Journal articles on the topic 'Companionship programme'

Abstract Background Academic physician burnout is concerning. Too little is known about factors associated with residency programme director burnout. Continued uncertainty risks adverse outcomes including graduate medical education leadership turnover and negative impact on recruiting and retaining under-represented minority residency programme directors. Objective This study assessed symptoms of burnout (emotional exhaustion, depersonalization) and depression along with evidence-based individual and environmental risk factors in a U.S. sample of family medicine residency programme directors. Methods The omnibus 2018 Council of Academic Family Medicine Education Research Alliance survey was used to contact programme directors at all Accreditation Council for Graduate Medical Education accredited U.S. family medicine residency programmes via email. Descriptive data included programme director and programme characteristics, Areas of Worklife (workload, values and control), loneliness (lack companionship, feel left out and feel isolated), burnout (emotional exhaustion, depersonalization) and depressive symptoms. Chi-square tests contrasted descriptive variables with burnout and depressive symptoms. Logistic regression (LR) modelled associations between significant descriptive variables and burnout and depressive symptoms. Results The survey response rate was 45.2% (268/590). Programme directors reported: emotional exhaustion (25.0%), depersonalization (10.3%) and depressive symptoms (25.3%). LR models found significant associations with emotional exhaustion (Workload: lacking time and other work-related resources); lack of companionship, depersonalization (North West Central residency region; Workload and lack of companionship) and depressive symptoms (Black/African American ethnicity). Conclusions One-quarter of U.S. programme directors report burnout or depressive symptoms. Future research should consider associated variables as possible intervention targets to reduce programme director distress and turnover.

A sample of 49 ‘elderly graduate’ residents of a hospital designated for closure were surveyed in 1987 and followed up five years later. Twenty-two patients (45%) had died: the mortality rate was much lower than that predicted by the regional health authority and approximated to that of the general population. All but one of the survivors was living in supported accommodation at the time of follow-up. The majority were satisfied with the move and were receiving an appropriate level of care. However there was significant unmet need for structured activities and companionship. During the follow-up period the survivors had declined in functioning.

Background: The Critical Ally and Critical Friend are two models in the early stages of developmental testing as part of a doctoral research programme. Together with the Critical Companionship model, they offer a theoretically coherent framework for developing expertise in the facilitation of learning about practice from within the workplace. The two new models are sequentially related models underpinned by key principles of practice development and critical social theory. Unlike Critical Companionship, the Critical Ally and Critical Friend models are aimed at novice and proficient practice developers respectively; we argue that, because of their design, they can offer stepping stones to Critical Companionship. Together, the three models offer a pathway for practice developers and practitioners to gain, in a systematic way over a longer timescale, a repertoire of facilitation skills and to build expertise. Aims: To describe the two new models and demonstrate their theoretical coherence with Critical Companionship. We also invite other practice developers and facilitators of workplace learning to debate the coherence of the two new models and the overall pathway, and to contribute to testing the models in a range of workplaces. Implications for practice: The two new models, when used in conjunction with the Critical Companionship model, offer a pathway for developing facilitation expertise within practice development The models offer a broad based introduction to learning in and from practice, which could be useful for preceptors, mentors, clinical supervisors and facilitators at all levels from novice to proficient As the three models offer a pathway, they could be useful as part of strategic workforce development, and learning and development planning The models offer a potential new midrange theory that can contribute to developing practice development knowledge

Homesharing programmes bring two or more individuals who are not linked by family bonds to live under the same roof, sharing domestic spaces and daily living activities. Intergenerational cohabitation programmes match an elderly homeowner (or a person with a rental agreement) who needs companionship and some help with a younger one who is looking for affordable accommodation. This article provides an overview of intergenerational homesharing by tracing their arrangements and salient characteristics, besides explaining the typological variety observed. Based on fieldwork carried out mainly by interviewing homesharing programme managers and policymakers over the period 2015-2019, this paper casts light on several dimensions that characterize homesharing programmes as an arrangement potentially capable of relieving loneliness and social isolation issues in old age, and of generating preventive and light forms of care. The study analyses the main critical aspects of homesharing as well as some of their evolution and transformation dynamics in recent years.

Research indicates that friendship contributes to wellbeing in later life in various ways: through the provision of companionship in daily life, support during stressful transitions, sustainment of identity under changing circumstances and adaptation to old age. However not all older people have friends available who fulfil these different functions. In order to promote wellbeing and reduce loneliness, an educational programme on friendship enrichment for older women has been developed and implemented in the Netherlands. The friendship programme's main goal is empowerment; it helps women clarify their needs in friendship, analyse their current social network, set goals in friendship and develop strategies to achieve goals. Reduction of loneliness, when present, is also an important goal of the programme. A study that followed 40 participants during the year after the programme demonstrates that a majority succeeded in developing new, or improving existing, friendships and in significantly reducing their loneliness. They also reported changes related to the self and social behaviour. Limitations of the research design, reflection on the feasibility of reducing loneliness through a single type of intervention, and possible applications of the programme's design to other areas, are presented in the discussion.

