An Integrative Review of Empathy, Attitude Change, and Historical Consciousness in Games: Mapping Gaps and Opportunities in Game-Based Digital Heritage Research

Abstract

Researchers over the past 20 years have steered their attention towards examining whether video games have the potential to positively affect behavioral/emotional traits in players, recognizing their potential to offer not only enjoyable, but also meaningful experiences. Insight from studies has informed video game design, to achieve diverse outcomes, e.g., building empathy, shaping attitudes, raising awareness, or impacting how players (re)appreciate history. Utilizing the integrative review instrument, we examine the literature on video games as empathy/attitude change stimulants, alongside the methodological approaches, tools, evaluation studies, and outcomes comprising the current state of evidence. Through this process, we formulate future research directions, which (a) overview the interdisciplinary priorities of researchers in the aforementioned topics, (b) highlight their key insights/perspectives, (c) outline their methodological approaches, and (d) summarize the discussions, challenges, and outlook on future work toward realizing video games as digital spaces of conscience that foster empathy, critical reflection, and collective remembrance.

1. Introduction

Leveraging technological advancements and innovative design, video games have outgrown their primordial purpose of just providing entertainment, and have become powerful outlets for meaningful storytelling, fostering empathy, and exposing players to different points of view [1]. Their interactive nature and diverse capabilities have attracted the interest of researchers from various fields. The abundance of studies exploring the transformational potential of video games has led to systematic reviews focusing on themes such as which game design choices influence video game players’ experience [2] and learning [3], as well as their positive effects on people’s well-being [4]. The persuasive prowess of video games to positively influence player behavior has also been studied by a considerable number of researchers [5].

Video games leveraging role-playing and perspective-taking strategies have the potential to enable players/observers to take on different identities, and be exposed to different cultural and political backgrounds. For this reason, they can be used as a medium to acquire knowledge about other ethnic or social groups, highlight their historical background and plights, and (potentially) stimulate a change of attitude towards them [6]. For observers to develop the skills necessary for perspective-taking, meaning-making, and social understanding of another person’s predicament and decision-making, the ability to empathize with others is a critical ingredient [7]. Empathy is linked to the development of skills that facilitate positive, or prosocial, human interactions, such as helping others and comforting them [8]. For situations dealing with injustice or conflict, empathy can be fostered for both those being oppressed, as well as for the oppressors, in both contemporary and historical contexts.

In the interdisciplinary field of computer and video game studies, exploring whether video games can be used as tools for fostering empathetic responses has been a topic of great interest to researchers. In the heritage context, exploration of empathy and attitude change extends further, as video games have been found to emulate the experiential effects of heritage sites visitation [9], engaging players with topics of collective memory and allowing them to reflect on historical legacies. Games have been developed that can tap into and simulate entire historical periods [10], frame historiographical arguments [11], and even portray historically contentious interpretations of past events [12]. Such games can be modeled with a variety of rules and audiovisual elements, often presenting players with complicated, potentially morally complex situations in the virtual world, encouraging them to empathize with the in-game characters [13,14]. As a result, players are likely to associate and mentally transfer what is depicted in the video game to real-world situations [15].

Through in-game perspective-taking mechanics, players can also be exposed to other people’s points of view [16]. Video games’ delivery of spherical knowledge on a topic, as well as their capacity to introduce players to different perspectives, can lead to different attitudes towards portrayed issues [17,18,19]. Hence, historically-themed video games can act as a unique platform through which past events can be represented, and historical insights can be conveyed, enabling players to reflect on the past and draw connections to the present [20]. Video games grant players a space where they are offered the freedom to make choices, feel part of the past, and ‘reconstruct history in a virtual environment’, thus shaping their historical consciousness [21].

A recent systematic literature review of empathy and games can be found in Schrier and Farber (2021) [22], whose goal was to investigate the published works on empathy and video games. Video games’ capacity to stimulate attitude change has also been investigated thoroughly in meta-analyses of studies. Kolek et al. (2023) [23] revealed that narrative video games can impact both the implicit and the explicit attitude of players on historical events, whereas Coyne et al. (2018) [24] highlighted the positive effect of prosocial media (including video games) on empathic concern. Empathy is considered an important element to stimulate attitude change (and the dearth of studies that explore their correlation). However, we encountered a surprising lack of research works that explore whether video games, as vehicles for building empathy, can further stimulate attitude change towards people and their historical struggles. More specifically, despite a strong foundation to support the idea that games can shape historical consciousness through empathetically engaging and attitude-shaping experiences, we have found almost no examples of historical video games applied to or employed as interventions for empathy or attitude change toward historical meaning-making.

