It's All in the Game

Tabletop game design to create awareness around growing up with cystic fibrosis

Growing up with a chronic disease can be hard. Having to deal with complicated day to day logistics and being distinctly different from healthy peers is a reality for children and young adults diagnosed with a chronic disease.Peer understanding and awareness of what it means to be chronically ill decreases social stress and increases quality of life. However, communicating the effects of chronic illness to peers is challenging. Directly communicating needs is misunderstood, only leads to short-term changes and puts the burden on the child with a chronic illness.We designed “It’s All in the Game’’ with the aim to explore how boardgames can be applied to communicate the effects of growing up with a chronic disease. Through the design of “It’s All in the Game“, we explore procedural communication of the effects of chronic disease, ultimately aiming to create awareness and empathy for children with a chronic disease.

2022 - Present | Work Experience
Related fields
Serious Games, Game Design, User Centered Design, Design for Communication, Graphic Design
Coached by
Max Birk

Project Summary

Communicating the effects of chronic illness to peers is challenging, because directly communicating needs is misunderstood, only leads to short-term changes, and puts the burden on the child with a chronic illness.

The potential of board games to procedurally communicate the effects of chronic illness are underexplored. Board games promise to provide a low barrier approach to learn about the effects of chronic illness by creating enjoyment focused play settings that generate shared experiences, provide a structured language around chronic disease, and potentially enable discussion among peers, ultimately aiming for attitude and behavioral change towards their vulnerable peers.

Cystic fibrosis (CF), for example, requires peers to understand the impact of regular medication intake, fluctuating energy levels, and vastly different time constraints compared to their peers due to a strict medical regime.  If misunderstood, children with CF are often excluded, brought into situations where they overextend their own abilities, and potentially worsen their illness. A situation generalizable to other chronic illnesses such as diabetes, asthma, and juvenile idiopathic arthritis. All have in common that the illness affects energy, time, motivation, and health.

To explore how boardgames can be applied to communicate the effects of chronic disease, we create „It’s All in the Game“. Following a user-centered design process, implementing insights from children affected by a chronic disease, medical experts, peers, and game designers, we created a board game around the theme of chronic disease. The game distilled insights about chronic disease into varying in-game procedures, e.g., restricting activities based on energy level, introduces theme integration, i.e., energy and motivation dependent weekly scheduling, and introduces random events to simulate the unforeseeable effects of chronic disease.

Week planning board

The board is shaped to fit the activity tokens only according to specific rules that fit the general limitations of planning in the life of a CF patient. No physiotherapy on the weekends, no more than one sports activity in the day and required rest after any physically draining activity.

Dealing with complicated day to day logistics and limitations in terms of energy and fatigue is translated into planning out a week as a kid with a chronic disease. It allows players to experience what it's like not being able to do everything in a day or week and taking all logistics into account while planning it out.

Communicates the complications in planning weekly activities while taking limitations and restrictions of living life with CF into account.

Activity tokens

The activity tokens are shaped to fit only according to the rules on the planning board. They all have a different color to easily distinguish between them and allow the player to visually represent the items in their head when forming their play strategy.

These activity tokens represent six different day to day activities that were extracted from the interviews and a creative session to be common amongst CF patients. Incorporating them all into their weeks is a continuous challenge for them in which medication and rest are often the first things to lose the battle.

Communicates the most commonly represented activities in young adolescents with CF and emphasizes the importance of rest and the time it takes to do so.

Chance Cards

Growing up with a chronic disease like cystic fibrosis means having to deal with unexpected events on a weekly basis. Whether this is waking up with no energy at all or having to go to the hospital to get an antibiotic drip, these are things that can happen just about any day when growing up with CF. These cards are a metaphor representing this.

Additionally, the chance cards give the opportunity for storytelling, informing about very specific aspects of a disease and incorporating everyday challenges that every child is dealing with, with or without a chronic disease, to put into perspective that not everything is different between a sickling and their healthy peer.

Communicates the unexpected aspects of dealing with a chronic disease and disease specific information.

Resource Cards

The resource cards are used to buy activity tokens. The right amount of the required cards has to be gathered to buy the needed tokens, in order to gather points and attempt to fulfill the personal challenge, as fast as possible.

Energy, health, motivation and time are chosen as the four main resources. These four resources are extracted from interviews conducted with CF patients, where they indicated these four as their main reason for doing or not doing something. They were also all indicated to be scarce from time to time.

Communicates the limited amount of health, energy, time and motivation available to plan activities.

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"The application of game design in real world context is still in its infancy, we often underestimate the power of play to create real impact. The boardgame „It’s All in the Game“ by Lieke Vermeulen is an exceptionally well-designed and thought-out playful experience. This game is clearly the result of a talented young designer applying user centric design with genuine empathy for the target audience (children with Cystic fibrosis). I feel the concept has the potential to be scaled to help children with other chronic illnesses and hope that Lieke takes that step. It is truly wonderful to see the application of play to create awareness of and empathy for children with a chronic disease, especially in such a well-polished product."

Tim Jansen, Game Designer at Frisse Blikken / Fresh Game studio

Reflection Highlights

& how the project relates to my professional identity and vision.