IntroductionWell-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria.MethodsWe adopted a realist evaluation design combining document review with 56 in-depth interviews of PHC workers, facility managers and policy-makers to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers’ motivation and which mechanisms explain how motivation works. We drew on Herzberg’s two-factor and Adam’s equity theories to unpack how context shapes worker motivation.ResultsA complex and dynamic interaction between the MCH programme and organisational and wider contexts triggered five mechanisms which explain PHC worker motivation: (1) feeling supported, (2) feeling comfortable with work environment, (3) feeling valued, (4) morale and confidence to perform tasks and (5) companionship. Some mechanisms were mutually reinforcing while others operated in parallel. Other conditions that enabled worker motivation were organisational values of fairness, recognition of workers’ contributions and culture of task-sharing and teamwork.ConclusionsPolicy designs and management strategies for improving workforce performance, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery and promote UHC. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.

Background Befriending is a popular way in which to intervene to combat loneliness and social isolation among older people. However, there is a need to improve our understanding about how these interventions work, for whom and in which contexts, to make the best use of the increasing investment in the provision and delivery of befriending services. Methods A realist evaluation was undertaken as it focuses on uncovering causal processes and interactions between mechanisms and contextual characteristics. Five case studies of befriending programmes in Northern Ireland were studied, reflecting variation in contextual variables, service user and provider characteristics. Data was collected via service documentation and semi-structured interviews (n = 46) with stakeholders involved in the delivery and receipt of befriending interventions. Results Eight initial programme theories were generated, which were ‘tested’ in the case study analysis to uncover context-mechanism-outcome relationships. Mechanisms identified included reciprocity, empathy, autonomy, and privacy which were triggered in different contexts to support the alleviation of loneliness and social isolation. Reciprocity was ‘triggered’ in contexts where service users and befrienders shared characteristics, the befriender was a volunteer and befriending took the form of physical companionship. Contexts characterised in terms of shared experiences between befriender and service user triggered empathy. Autonomy was triggered in contexts where befriending relationships were delivered long-term and did not focus on a pre-defined set of priorities. Privacy was triggered in contexts where service users had a cognitive/sensory impairment and received one-to-one delivery. Conclusion This study improves understanding about how and why befriending interventions work. Findings indicate that services should be tailored to the needs of service users and take into consideration characteristics including mobility, impairments e.g. physical, sensory and/or cognitive, as well as the influence of service characteristics including payment for befrienders, fixed/long-term befriending relationship, one-to-one support and the impact of non-verbal communication via face-to-face delivery.

Background Reablement is an intensive, time-limited intervention for people at risk of needing social care or an increased intensity of care. Differing from home care, it seeks to restore functioning and self-care skills. In England, it is a core element of intermediate care. The existing evidence base is limited. Objectives To describe reablement services in England and develop a service model typology; to conduct a mixed-methods comparative evaluation of service models investigating outcomes, factors that have an impact on outcomes, costs and cost-effectiveness, and user and practitioner experiences; and to investigate specialist reablement services/practices for people with dementia. Methods Work package (WP) 1, which took place in 2015, surveyed reablement services in England. Data were collected on organisational characteristics, service delivery and practice, and service costs and caseload. WP2 was an observational study of three reablement services, each representing a different service model. Data were collected on health (EuroQol-5 Dimensions, five-level version) and social care related (Adult Social Care Outcomes Toolkit – self-completed) quality of life, practitioner (Barthel Index of Activities of Daily Living) and self-reported (Nottingham Extended Activities of Daily Living scale) functioning, individual and service characteristics, and resource use. They were collected on entry into reablement (n = 186), at discharge (n = 128) and, for those reaching the point on the study timeline, at 6 months post discharge (n = 64). Interviews with staff and service users explored experiences of delivering or receiving reablement and its perceived impacts. In WP3, staff in eight reablement services were interviewed to investigate their experiences of reabling people with dementia. Results A total of 201 services in 139 local authorities took part in the survey. Services varied in their organisational base, their relationship with other intermediate care services, their use of outsourced providers, their skill mix and the scope of their reablement input. These characteristics influenced aspects of service delivery and practice. The average cost per case was £1728. Lower than expected sample sizes meant that a comparison of service models in WP2 was not possible. The findings are preliminary. At discharge (T1), significant improvements in mean score on outcome measures, except self-reported functioning, were observed. Further improvements were observed at 6 months post discharge (T2), but these were significant for self-reported functioning only. There was some evidence that individual (e.g. engagement, mental health) and service (e.g. service structure) characteristics were associated with outcomes and resource use at T1. Staff’s views on factors affecting outcomes typically aligned with, or offered possible explanations for, these associations. However, it was not possible to establish the significance of these findings in terms of practice or commissioning decisions. Service users expressed satisfaction with reablement and identified two core impacts: regained independence and, during reablement, companionship. Staff participating in WP3 believed that people with dementia can benefit from reablement, but objectives may differ and expectations for regained independence may be inappropriate. Furthermore, staff believed that flexibility in practice (e.g. duration of home visits) should be incorporated into delivery models and adequate provision made for specialist training of staff. Conclusions The study contributes to our understanding of reablement, and what the impacts are on outcomes and costs. Staff believe that reablement can be appropriate for people with dementia. Findings will be of interest to commissioners and service managers. Future research should further investigate the factors that have an impact on outcomes, and reabling people with dementia. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Sociability refers to the extent to which animals seek social companionship. Individual differences in social behaviour exist between animals. It is important to measure individual social motivation in order to develop suitable temperament scores that can be used in future breeding programmes or as part of welfare assessment schemes. Runway tests have been shown as reliable methods of measuring sociability in animals (Birds Mills & Faure, 1991; Sheep Sibbald et al., 2005). The aim was to develop a suitable test that could be used to measure sociability of cows in a commercial situation. The following questions were addressed i) How repeatable is the runway test when carried out on dairy cattle, ii) Does a cow’s performance in a runway test correlate with social behaviour within a group house setting?

