Abstract
Over 10 per cent of the world’s population lives with Type 2 diabetes, making it a significant public health concern. In Singapore, the government launched the “War on Diabetes” in 2016, initiating efforts focused on prevention, early detection, and better disease management. A challenge that remains is promoting informed dietary choices within hawker centres - open-air food complexes central to Singaporean food culture - where diverse offerings can complicate healthy decision-making for diabetes prevention and control. This paper presents a case study of A Choice for Life, a practice-as-research project developing a virtual reality (VR) experience aimed at educating users on making healthier food choices in hawker centres. Drawing on evidence that VR experiences can influence real-world behaviour, the project integrates insights from medical professionals, animators, and game designers. The discussion focuses on the iterative development of the user interface and innovative feedback mechanisms, including emoji responses that reflect the nutritional value of users’ food selections in the virtual setting. Presenting initial findings from prototype testing, it reflects upon the value that immersive experiences hold for the future of diabetes education and plans for the further development of the project.
References
Alsalman, Demah et al. (2020), Gamification for Diabetes Type 1 Management: A Review of the Features of Free Apps in Google Play and App Stores. Journal of Multidisciplinary Healthcare, 13, pp. 425-432. https://doi.org/10.2147/JMDH.S249664 (accessed 10 July 2025).
Brady, Veronica Joyce et al. (2023), Impact of Gaming (Gamification) on Diabetes Self-Care Behaviors and Glycemic Outcomes Among Adults With Type 2 Diabetes. The Science of Diabetes Self-Management and Care, 49(6), pp. 493-511. https://doi.org/ 10.1177/26350106231208153 (accessed 10 July 2025).
Deterding, Sebastian et al. (2011), From game design elements to gamefulness: defining “gamification”. In A. Lugmayr (ed.), Proceedings of the 15th International Academic Mindtrek Conference: Envisioning Future Media Environments, New York: ACM, pp. 9-15. https://doi.org/10.1145/2181037.2181040 (accessed 02 October 2024).
Harteveld, Casper (2010), Triadic game evaluation: A framework for assessing games with a serious purpose. Paper presented at Workshop of the ACM SIGCHI Symposium on Engineering Interactive Computing Systems, Berlin, January. Available from https://www.researchgate.net/publication/319449032_Triadic_Game_Evaluation_A_Framework_for_Assessing_Games_with_a_Serious_Purpose (accessed 01 October 2024).
Hodgkinson, Gray (2023). Can a visual design and game approach for VR increase engagement with health issues? Gameplay & Interface. Paper presented at 2023 IEEE Conference on Virtual Reality and 3D User Interfaces, Shanghai, China, 25th-29th March.
Hong, Sun et al. (2022), IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2024. Diabetes Research and Clinical Practice, 183 (109119), pp. 1-13. https://doi.org/10.1016/j.diabres.2021.109119 (accessed 02 October 2024).
Johnson, Constance et al. (2014), Feasibility and Preliminary Effects of a Virtual Environment for Adults With Type 2 Diabetes: Pilot Study. JMIR Research Protocols, 3 (2). https://doi.org/10.2196/resprot.3045 (accessed 10 July 2025).
Makhlysheva, Alexandra et al. (2016), Review of Serious Games for People with Diabetes. In Novák, Daniel et al. (eds.), Handbook of Research on Holistic Perspectives in Gamification for Clinical Practice. Hershey, Pennsylvania: IGI Global, pp. 412-447. https://doi.org/ 10.4018/978-1-4666-9522-1.ch019 (accessed 01 September 2024).
Martos-Cabrera, María Begoña et al. (2020), Games and Health Education for Diabetes Control: A Systematic Review with Meta-Analysis. Healthcare (Basel), 8 (4). https://doi.org/10.3390/healthcare8040399 (accessed 10 July 2025)
McIntosh, Josh (2018), Empathy and Emotion in Computer Animation. Cartoon and Animation Studies, 53, pp. 557-570. https://doi.org/10.7230/KOSCAS.2018.53.557 (accessed 02 October 2024).
Ministry of Health, Singapore Epidemiology and Disease Control Division (2011), National Health Survey 2010 [Online]. Singapore. Available from: https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/nhs2010---low-res.pdf?sfvrsn=e54926c6_0 (accessed 15 September 2024).
Ministry of Health Singapore (2019), War on Diabetes Summary Report 2016-2019 [Online]. Singapore. Available from: https://www.moh.gov.sg/docs/librariesprovider5/war-on-diabetes/wod_public_report.pdf (accessed 15 September 2024).
Ministry of Health Singapore (2023), War on Diabetes. Available from https://www.moh.gov.sg/wodcj (accessed 15 September 2024).
Michie, Susan et al. (2011), The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science 6 (1), 42, pp. 1-11. https://doi.org/10.1186/1748-5908-6-42 (accessed 02 September 2024).
Morina, Nexhmedin et al. (2015), Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behaviour Research and Therapy, 74, pp. 18-24. https://doi.org/10.1016/j.brat.2015.08.010 (accessed 01 October 2024).
Morrison, India and Ziemke, Tom (2005), Empathy with Computer Game Characters: A Cognitive Neuroscience Perspective. Paper presented at AISB’05: Social Intelligence and Interaction in Animals, Robots and Agents, University of Hertfordshire, UK, 12-15th April. Available from https://ris.utwente.nl/ws/portalfiles/portal/232516446/Proceedings_AISB_2005.pdf (accessed 10 July 2025), pp. 73-79.