Hence, in this work, we explore the effect of video games on both empathy and attitude change, their correlation, and the extent to which these two aspects can be investigated in combination, thereby proposing research directions and highlighting the need for future work. At the same time, we extend aforementioned works where the two aspects are not investigated together. We aim to uncover the types of connections made by incorporating evidence from experimental works only, where video games are used as an intervention. We categorize our review approach as ‘integrative’, in accordance with the guidelines of Snyder (2019) [25], as the purpose of our work is not to present the full body of literature on empathy, attitude change, and video games in general, but rather, “to analyze and examine the literature and the main ideas and relationships”, with the aim to motivate further research and development towards video games as vehicles for meaningful societal outcomes.

The remainder of this paper is organized as follows: Section 2 provides the necessary background on the topics of empathy and attitude change, so that readers can recognize and draw the necessary parallels between them. In Section 3, we address how the integrative review was carried out, describing the methodology followed to collect the literature, paper eligibility criteria, databases searched, and keywords used in our search. We present the outcomes of the analysis of included works in Section 4, where we elaborate on the core ideas established in the literature regarding the design of video game interventions for measuring their impact on empathy and attitude change, exploring aspects such as the length of intervention and the effects of short-term studies versus longitudinal ones. Our survey also identifies the video games used in these interventions, offering researchers a useful compendium of game references in the form of a “Ludography” [26] (Supplementary Materials, Table S1). Finally, in Section 5, we discuss our findings, insights, and propositions for future research directions.

2. Background

2.1. Video Games and Their Effects on Players

Emerging in the late 1950s, and exploding into the mainstream during the 1980s and 1990s, video games have become a ubiquitous part of everyday life, and currently comprise one of the largest and most lucrative industries worldwide, estimated of having generated over $450 billion in revenue in 2024 [27]. Despite video games being primordially and foremost a leisure activity, in recent years, practitioners in various domains have started implementing ways to integrate purpose-built games and game-like interactive entertainment software in their activities (collectively referred to as “serious games”, though not to be confused with the practice of “gamification”). These games emulate and leverage the appeal and promise of video game entertainment, but differ from leisure games in that they mainly aim to educate players [28]. To contrast serious games, in the remainder of this work, we shall refer to a video game as a “leisure game” when that game has been designed and developed by a video game company, team, or individual developer in a commercial and/or artistic context, to be enjoyed for its intrinsic value and the quality of experience it provides.

Studies investigating video games’ positive influence have “been relatively sparse” [29]. It has been suggested that exposure to prosocial video game content can contribute to promoting prosocial behaviors in young people [30]. Games that model prosocial behavior and the act of playing co-operatively with others have been associated with increases in social satisfaction, perceived peer support, and prosocial behavior in real-life settings. Hence, video games have been proposed as a powerful educational tool, teaching the value of important social skills in school children [31,32]. However, other studies do not support the perception that video games can affect prosocial characteristics, such as in Garcia et al. (2022) [33], which did not reveal an impact of the content of video games on empathy. Due to the complex nature of video games, and the fact that individuals may respond differently to the exposure of video games due to their personality characteristics [34], exploring their effects on players constitutes a challenging task.

2.2. Empathy

Empathy is considered a desirable trait in many situations, from school to the workplace, because it contributes to smooth everyday interpersonal interactions. Possessing empathy has been linked to a person being more tolerant and less prejudiced towards people who are different [35]. The concept of empathy has been studied in many disciplines, such as psychology, nursing, and education [22].

Defining empathy is not an easy task, and the concept has been given multiple definitions [36]. In addition, many approaches to measuring empathy exist in the literature [37]. One of the most popular approaches to measuring empathy was offered by Batson and Ahmad (2009) [38], who mention four states, namely (a) imagine-self perspective (imagining oneself in another person’s situation); (b) imagine-other perspective (“imagining how another person thinks or feels given their situation”); (c) emotion matching (“feeling as another person feels”); and (d) empathic concern (“feeling for another person who is in need”). The first two constitute cognitive states, whereas the last two are affective/emotional states. Although consensus regarding the definitions has not been reached, the multi-dimensional nature of empathy is generally acknowledged [39]. Cognitive empathy refers to one’s ability to understand how another person feels, whereas affective empathy (also referred to as emotional empathy) is one’s ability to experience another person’s emotional state [40].