Despite many health benefits of physical activities, both physically and mentally, the majority of the older women in the rural areas of Malaysia are showing a low prevalence of physical activities. Understanding the roles of social support to improve physical activities is imperative to promote active and healthy ageing among the rural-dwelling older women in Malaysia. Hence, this qualitative study adopted an inductive design using 17 in-depth interviews to understand the role of social support on physical activity behaviour among the rural community-dwelling older woman in Kuala Pilah District, Negeri Sembilan, Malaysia from December 2019 to January 2020. Three categories of themes were identified in this study. Firstly, adaptive social support in terms of informational, companionship and emotional supports reported enhancing physical activity levels among older women. Secondly, the absence of help and assistance from the social network asserts independence and triggers the older women to perform the activities by themselves, thus engage in physically active lifestyles. Thirdly, lacking social support demotivate older women to be engaged in physical activities. In particular, loss of companionship support, poor acceptance or appraisal support, logistic issues to attend exercise programmes and neighbourhood safety and security issues were among the main barriers of physical activities reported by the older women. The main findings of this study shed some light on the exigency of strengthening social support from the social network to engage the older women in physical activities. The roles of social media, effective patient-doctor communication and interventions targeting the spouses and family members must be strengthened to create a supportive atmosphere to enhance physical activity levels among older women.

<p>The employment of domestic servants is a common phenomenon in Nigeria, where vulnerable children are internally trafficked to work as domestic servants in affluent urban households. While scholars have investigated the push factors aiding the demand for child domestic servants in West Africa, attempts to understand the dynamics underlying the demand are scarce. Hence, this study investigated factors that propel demand for domestic servants in Oyo State. The data were generated using both the quantitative and qualitative methods. The results show three categories of employers: newly married women, married women with grown-up children, and isolated widows and grandparents. The demand is driven by role dualism, workload, and the need for companionship. The incipient decline in the extended family structure of social exchange system (fostering) and preference for “outsiders” rather than family members justify the demand for and use of domestic servants. The study recommended welfare programmes targeted at demanding households and an intervention strategy for the trafficked children. </p>

BackgroundThe research examined an innovative volunteer doula service, established in one city and rolled out to four other sites. The initiative offers support to disadvantaged women with the aim of enhancing well-being and improving the uptake of health services.AimsThe project addressed four broad questions: implications for the NHS; health and psychosocial impacts for women; impacts on doulas; and the processes of implementing and sustaining a volunteer doula service for disadvantaged childbearing women.DesignA mixed-methods study using interviews, focus groups and questionnaires to obtain primary data from a range of stakeholders. Existing data sets were used to examine clinical and public health outcomes and contributed to a cost–consequence analysis. A realistic evaluation perspective supported investigation of a complex intervention in its real-world context.OutcomesWe assessed impacts, perceptions and experiences of women, doulas, midwives and heads of midwifery. Clinical and public health outcomes included epidural use, rates of caesarean section, low birthweight, admission to neonatal unit, smoking and breastfeeding. The costs of running a doula service and cost implications for the NHS were calculated.Data sourcesData sources included the service database at the original site; available outcomes were compared against those in reference data sets. Women completed questionnaires and a small number participated in focus groups. Doulas contributed information through focus groups, postal questionnaires and telephone interviews. Staff, commissioners and local champions of doula services provided information through interviews and focus groups. Midwives and heads of midwifery took part in focus groups and telephone interviews respectively.ResultsAlthough doula-supported women in the original site used fewer epidurals and generally required fewer caesarean sections than women in reference groups, these differences were not statistically significant. The utility of comparisons is constrained by the absence of parity information from comparison data. For outcomes with a low incidence, data were pooled across years; this included comparisons for low birthweight and admission to neonatal units where no significant differences were observed. Reductions in rates of smoking at birth were not consistently statistically significantly different from available comparators. More doula-supported women initiated breastfeeding and were continuing at 6 weeks. Initiation rates were significantly higher for most years than in reference groups and significantly higher for continued breastfeeding for all years. The majority of women who accepted doula support valued it highly for its continuity and doulas’ availability and flexibility, being listened to by someone who was non-judgemental and having fears allayed, together with building self-esteem. Women also appreciated volunteer doulas for the knowledgeable companionship, relief of isolation and help with accessing services. Nearly all doulas enjoyed the role and felt well prepared by their training and the majority felt well supported. Midwifery staff appreciated volunteer doulas for their commitment and support to women. Doula services’ challenges in implementing and sustaining their services included funding, balancing referrals and volunteer availability, and relationships with other organisations. The costs of providing a doula service varied considerably, with some costs absorbed by host organisations. Some improved clinical outcomes point to potential cost benefits to the NHS although these were less than the per birth costs of the service in the original site.ConclusionsThis is the largest independent evaluation of volunteer doula support in the UK. Limitations include lower than optimal questionnaire response rates and the relatively small sample size available for outcome measurement. Our findings of positive psychosocial impacts reflect those reported among women in other settings, where women may not have access to midwifery support. Significant improvements in maintaining breastfeeding were particularly striking. Volunteer doulas were highly regarded by women and doula support was accepted by NHS midwives. Doulas enjoyed the role and reported positive impacts for various areas of their lives. Funding was a continuing challenge for doula services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