National Environment Agency (2019), High Majority of Patrons Satisfied With Hawker Centres. Available from https://www.nea.gov.sg/media/news/news/index/high-majority-of-patrons-satisfied-with-hawker-centres (accessed 01 September 2024).
Neira-Tovar, Leticia, and Elizondo Elizondo, Marco Eduardo (2018), A Virtual Reality Serious Game to Prevent Type 2 Diabetes Mellitus. In: Torres Guerrero, et al. (eds) Smart Technology. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, 213, pp. 178-188. Cham: Springer. https://doi.org/10.1007/978-3-319-73323-4_17 (accessed 01 May 2024).
Park, Jisu et al. (2019), Does a Character’s Visual Style Affect Audience Empathy and Sympathy?. In: Yamamoto, S., Mori, H. (eds) Human Interface and the Management of Information. Visual Information and Knowledge Management. HCII 2019. Lecture Notes in Computer Science, 11569, pp. 476–488. Cham: Springer. https://doi.org/10.1007/978-3-030-22660-2_35 (accessed 10 September 2024).
Phan Thao P. et al. (2014), Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore. BMJ Open Diabetes Research and Care, 2(1), pp. 1-9. https://doi.org/10.1136/bmjdrc-2013-000012 (accessed 01 September 2024).
Powers, Margaret A. et al. (2016), Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical Diabetes, 34 (2), pp. 70-80. https://doi.org/10.2337/diaclin.34.2.70 (accessed 10 July 2025).
Rall, Hannes et al. (2024), Animación en entornos inmersivos: ampliación de las teorías de la autenticidad en contextos educativos, históricos y politicos. Con A de animación, 18, pp. 108-133. https://doi.org/10.4995/caa.2024.20603 (accessed 01 September 2024).
Rodrigues, D et al. (2018), Lisbon Emoji and Emoticon Database (LEED): Norms for emoji and emoticons in seven evaluative dimensions. Behavior Research Methods, 50, pp. 392-405. https://doi.org/10.3758/s13428-017-0878-6 (accessed 01 October 2024).
Rosal, Milagros C. et al. (2012), Design and Methods for a Comparative Effectiveness Pilot Study: Virtual World vs. Face-to-Face Diabetes Self Management. JMIR Research Protocols, 1(2), pp. 1-9. https://doi.org/10.2196/resprot.2415 (accessed 02 October 2024).
Ruggiero, Laurie et al. (2014), Diabetes island: preliminary impact of a virtual world self-care educational intervention for African Americans with type 2 diabetes. JMIR Serious Games. 2(2). https://doi.org/10.2196/games.3260
Sailer, Michael and Homner, Lisa (2020), The Gamification of Learning: a Meta-analysis. Educational Psychology Review, 32, pp. 77-112. https://doi.org/10.1007/s10648-019-09498-w (accessed 20 May 2024).
Saw Swee Hock School of Public Health (2016), Cost of diabetes to Singapore to soar beyond $2.5b by 2050. Available from https://sph.nus.edu.sg/blog/2016/04/14/cost-of-diabetes-to-singapore-to-soar-beyond-2-5b-by-2050/ (accessed 15 September 2024).
Taufik, Danny et al. (2021), Changing consumer behaviour in virtual reality: A systematic literature review. Computers in Human Behavior Reports, 3, pp. 1-16. https://doi.org/10.1016/j.chbr.2021.100093 (accessed 20 May 2024).
Thai AC et al. (1990), Diabetes mellitus and its chronic complications in Singapore: an increasing healthcare problem. Annals of the Academy of Medicine, Singapore, 19(4), pp. 517-523. https://europepmc.org/article/med/2221812 (accessed 01 October 2024).
Tung, Ai Jui (2021), Hawker Centres. Singapore Infopedia. Available from https://www.nlb.gov.sg/main/article-detail?cmsuuid=d30b9e62-9e71-4e1e-9f5e-a6573380f4b6 (accessed 01 October 2024).
Vanden Abeele, Vero et al. (2012), P-III: A Player-Centered, Iterative, Interdisciplinary and Integrated Framework for Serious Game Design and Development. In: De Wannemacker, S., Vandercruysse, S., Clarebout, G. (eds) Serious Games: The Challenge. ITEC/CIP/T 2011. Communications in Computer and Information Science, vol 280. Berlin and Heidelberg: Springer, pp. 82-86. https://doi.org/10.1007/978-3-642-33814-4_14 (accessed 01 October 2024).
van Rooij, Malou (2019), Carefully Constructed Yet Curiously Real: How Major American Animation Studios Generate Empathy Through a Shared Style of Character Design. Animation, 14, pp. 191-206. https://doi.org/10.1177/1746847719875071 (accessed 01 October 2024).
Vaughan, Neil (2024), Virtual Reality Meets Diabetes. Journal of Diabetes Science and Technology, 19 (3), pp. 810-819. https://doi.org/10.1177/19322968231222022 (accessed 16 July 2025).
Weber, Wibke and Rall, Hans-Martin (2019), Comics Journalism and Animated Documentary: Understanding the Balance Between Fact and Fiction. ImageTexT, 11(1). https://imagetextjournal.com/comics-journalism-and-animated-documentary-understanding-the-balance-between-fact-and-fiction/ (accessed 01 September 2024).
Wong, Sabrina (2023). Applying behavioural health concepts in designing VR interventions for health. Paper presented at 2023 IEEE Conference on Virtual Reality and 3D User Interfaces, Shanghai, China, 25th-29th March.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Emma Harper, Hannes Rall, Sabrina Wong, Gray Hodgkinson