Whereas some hold the belief that empathy is a genetic, personological trait that is more fixed, others have purported that empathy can be taught, and in the literature, there are several techniques implemented to induce it [41]. It is a common phenomenon that empathy interventions may incorporate more than one technique [42]. One popular technique is perspective-taking, which can be achieved through simulations [43], with positive short-term results. Another widely used method is role-playing [44], supporting the development of perspective-taking skills. Interventions for inducing empathy may also include classroom lectures, although this technique does not involve a high level of interaction [42].

2.3. Attitude Change

Despite the crucial role of empathy in inter-group relations, it may not be enough if this is not accompanied by the suitable attitude towards another individual. Assessment of attitude, as a field of study, appeared more than a century ago [45]. Attitude is the evaluation of an item, a person, or a value [46]. Several models have been proposed regarding attitudes, which can be divided into two main categories: those embracing the belief that attitudes are stable evaluations stored in memory, and those stating that attitudes are constructed on the spot [46]. Also, there are models combining the two views. Within these hybrid models, attitude can be stable, but is also subject to change [45].

Attitude change occurs when people are exposed to a new instance of the evaluation object they were not exposed to before. However, the previous evaluation does not cease to exist. According to Wilson et al. (2000) [47], people can hold different evaluations towards an object, one which is automatic (implicit), and one which is explicit. The evaluation that will be exhibited depends on the person’s ability to access the most recent (explicit) attitude. This difference in evaluations towards a stimulus can emerge when a person is assessed on their implicit and explicit attitudes towards, e.g., a minority group. The implicit test results may reveal negative attitudes towards the minority group. Therefore, exposing the individual to a new stimulus, after having first triggered empathy towards the minority group, can yield change in the next explicit evaluation, but not necessarily the implicit one.

Empathy has been found to be a contributing factor on changing attitudes not only towards an individual, but also towards the group the individual belongs to. This has been particularly investigated with respect to intergroup relations and attitudes towards outgroup members [48,49], where empathy for a member of a group was related with more positive attitudes towards the group as a whole. Empathy is considered to be significant in changing attitudes in children as well [50], as shown in works investigating best practices for reducing ethnic prejudice and promoting diversity in schools [51].

2.4. Historical Awareness and Historical Consciousness

In the context of the present paper, historical awareness is largely synonymous with historical consciousness, as both terms have often been used interchangeably, or to define one another in a significant number of scientific sources [52,53,54,55,56]. In either case, the terms refer to a process of acquiring and understanding of the past, recognizing its relationship with the present and future, and thereby creating specific meaning from history [57,58]. In this respect, historical consciousness is understood as a process beyond the memorization of historical facts, chronology, and narratives, but rather the skill to interpret and find personal meaning in historical events [59].

In the field of education, historical consciousness is gaining increasing recognition among teachers and educators as a means to make history learning more meaningful, especially for students who may otherwise be disinterested in the subject [60].

2.5. Practical Implications and Motivation for This Research

Our interest in the above topics stems from the conceptual interconnections among empathy, attitude change, and historical consciousness, and their perceived significant practical implications in the social context. For instance, over the past twenty years, social scientists have been interested in changing negative attitudes towards migrants. Reasons accounting for prejudicial attitudes vary, from a social group feeling threat from outgroup members, such as an economic or cultural one [61], to the personality traits that a person possesses [62]. In such cases, it would be worth exposing the individual to a different perspective, providing an insight into people’s struggles, beliefs, and social values. Consequently, this would offer the individual a different point of view, thereby evoking empathy. Intervention programs for changing attitudes towards minority groups have been implemented, with positive results [51].

To achieve more widespread results, it is important to examine ways in which empathy can be raised in a more pervasive and ubiquitous manner. Leveraging historical empathy (whereupon one can perceive, understand, empathize, and make sense of historical events and past people’s actions and decisions [63]) in this context provides a unique opportunity, since history can hold important lessons for future generations, thereby fostering historical consciousness [60]. Major historical events and incidents of past injustices and atrocities form an important part of our collective heritage and memory, with the purpose to inform consciences across the globe based on modern societal values and moral philosophies. Memorialization of atrocities occurs through various remembrance practices, such as memorial museums, exhibits, and commemorative events [64], as well as through postmemorial fiction, most notably written works and cinema [65]. Recently, researchers and video game producers have started asking the question of whether video games are an appropriate medium for representing such contested and traumatic histories [66].