This study investigates the influence of foreign football and its digital coverage among youths in Abeokuta. It examines the values portrayed by internet/satellite technology, the extent to which these values affect Nigerian youths, and the extent to which Nigerian youths’ exposure to foreign football through the internet/satellite technology affects their commitment to Nigerian football.The study employed qualitative method of Focus Group Discussion (FGD), using discussion guide to source data from youth in Abeokuta South and Abeokuta North Local Government Areas.Among others, the study discovered that major values promoted by internet technology such as technical companionship, global citizenship and technological determinism enhances western values and interests, and have undermined to a very large extent the citizenship values of Nigerian youths. Nigerian youths have practically abandoned their citizenship values such as love and loyalty to the country, patriotism and commitment to national ideas, and have embraced the values promoted by the internet with their passion for foreign football.The main findings recognises Nigerian youths interest in European football was motivated by good organization, adequate and quality facilities and good football on the field of play; hence Nigerian youths abandoned Nigerian football due to poor management, inadequate and poor facilities and insecurity at match venues, among other factors.Based on the findings of this study, it is recommended that Nigerian football should be overhauled. There is need for proper funding to fix facilities like quality stadia, provision of security at match venues and ensure proper administration of the games. Youth football should be revived in Nigeria and grassroots football should be re-introduced at primary and secondary school levels to discover raw talents. Adequate arrangement should be made for marketing and sponsorship programmes, including live coverage of football events on the Nigeria television network.

Abstract Background 'Local People' programme operates in 29 UK communities experiencing disadvantage and economic stressors that impact on population wellbeing. The programme uses a community empowerment approach to increase social connections, and collective control, improve health, and reduce inequalities. This links to SDGs 3 and 11. Mechanisms include a decision-making group led by residents, a project lead, funding, and support from a national charity. Methods A mixed method evaluation was conducted (2017-19) to identify processes and assess outcomes and impacts. This presentation outlines the findings from five in-depth qualitative case studies (c140 interviews) with emphasis on one post-industrial UK town suffering from the effects of industrial decline. A within case and cross case qualitative analysis was undertaken using a thematic framework. Results Priorities set by local areas focused on increasing community involvement and connections between people. A wide range of activities took place including regular classes and community events. The five case studies found strong qualitative evidence of increased social connectedness, community spirit and a sense of purpose, along with the area becoming a better place to live. People involved in project delivery gained confidence and skills, improved their wellbeing and gained a sense of control. There is, as yet, limited evidence that increased involvement has influenced the wider determinants of health. In the post-industrial town, people's social networks expanded, enriching their lives and providing missed companionship. Participants in the programme reported improved mental and physical health, as well as increased confidence and skills. Involvement gave a voice to marginalised older people in the area. Conclusions Empowering communities and putting residents in control can lead to improvements in connectedness and some aspects of health and wellbeing, even in post-industrial towns facing considerable and complex challenges. Key messages The community empowerment programme increased social connectedness. The programme led to improved mental and physical health in participants.

Broadcast television and its audiences live a paradoxical situation: on the one hand, channels still schedule according to the concept of flow; on the other hand, viewers’ zapping counters it. This paper wishes to ascertain the audiences’ practices regarding their fidelity to flow. The research tries to answer these questions: how many viewers watch the same channel during a long consecutive period? How many viewers watch a complete programme? Are there significant differences in zapping versus flow faithfulness according to sex, age, socio-demographic class and cable TV access? Is “companionship television” still a viewers’ consume practice? The research verifies the effectiveness of flow scheduling, which, while being an ideology and a scheduling and self-promotion practice, is not a practice of most viewers. The results show that flow faithfulness flow is a minority behaviour mainly of older people, women, lower classes and viewers without occupation.

Introduction: The current focus on volunteering related to civic engagement in Norway has led to a rise in complementary private initiatives and public funding, specifically with regard to the preservation of historic ships. Volunteers for this programme are primarily men aged over 50 years who spend significant amounts of leisure time in municipalities along the coast, fjords, and lakes of Norway. Despite the historical significance of this kind of volunteering, the social capital that is gained and the substantial funding that the Directorate for Cultural Heritage provides, no study has mapped the impact or outcome of these efforts over the past 20 years. Objective: The primary objective has been to study the scope of formal voluntary ship-preservation work in Norway. This article aims to map the volunteers in associations in this programme, the breadth of their efforts, and their motivations. Design: All ships (n = 90) that were funded by the Directorate in 2009 were included in the case study. A qualitative survey of telephone interviews with 82 key informants (100% response rate) was conducted, and questionnaires were mailed to gather descriptive statistics. Results: Age, gender and a robust relationship with the region and the specific ships appear to be relevant to voluntary ship preservation activities. The reasons for commitment and effort were companionship, unity, and memories of and relationship to the specific ships. The strong socio-political aspect of the volunteers’ efforts was reflected in an aggregate of approximately 5.5 million euros in unpaid work. Conclusion: Volunteering in this context is an important component of social capital among elderly men in Norway. The group dynamics and strong collective aspect of these voluntary associations maintain internal cohesion and the members only leave when forced by increasing age, poor health, or insufficient financial resources.

