical for the creation of effective serious games. This study aimed to examine how varying levels of fidelity affect players' visual recognition, visual preference, and overall experience in serious gaming, using a mixed-method case study in the Bhaktapur district, Kathmandu, Nepal. Forty-four participants, aged 13 to 16 years, were enrolled in an A/B gameplay test. Fourteen students participated in in-depth interviews, thirty-six completed a questionnaire, and twenty-two provided valid telemetry data. We found that higher fidelity led to more positive affect, better recognition, stronger preference, higher familiarity, and positive emotional response from players. However, challenges were encountered regarding the identification of local food items. This highlights the key role of visual literacy, as adolescents are more influenced by familiar media than by real-life experiences in terms of visual recognition and preference. Effective visual communication in serious games should consider individual differences and the playing environment. This study contributes to serious game research by providing insights into an underrepresented demographic and demonstrating the importance of cultural context in visual communication. Findings offer practical guidance for game developers to design more inclusive and effective serious games.

Place, publisher, year, edition, pages
Genova: Serious Games Society , 2025. Vol. 12, no 3, p. 47-68
Keywords [en]
Visual communication, serious games, cross-cultural, game graphic, visual literacy, health
National Category
Human Computer Interaction Public Health, Global Health and Social Medicine
Research subject
Research on Citizen Centered Health, University of Skövde (Reacch US); Interaction Lab (ILAB); GAME Research Group
Identifiers
URN: urn:nbn:se:his:diva-25700DOI: 10.17083/229hsa32ISI: 001542011000005Scopus ID: 2-s2.0-105013126119OAI: oai:DiVA.org:his-25700DiVA, id: diva2:1987268
Funder
Swedish Research Council, 2020-03333
Note

CC BY-NC-ND 4.0

Alternativ titel:

The Influence of Visual Recognition and Preference in Serious Games:A Pilot Study in Nepal

"We acknowledge support from the Swedish Research Council to A. Krettek (grant number 2020-03333) and Shanghai Gongqiao Technology to Hua Bai (grant number FS 2021/7)."

Available from: 2025-08-05 Created: 2025-08-05 Last updated: 2026-09-03Bibliographically approved
In thesis
1. Visuals Make Connections: A Framework for Effective Visual Communication in Cross-Cultural Serious Games
Open this publication in new window or tab >>Visuals Make Connections: A Framework for Effective Visual Communication in Cross-Cultural Serious Games
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Designing serious game visuals for multiple cultural contexts presents significant challenges, as imagery familiar to one audience may be misunderstood or carry different meanings in another. This thesis adopts the perspective that visuals in serious games are not merely decorative but function as connectors between game content and players’ cultural and perceptual contexts. It argues that visual elements must be both clear and appealing across different cultural and domain contexts, and therefore investigates how varying levels of visual fidelity influence players’ visual recognition and visual preferences in cross-cultural serious game contexts.

A mixed-methods research approach was adopted, combining a literature review, fieldwork, and multiple case studies, with qualitative and quantitative data collected in Nepal and Sweden. To support the empirical investigation, a serious game titled Happy Heart was designed and developed as both an educational game and a research instrument, enabling systematic evaluation of visual fidelity across culturally distinct contexts. In both locations, the same Happy Heart game was implemented in localized versions and playtested with local participants.

The findings indicate that higher levels of visual fidelity generally support improved recognition, increased preference, and greater familiarity with serious games in both cultural contexts. However, higher visual fidelity did not consistently result in stronger emotional responses. Participants in both Nepal and Sweden experienced difficulties identifying culturally specific food items, highlighting the role of visual literacy in shaping how visual representations are interpreted. The results further suggest that adolescents’ visual recognition and preferences are shaped more strongly by exposure to global media, such as video games, animation, and social platforms, than by everyday lived experiences. A clear preference for 3D graphics and globally recognizable game aesthetics was observed, reflecting increasing familiarity with shared visual design conventions across cultures.

Based on these findings, this thesis proposes a Visual Alignment Framework to support culturally inclusive serious game design. The framework offers structured guidance for selecting representational objects and determining appropriate levels of visual fidelity when designing for diverse audiences, thereby reducing the risk of visual miscommunication in cross-cultural contexts. This research contributes both empirically and conceptually to the field of serious games by providing cross-cultural evidence and a theoretical foundation for visual alignment in game visuals. By synthesizing insights from the Nepalese and Swedish case studies, the thesis advances understanding of how visual communication can be strategically aligned with players’ cultural and perceptual contexts to support more effective (in terms of visual recognition and visual preference) and inclusive educational game design. Future research is encouraged to further evaluate the framework across additional cultural settings and game genres.