In these cases, empathy provides a vehicle through which individuals can imaginatively connect with distant people, places, and experiences from the past. Through this emotional engagement, audiences can be convinced to perceive cultural differences and social justice and be reminded of their responsibility to remember the past. This in turn can foster a deeper awareness of how the past informs present and future decision-making, thereby making audiences’ encounters with historical material socially meaningful (i.e., developing historical consciousness). Memorial museums are known to engage audiences in such empathetic responses and towards increased support of democratic values and institutions [67]. Further, scientific evidence suggests that playing a video game is a very similar experience to visiting a museum, as both trigger the same experiential modules [9]. Hence, new opportunities are opened in the context of digital heritage research for using video games as tools in pursuit of promoting education, reconciliation, and healing [68].

Video games offer a reconstruction of past places and events, allowing players to experience historic heritage virtually [69]. Such history-themed video games can be built around difficult topics to develop empathy with marginalized groups and prevent erasure of atrocities [68]. This holds significant promise due to the ubiquity and lasting appeal of video games, as well as their capacity to engage the player more vividly, as an actual actor in perspective-taking scenarios. Granting opportunities to experience events and re-enact behaviors, these games allow players to take on the role of observers, accomplices or victims in past situations [16]. In addition, “historiographical” video games (e.g., games designed by or with historians’ input [11]) can convincingly reconstruct and illustrate arguments toward empathetic persuasion. The term persuasive games (defined as games that “strive to alter or affect player opinion outside of the game” [70]) has been used to describe games aiming to change a person’s beliefs about a particular topic. Persuasive games that raise awareness on social issues and injustices, or offer a new perspective regarding humanitarian crises [71], have been developed and yet the topic remains largely under-explored and underrepresented in the literature. Thus, in the present work, we aim at informing the design of future game interventions, particularly those with a historically-themed narrative component, and hopefully motivate the development of more such games.

In staking these goals, we believe our work contributes to prior relevant meta-analyses that summarize the effects of video game play (and media in general), and their effects on empathy and prosocial behavior (e.g., [24]). Whereas prior works utilize the meta-analysis tool to verify associations between violent and prosocial video game play with social behavior, in our review we use the integrative approach [25,72] to provide a broad and diverse scope into a new perspective and conceptual understanding, one that also invites the under-represented perspective of historical consciousness. Our work is guided by three central questions: (1) how empathy, attitude change, and historical consciousness intersect (if at all) within video games research; (2) in what ways the behavioral effects of video games are explored in the context of digital heritage, and other fields; and (3) how insights from the existing literature can inform the design and evaluation of future video game interventions aimed at fostering empathy, attitude change, and historical consciousness. Given the exploratory aims of this study, we decided to adopt the integrative methodological approach, as our topic sits at the crossroads of several disciplines, including game studies, behavioral science, and heritage research, hence inviting highly heterogeneous empirical and conceptual inputs. Whereas traditional systematic reviews or meta-analyses require methodological consistency, integrative reviews are well-suited to accommodate the rich diversity of study designs, allowing us to synthesize current knowledge, map cross-disciplinary connections, and lay the foundation for a new line of scientific inquiry.

We discuss the various games employed and their characteristics, measurement tools, methodologies, sample sizes, context, and distinction between short-term and long-term behavioral change, hoping to capture recurring motifs around intervention study design, and thereby offer insight and motivations to investigate further how video games encompassing historical themes could influence player social behavior.

3. Method

Our objective is to offer game scholars and producers of video game content a comprehensive overview of the state of affairs regarding the use of video games for fostering empathy (including historical empathy, by informing historical consciousness), and motivating attitude change in players. We should note that the purpose of this work is not to critically analyze all existing literature identified. Instead, we opt to synthesize perspectives on video games and empathy and attitude change, toward concretely establishing the main ideas and relationships between these aspects, and encouraging/motivating further research and development toward games that can shape social attitudes and cultivate historical consciousness, i.e., games with significant transformational potential. We opted for this type of review as it does not aim to present extensively the literature in one specific field (especially one so fragmented), but rather to give the reader an overview of the most related work that has been carried out, as well as offer key insights and identify possible gaps for future research [72].