Recent research has revealed beneficial post-partum, psychosocial effects on the mother following labour which was accompanied by supportive companions. Whether these effects are obtained as a result of having companionship during labour or because of specific personality characteristics of the companions provided is important and is explored in this paper. Although findings revealed few differences in adjustment between women who were supported by different companions, some variability in the post-partum state anxiety and depression scores were noted which suggest that selection of an appropriate supporter is an important aspect of such programmes.

In the face of the sudden outbreak of coronavirus 2019 (COVID-19), some students showed resilience in coping with difficulties while some did not. While different types of students showed different levels of resilience, are there significant characteristics among students with similar levels of resilience? In this study, 3,454 students (aged 15–25 years) were surveyed to understand students' perceived social support-coping modes while investigating the demographic characteristics and mental health status of subclasses of different modes. We found that (1) in the two subgroups of students with extremely low and low levels of perceived social support, the source of students' perceived social support did not have a clear orientation; in the two subgroups with moderate and high levels of perceived social support, the most perceived emotional support was from family and friends, while the least perceived support was companionship from teachers, classmates, and relatives, and problems related to the dependability of friends and communication with family. (2) The degree of social support perceived by students is directly proportional to the coping tendency, i.e., as the degree of perceived social support increases, the proportion of students adopting active coping strategies increases while that of students adopting negative coping strategies decreases; thus, we concluded that high levels of emotional support from family and friends can increase students' tendency of adopting positive strategies to cope with difficulties, while problems related to the dependability of friends and communication with family decrease students' tendency of adopting positive coping strategies. (3) Gender had a significant impact on the extremely low and low levels of perceived social support-negative coping tendencies; these subgroups accounted for 34.6% of the total students. Gender showed no significant influence on other subgroups, a school type had no impact on the distribution of the subgroups. (4) The higher the degree of perceived social support, the lower is the degree of students' general anxiety, and the lower is the degree of impact by the COVID-19 pandemic. The subdivision of student groups allows us to design more targeted support programmes for students with different psychological characteristics to help them alleviate stress during the COVID-19 epidemic.