Abstract [sv]

Att designa visuella element i serious games för flera kulturella kontexter innebär betydande utmaningar, eftersom bildspråk som är bekant för en målgrupp kan missförstås eller bära andra betydelser i en annan. Denna avhandling utgår från perspektivet att visuella element i serious games inte enbart är dekorativa, utan fungerar som länkar mellan spelets innehåll och spelarnas kulturella och perceptuella kontexter. Avhandlingen argumenterar för att visuella element måste vara både tydliga och tilltalande i olika kulturella och ämnesspecifika sammanhang, och undersöker därför hur varierande nivåer av visuell fidelitet påverkar spelares visuella igenkänning och visuella preferenser i tvärkulturella serious game-kontexter.

En flermetod (mixed method)-ansats tillämpades, där litteraturstudie, fältarbete och flera fallstudier kombinerades, med både kvalitativa och kvantitativa data insamlade i Nepal och Sverige. För att möjliggöra den empiriska undersökningen designades och utvecklades ett serious game med titeln Happy Heart, som fungerade både som ett utbildningsspel och som ett forskningsinstrument. Detta möjliggjorde en systematisk utvärdering av visuell fidelitet i kulturellt skilda kontexter. På båda platserna implementerades lokaliserade versioner av Happy Heart, vilka speltestades med lokala deltagare.

Resultaten visar att högre nivåer av visuell fidelitet generellt stödjer förbättrad igenkänning, ökad preferens och större förtrogenhet med serious games i båda kulturella kontexterna. Däremot ledde högre visuell fidelitet inte konsekvent till starkare emotionella responser. Deltagare i både Nepal och Sverige hade svårigheter att identifiera kulturellt specifika livsmedel, vilket belyser den visuella läskunnighetens (visual literacy) betydelse för hur visuella representationer tolkas. Vidare indikerar resultaten att ungdomars visuella igenkänning och preferenser i högre grad formas av exponering för globala medier – såsom datorspel, animation och sociala plattformar – än av vardagliga erfarenheter. En tydlig preferens för 3D-grafik och globalt igenkännbara spelestetiker observerades, vilket speglar en ökande förtrogenhet med gemensamma visuella designkonventioner över kulturella gränser.

Baserat på dessa resultat föreslår avhandlingen ett Visual Alignment Framework för att stödja kulturellt inkluderande design av serious games. Ramverket erbjuder strukturerad vägledning för val av representativa objekt och fastställande av lämpliga nivåer av visuell fidelitet vid design för diversifierade målgrupper, med syfte att minska risken för visuell misskommunikation i tvärkulturella sammanhang. Forskningen bidrar både empiriskt och konceptuellt till området serious games genom III att tillhandahålla tvärkulturella belägg samt en teoretisk grund för visuell anpassning av spelgrafik. Genom att syntetisera insikter från fallstudierna i Nepal och Sverige fördjupar avhandlingen förståelsen för hur visuell kommunikation strategiskt kan anpassas till spelares kulturella och perceptuella kontexter för att stödja mer effektiv (vad gäller visuell igenkänning och visuell preferens) och inkluderande design av serious games. För framtida forskning rekommenderas att vidareutvärdera ramverket i ytterligare kulturella miljöer och för andra spelgenrer. 

Place, publisher, year, edition, pages
Skövde: University of Skövde, 2026. p. xvii, 114
Series
Dissertation Series ; 70
Keywords
Visual Communication, Cross-Cultural Serious Games, Visual Development Framework, Visual Fidelity, Health
National Category
Computer and Information Sciences Human Computer Interaction
Research subject
GAME Research Group
Identifiers
urn:nbn:se:his:diva-26889 (URN)978-91-989081-4-5 (ISBN)978-91-989081-3-8 (ISBN)
Public defence
2026-09-18, G110, 13:00 (English)
Opponent
Supervisors
Note

Ett av sex delarbeten (övriga se rubriken Delarbeten/List of papers):

6. Bai, H., Wilhelmsson, U., Zhang, R., Alklind Taylor, A. S., Backlund, P., Krettek, A. Cultural Alignment and Effective Visual Design in Cross-Culture Serious Games. Submitted to International Journal of Computer Games Technology. (In review)

Available from: 2026-07-16 Created: 2026-07-08 Last updated: 2026-07-16Bibliographically approved

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Bai, HuaWilhelmsson, UlfBankler, VictorZhang, RanAlklind Taylor, Anna-SofiaVaidya, AbhinavOli, NataliaKrettek, AlexandraLebram, Mikael

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