3.1. Databases Queried

We elected Scopus and Web of Science (WoS, Core Collection and All Databases) for obtaining the pool of relevant papers because they continue to be regarded as the top bibliographic databases in academic research [73]. As a cut-off point, our review includes works published until the end of 2024.

We first set to verify that all of the above-mentioned concepts of Empathy, Attitude Change, and Historical Consciousness (also Awareness) were indeed not studied together in the context of a video game intervention study in one single paper. This absence of studies supporting and testing the hypothesis that games can shape historical consciousness via empathy and attitude change constitutes a central finding of our review, highlighting a significant research gap and underscoring the need for further research in this area.

We then considered whether these constructs might have been addressed separately in the literature, rather than in combination. Our search strategy began with the same broad terms, related to the following four categories: (a) video games and empathy; (b) video games and attitude change; (c) video games and historical awareness; and (d) video games and historical consciousness. This would enable us to capture nuance involved in each respective research area. More specifically, we applied the following search terms:

• “video game” AND “empathy” (both databases);
• “video game” AND “attitude” AND “change” (to ensure that there are results that include a diversity of phrase such as change in attitude, attitude changed towards, etc.) (both databases);
• “video game” AND “historical” AND “awareness” OR “history” AND “awareness” (Scopus);
• “video game” AND “historical” AND “consciousness” OR “history” AND “consciousness” (Scopus);
• “video game” AND “historical” AND “awareness” OR “video game” AND “history” AND “awareness” (WoS);
• “video game” AND “historical” AND “consciousness” OR “video game” AND “history” AND “consciousness” (WoS).

The number of papers returned from the two databases are shown in

Table 1. Papers yielded from the databases Scopus and WoS (Core Collection and All Databases).

Database	Aspect	Number of Results
Scopus	Empathy	337
Scopus	Attitude Change	238
Scopus	Historical Awareness	16
Scopus	Historical Consciousness	17
WoS	Empathy	379
WoS	Attitude Change	186
WoS	Historical Awareness	4
WoS	Historical Consciousness	3

below.

We then screened each paper over multiple stages, applying concrete criteria in alignment with the purpose and aims of this integrative review. The screening procedures applied and criteria used to determine inclusion or exclusion are detailed in the following sections. We also provide a detailed flow diagram in Figure 1, with which we illustrate our elimination process from initial search results to the final corpus of included studies.

3.2. Inclusion and Exclusion Criteria

Inclusion or exclusion were directed by the relevance of each study to the constructs and methodological approach under investigation (i.e., the idea that using digital games can produce behavioral effects in players). To ensure our synthesis would be driven by concrete, observable data and evidence (i.e., from studies in which an intervention was implemented, and its effects were measured, rather than speculative or hypothetical effects), we restricted our review to empirical works reporting actual experiments or interventions (regardless of their outcomes). Hence, for a paper to be included in our corpus, conclusions needed to be drawn in it after a study with human participants was carried out, in which researchers used a video game as the intervention tool. In this way, we would ensure that outcomes and insights drawn upon them would be based on empathy and attitude change being definitively measured with at least one tool used being quantitative. In addition, we further opted to exclude works that

• Were not written in the English language, due to the linguistic barrier;
• Were not classified as a scholarly publication (i.e., abstracts, index references, opinion pieces, and grey literature were excluded from this review);
• Did not employ “video” or “digital” games (either leisure or serious) as an intervention tool. Hence, the use of mobile apps (i.e., applications relying on functional features such as menus, forms, and buttons, as opposed to game mechanics), board games, or other physical (i.e., non-digital) games were excluded as ‘out of scope’.

Since our aim was to investigate the potential of video games to induce empathy, studies which investigated if violent video games lead to a decrease in empathy or to aggressive behaviors (e.g., the 2010 analytic review by Anderson et al. [74]) were excluded.

3.3. Obtaining the Paper Pool

The search yielded initially 1180 papers found to satisfy the search criteria. First, duplicates were removed, which left us with 780 papers. These papers entered an abstract screening process, carried out to determine whether the work was an intervention study, or otherwise, if it was of relevance to the scope of the current work, as dictated by our inclusion and exclusion criteria. Prior to discarding a paper for not meeting those criteria, we scanned the full text for relevant keywords to ensure that no pertinent content was overlooked, and that the paper was genuinely outside the focus of our research. Based on this screening, 193 works remained, which were then thoroughly read and screened against our criteria. We were interested in finding sources contributing to the following aspects:

• Whether the game was employed to measure changes in player’s empathy;
• Whether the game was employed to measure effects pertaining to attitude change;
• Whether the game was employed to measure any effects on historical empathy, awareness, or consciousness.