The contemporary video game market is as recognisable for its brands as it is for the characters that populate their game worlds, from franchise-leading characters like Garrus Vakarian (Mass Effect original trilogy), Princess Zelda (The Legend of Zelda franchise) and Cortana (HALO franchise) to more recent game icons like Miles Morales (Marvel's Spiderman game franchise) and Judy Alvarez (Cyberpunk 2077). Interactions with these casts of characters enhance the richness of games and their playable worlds, giving a sense of weight and meaning to player actions, emphasising thematic interests, and in some cases acting as buffers to (or indeed hindering) different aspects of gameplay itself. As Jordan Erica Webber writes in her essay The Road to Journey, “videogames are often examined through the lens of what you do and what you feel” (14). For many games, the design of interactions between the player and other beings in the world—whether they be intrinsic to the world (non-playable characters or NPCs) or other live players—is a bridging aspect between what you do and how you feel and is thus central to the communication of more cohesive and focussed work. This essay will discuss two examples of game design techniques present in Transistor by Supergiant Games and Journey by thatgamecompany. It will consider how the design of “playful” interactions between the player and other characters in the game world (both non-player characters and other player characters) can be used as a tool to align a player’s experience of “intent” with the thematic objectives of the designer. These games have been selected as both utilise design techniques that allow for this “playful” interaction (observed in this essay as interactions that do not contribute to “progression” in the traditional sense). By looking closely at specific aspects of game design, it aims to develop an accessible examination by “focusing on the dimensions of involvement the specific game or genre of games affords” (Calleja, 222). The discussion defines “intent”, in the context of game design, through a synthesis of definitions from two works by game designers. The first being Greg Costikyan’s definition of game structure from his 2002 presentation I Have No Words and I Must Design, a paper subsequently referenced by numerous prominent game scholars including Ian Bogost and Jesper Juul. The second is Steven Swink’s definition of intent in relation to video games, from his 2009 book Game Feel: A Game Designer’s Guide to Virtual Sensation—an extensive reference text of game design concepts, with a particular focus on the concept of “game feel” (the meta-sensation of involvement with a game). This exploratory essay suggests that examining these small but impactful design techniques, through the lens of their contribution to overall intent, is a useful tool for undertaking more holistic studies of how games are affective. I align with the argument that understanding “playfulness” in game design is useful in understanding user engagement with other digital communication platforms. In particular, platforms where the presentation of user identity is relational or performative to others—a case explored in Playful Identities: The Ludification of Digital Media Cultures (Frissen et al.). Intent in Game Design Intent, in game design, is generated by a complex, interacting economy, ecosystem, or “game structure” (Costikyan 21) of thematic ideas and gameplay functions that do not dictate outcomes, but rather guide behaviour and progression forward through the need to achieve a goal (Costikyan 21). Intent brings player goals in line with the intrinsic goals of the player character, and the thematic or experiential goals the game designer wants to convey through the act of play. Intent makes it easier to invest in the game’s narrative and spatial context—its role is to “motivate action in game worlds” (Swink 67). Steven Swink writes that it is the role of game design to create compelling intent from “a seemingly arbitrary collection of abstracted variables” (Swink 67). He continues that whether it is good or bad is a broader question, but that “most games do have in-born intentionality, and it is the game designer who creates it” (67). This echoes Costikyan’s point: game designers “must consciously set out to decide what kind of experiences [they] want to impart to players and create systems that enable those experiences” (20). Swink uses Mario 64 as one simple example of intent creation through design—if collecting 100 coins did not restore Mario’s health, players would simply not collect them. Not having health restricts the ability for players to fulfil the overarching intent of progression by defeating the game’s main villain (what he calls the “explicit” intent), and collecting coins also provides a degree of interactivity that makes the exploration itself feel more fulfilling (the “implicit” intent). This motivation for action may be functional, or it may be more experiential—how a designer shapes variables into particular forms to encourage the particular kinds of experience that they want a player to have during the act of play (such as in Journey, explored in the latter part of this essay). This essay is interested in the design of this compelling thematic intent—and the role “playful” interactions have as a variable that contributes to aligning player behaviours and experience to the thematic or experiential goals of game design. “Playful” Communication and Storytelling in Transistor Transistor is the second release from independent studio Supergiant Games and has received over 100 industry accolades (Kasavin) since its publication in 2014. Transistor incorporates the suspense of turn-based gameplay into an action role-playing game—neatly mirroring a style of gameplay to the suspense of its cyber noir narrative. The game is also distinctly “artful”. The city of Cloudbank, where the game takes place, is a cyberpunk landscape richly inspired by art nouveau and art deco style. There is some indication that Cloudbank may not be a real city at all—but rather a virtual city, with an abundance of computer-related motifs and player combat abilities named as if they were programming functions. At release, Transistor was broadly recognised in the industry press for its strength in “combining its visuals and music to powerfully convey narrative information and tone” (Petit). If intent in games in part stems from a unification of goals between the player and design, the interactivity between player input and the actions of the player character furthers this sense of “togetherness”. This articulation and unity of hand movement and visual response in games are what Kirkpatrick identified in his 2011 work Aesthetic Theory and the Video Game as the point in which videogames “broke from the visual entertainment culture of the last two centuries” (Kirkpatrick 88). The player character mediates access to the space by which all other game information is given context and allows the player a degree of self-expression that is unique to games. Swink describes it as an amplified impression of virtual proprioception, that is “an impression of space created by illusory means but is experienced as real by the senses … the effects of motion, sound, visuals, and responsive effects combine” (Swink 28). If we extend Swink’s point about creating an “impression of space” to also include an “impression of purpose”, we can utilise this observation to further understand how the design of the playful interactions in Transistor work to develop and align the player’s experience of intent with the overarching narrative goal (or, “explicit” intent) of the game—to tell a compelling “science-fiction love story in a cyberpunk setting, without the gritty backdrop” (Wallace) through the medium of gameplay. At the centre of any “love story” is the dynamic of a relationship, and in Transistor playful interaction is a means for conveying the significance and complexity of those dynamics in relation to the central characters. Transistor’s exposition asks players to figure out what happened to Red and her partner, The Boxer (a name he is identified by in the game files), while progressing through various battles with an entity called The Process to uncover more information. Transistor commences with player-character, Red, standing next to the body of The Boxer, whose consciousness and voice have been uploaded into the same device that impaled him: the story’s eponymous Transistor. The event that resulted in this strange circumstance has also caused Red to lose her ability to speak, though she is still able to hum. The first action that the player must complete to progress the game is to pull the Transistor from The Boxer’s body. From this point The Boxer, speaking through the Transistor, becomes the sole narrator of the game. The Boxer’s first lines of dialogue are responsive to player action, and position Red’s character in the world: ‘Together again. Heh, sort of …’ [Upon walking towards an exit a unit of The Process will appear] ‘Yikes … found us already. They want you back I bet. Well so do I.’ [Upon defeating The Process] ‘Unmarked alley, east of the bay. I think I know where we are.’ (Supergiant Games) This brief exchange and feedback to player movement, in medias res, limits the player’s possible points of attention and establishes The Boxer’s voice and “character” as the reference point for interacting with the game world. Actions, the surrounding world, and gameplay objectives are given meaning and context by being part of a system of intent derived from the significance of his character to the player character (Red) as both a companion and information-giver. The player may not necessarily feel what an individual in Red’s position would feel, but their expository position is aligned with Red’s narrative, and their scope of interaction with the world is intrinsically tied to the “explicit” intent of finding out what happened to The Boxer. Transistor continues to establish a loop between Red’s exploration of the world and the dialogue and narration of The Boxer. In the context of gameplay, player movement functions as the other half of a conversation and brings the player’s control of Red closer to how Red herself (who cannot communicate vocally) might converse with The Boxer gesturally. The Boxer’s conversational narration is scripted to occur as Red moves through specific parts of the world and achieves certain objectives. Significantly, The Boxer will also speak to Red in response to specific behaviours that only occur should the player choose to do them and that don’t necessarily contribute to “progressing” the game in the mechanical sense. There are multiple points where this is possible, but I will draw on two examples to demonstrate. Firstly, The Boxer will have specific reactions to a player who stands idle for too long, or who performs a repetitive action. Jumping repeatedly from platform to platform will trigger several variations of playful and exasperated dialogue from The Boxer (who has, at this point, no choice but to be carried around by Red): [Upon repeatedly jumping between the same platform] ‘Round and round.’ ‘Okay that’s enough.’ ‘I hate you.’ (Supergiant Games) The second is when Red “hums” (an activity initiated by the player by holding down R1 on a PlayStation console). At certain points of play, when making Red hum, The Boxer will chime in and sing the lyrics to the song she is humming. This musical harmonisation helps to articulate a particular kind of intimacy and flow between Red and The Boxer —accentuated by Red’s animation when humming: she is bathed in golden light and holds the Transistor close, swaying side to side, as if embracing or dancing with a lover. This is a playful, exploratory interaction. It technically doesn’t serve any “purpose” in terms of finishing the game—but is an action a player might perform while exploring controls and possibilities of interactivity, in turn exploring what it is to “be” Red in relation to the game world, the story being conveyed, and The Boxer. It delivers a more emotional and affective thematic idea about a relationship that nonetheless relies just as much on mechanical input and output as engaging in movement, exploration, and combat in the game world. It’s a mechanic that provides texture to the experience of inhabiting Red’s identity during play, showcasing a more individual complexity to her story, driven by interactivity. In techniques like this, Transistor directly unifies its method for information-giving, interactivity, progression, and theme into a single design language. To once again nod to Swink and Costikyan, it is a complex, interacting economy or ecosystem of thematic ideas and gameplay structures that guide behaviour and progression forward through the need to achieve a single goal (Costikyan 21), guiding the player towards the game’s “explicit” intent of investment in its “science fiction love story”. Companionship and Collaboration in Journey Journey is regularly praised in many circles of game review and discussion for its powerful, pared-back story conveyed through its exceptional game design. It has won a wide array of awards, including multiple British Academy Games Awards and Game Developer’s Choice Awards, and has been featured in highly regarded international galleries such as the Victoria and Albert Museum in London. Its director, Jenova Chen, articulated that the goal of the game (and thus, in the context of this essay, the intent) was “to create a game where people who interact with each other in an online community can connect at an emotional level, regardless of their gender, age, ethnicity, and social status” (Webber 14). In Journey, the player controls a small robed figure moving through a vast desert—the only choices for movement are to slide gracefully through the sand or to jump into the air by pressing the X button (on a PlayStation console), and gracefully float down to the ground. You cannot attack anything or defend yourself from the elements or hostile beings. Each player will “periodically find another individual in the landscape” (Isbister 121) of similar design to the player and can only communicate with them by experimenting with simple movements, and via short chirping noises. As the landscape itself is vast and unknown, it is what one player referred to as a sense of “reliance on one another” that makes the game so captivating (Isbister 12). Much like The Boxer in Transistor, the other figure in Journey stands out as a reference point and imbues a sense of collaboration and connection that makes the goal to reach the pinprick of light in the distance more meaningful. It is only after the player has finished the game that the screen reveals the other individual is a real person, another player, by displaying their gamer tag. One player, playing the game in 2017 (several years after its original release in 2012), wrote: I went through most of the game by myself, and when I first met my companion, it was right as I walked into the gate transitioning to the snow area. And I was SO happy that there was someone else in this desolate place. I felt like it added so much warmth to the game, so much added value. The companion and I stuck together 100% of the way. When one of us would fall the slightest bit behind, the other would wait for them. I remember saying out loud how I thought that my companion was the best programmed AI that I had ever seen. In the way that he waited for me to catch up, it almost seemed like he thanked me for waiting for him … We were always side-by-side which I was doing to the "AI" for "cinematic-effect". From when I first met him up to the very very end, we were side-by-side. (Peace_maybenot) Other players indicate a similar bond even when their companion is perhaps less competent: I thought my traveller was a crap AI. He kept getting launched by the flying things and was crap at staying behind cover … But I stuck with him because I was like, this is my buddy in the game. Same thing, we were communicating the whole time and I stuck with him. I finish and I see a gamer tag and my mind was blown. That was awesome. (kerode4791) Although there is a definite object of difference in that Transistor is narrated and single-player while Journey is not, there are some defined correlations between the way Supergiant Games and thatgamecompany encourage players to feel a sense of investment and intent aligned with another individual within the game to further thematic intent. Interactive mechanics are designed to allow players a means of playful and gestural communication as an extension of their kinetic interaction with the game; travellers in Journey can chirp and call out to other players—not always for an intrinsic goal but often to express joy, or just to experience and sense of connectivity or emotional warmth. In Transistor, the ability to hum and hear The Boxer’s harmony, and the animation of Red holding the Transistor close as she does so, implying a sense of protectiveness and affection, says more in the context of “play” than a literal declaration of love between the two characters. Graeme Kirkpatrick uses dance as a suitable metaphor for this kind of experience in games, in that both are characterised by a certainty that communication has occurred despite the “eschewal of overt linguistic elements and discursive meanings” (120). There is also a sense of finite temporality in these moments. Unlike scripted actions, or words on a page, they occur within a moment of being that largely belongs to the player and their actions alone. Kirkpatrick describes it as “an inherent ephemerality about this vanishing and that this very transience is somehow essential” (120). This imbuing of a sense of time is important because it implies that even if one were to play the game again, repeating the interaction is impossible. The communication of narrative within these games is not a static form, but an experience that hangs unique at that moment and space of play. Thatgamecompany discussed in their 2017 interviews with Webber, published as part of her essay for the Victoria & Albert’s Video Games: Design/Play/Disrupt exhibition, how by creating and restricting the kind of playful interaction available to players within the world, they could encourage the kind of emotional, collaborative, and thoughtful intent they desired to portray (Webber 14). They articulate how in the development process they prioritised giving the player a variety of responses for even the smallest of actions and how that positive feedback, in turn, encourages play and prevented players from being “bored” (Webber 22). Meanwhile, the team reduced responsiveness for interactions they didn’t want to encourage. Chen describes the approach as “maximising feedback for things you want and minimising it for things you don’t want” (Webber 27). In her essay, Webber writes that Chen describes “a person who enters a virtual world, leaving behind the value system they’ve learned from real life, as like a baby banging their spoon to get attention” (27): initially players could push each other, and when one baby [player] pushed the other baby [player] off the cliff that person died. So, when we tested the gameplay, even our own developers preferred killing each other because of the amount of feedback they would get, whether it’s visual feedback, audio feedback, or social feedback from the players in the room. For quite a while I was disappointed at our own developers’ ethics, but I was able to talk to a child psychologist and she was able to clarify why these people are doing what they are doing. She said, ‘If you want to train a baby not to knock the spoon, you should minimise the feedback. Either just leave them alone, and after a while they’re bored and stop knocking, or give them a spoon that does not make a sound. (27) The developers then made it impossible for players to kill, steal resources from, or even speak to each other. Players were encouraged to stay close to each other using high-feedback action and responsiveness for doing so (Webber 27). By using feedback design techniques to encourage players to behave a certain way to other beings in the world—both by providing and restricting playful interactivity—thatgamecompany encourage a resonance between players and the overarching design intent of the project. Chen’s observations about the behaviour of his team while playing different iterations of the game also support the argument (acknowledged in different perspectives by various scholarship, including Costikyan and Bogost) that in the act of gameplay, real-life personal ethics are to a degree re-prioritised by the interactivity and context of that interactivity in the game world. Intent and the “Actualities of (Game) Existence” Continuing and evolving explorations of “intent” (and other parallel terms) in games through interaction design is of interest for scholars of game studies; it also is an important endeavour when considering influential relationships between games and other digital mediums where user identity is performative or relational to others. This influence was examined from several perspectives in the aforementioned collection Playful Identities: The Ludification of Digital Media Cultures, which also examined “the process of ludification that seems to penetrate every cultural domain” of modern life, including leisure time, work, education, politics, and even warfare (Frissen et al. 9). Such studies affirm the “complex relationship between play, media, and identity in contemporary culture” and are motivated “not only by the dominant role that digital media plays in our present culture but also by the intuition that ‘“play is central … to media experience” (Frissen et al. 10). Undertaking close examinations of specific “playful” design techniques in video games, and how they may factor into the development of intent, can help to develop nuanced lines of questioning about how we engage with “playfulness” in other digital communication platforms in an accessible, comparative way. We continue to exist in a world where “ludification is penetrating the cultural domain”. In the first few months of the global COVID-19 pandemic, Nintendo released Animal Crossing: New Horizons. With an almost global population in lockdown, Animal Crossing became host to professional meetings (Espiritu), weddings (Garst), and significantly, a media channel for brands to promote content and products (Deighton). TikTok, panoramically, is a platform where “playful” user trends— dances, responding to videos, the “Tell Me … Without Telling Me” challenge—occur in the context of an extremely complex algorithm, that while automated, is created by people—and is thus unavoidably embedded with bias (Dias et al.; Noble). This is not to say that game design techniques and broader “playful” design techniques in other digital communication platforms are interchangeable by any measure, or that intent in a game design sense and intent or bias in a commercial sense should be examined through the same lens. Rather that there is a useful, interdisciplinary resource of knowledge that can further illuminate questions we might ask about this state of “ludification” in both the academic and public spheres. We might ask, for example, what would the implications be of introducing an intent design methodology similar to Journey, but using it for commercial gain? Or social activism? Has it already happened? There is a quotation from Nathan Jurgensen’s 2016 essay Fear of Screens (published in The New Inquiry) that often comes to my mind when thinking about interaction design in video games in this way. In his response to Sherry Turkle’s book, Reclaiming Conversation, Jurgensen writes: each time we say “IRL,” “face-to-face,” or “in person” to mean connection without screens, we frame what is “real” or who is a person in terms of their geographic proximity rather than other aspects of closeness — variables like attention, empathy, affect, erotics, all of which can be experienced at a distance. We should not conceptually preclude or discount all the ways intimacy, passion, love, joy, pleasure, closeness, pain, suffering, evil and all the visceral actualities of existence pass through the screen. “Face to face” should mean more than breathing the same air. (Jurgensen) While Jurgensen is not talking about communication in games specifically, there are comparisons to be drawn between his “variables” and “visceral actualities of existence” as the drivers of social meaning-making, and the methodology of games communicating intent and purpose through Swink’s “seemingly arbitrary collection of abstracted variables” (67). When players interact with other characters in a game world (whether they be NPCs or other players), they are inhabiting a shared virtual space, and how designers articulate and present the variables of “closeness”, as Jurgensen defines it, can shape player alignment with the overarching design intent. These design techniques take the place of Jurgensen’s “visceral actualities of existence”. While they may not intrinsically share an overarching purpose, their experiential qualities have the ability to align ethics, priorities, and values between individuals. Interactivity means game design has the potential to facilitate a particular kind of engagement for the player (as demonstrated in Journey) or give opportunities for players to explore a sense of what an emotion might feel like by aligning it with progression or playful activity (as discussed in relation to Transistor). Players may not “feel” exactly what their player-characters do, or care for other characters in the world in the same way a game might encourage them to, but through thoughtful intent design, something of recognition or unity of belief might pass through the screen. References Bogost, Ian. Persuasive Games: The Expressive Power of Video Games. MIT P, 2007. 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