If any of these aspects was indeed measured, the paper was included in the corpus. In conclusion, we included 61 papers in the current integrative review. The full list can be viewed in Table S2 in our Supplementary Materials.

4. Results

After obtaining our paper pool, each work was thoroughly analyzed to extract interesting data about the way researchers have designed, and carried out their interventions. We accumulated interesting insight regarding the actual video games used in the intervention (particularly, if they were leisure or serious games), the covered thematic areas, the various tools and measurement instruments used for measuring empathy and attitude change, the different outcomes, and various factors that could affect these outcomes. The current section presents the insights from these works in corresponding key thematic areas.

4.1. Video Games Used

Studies at the crossroads of empathy, attitude change, and historical awareness can be conducted with all kinds of video games. It is common place for researchers with specific hypotheses and research questions to develop their own software: Within the integrative review we found 29 papers where the games were designed and developed specifically for the purposes of the research study, with no commercialization structure in place. Considering that these studies use video games as an intervention to investigate the extent to which they accomplish a learning purpose (in other words, the research goal drives the game’s design, rather than the quality of experience on offer), we classify such games under the “serious game” umbrella term (several definitions have been proposed regarding what serious games are, yet all converge on serious game design prioritizing the learning over entertainment [75]). The most common labels used by the authors themselves for the video games used in their research are (a) serious games; (b) prosocial video games; and (c) educational games.

Given the vast number of video games released on digital storefronts on a daily basis, the use of leisure video games (used throughout this work as an antonym to “serious games”) in such studies can be both practical and reasonable. We found 18 studies which used leisure “non-scientific” games, i.e., games not created for the purposes of the research study in which they were employed. One work employed both a leisure and a self-developed video game [76]. Thirteen studies do not provide information regarding the developer. We retrieved the related information by examining sources external to these papers. Out of the 13 games utilized in these papers, four (4) were found to be leisure games, and nine (9) were classified as serious games.

We provide a complete list of all game references in these studies (referred to as a “ludography”) in Table S1 of our Supplementary Materials, providing details regarding which version of a particular game was used in each study. We also compile an integrated inventory of the game mechanics that characterize each title, referring to their reported potential to produce behavioral effects aligned with each study’s aims and purpose. These elements are presented as a compendium that can inform the design of new game experiences, cross-referenced with each study and its reported findings.

4.2. Themes Explored

4.2.1. Themes in Papers Exploring Empathy

The main themes observed in the identified studies include (i) investigating if video games can enhance empathy towards people, i.e., from a different ethnic background [77,78,79,80,81,82,83], or people with disabilities [84]; (ii) the use of video games as an intervention for raising players’ awareness on issues such as mental health [85] and poverty [86,87]; (iii) educating players, for instance, about gender-related matters, such as child marriage in third-world countries [88] and gender-based violence [89]; and (iv) use of video games as tools for school-based prevention programs (e.g., cyberbullying prevention [90]) and for the promotion of sports prosocial behavior among athletes [91]. The capacity of games to raise empathy towards virtual characters [92,93,94,95] and environmental issues [96] is also explored. In three works the potential of video games to elicit empathic experiences [97,98] or historical empathy [99] in general is investigated, whereas in one study [100], empathy is implied through a game focused on cleaning up waste.

4.2.2. Themes in Papers Exploring Attitude Change

In terms of informing and fostering attitude change towards socio-political topics, few works were identified. Alhabash & Wise (2012) [6] and Cuhadar & Kampf (2015) [101] provide insight on video games as a means to change attitudes regarding armed conflict in the Middle East. In a similar study, Kampf & Nicolaidou (2024) [76] examined the effect of two video games on multiperspectivity regarding two different conflicts, studying aspects such as the order in which the games were played, or the impact of only experiencing one of the games. The role of perspective-taking in influencing willingness to help immigrants is investigated in [19]. Kolek et al. [102,103] have investigated short- and long-term effects of video game play on players’ attitudes regarding contested histories. In their meta-analysis [23], they conclude that video games with a narrative component can affect players’ attitudes towards the depicted content, highlighting them as potential vehicles for players attaining historical awareness. Shliakhovchuk (2024) [104] conducted an experimental study where three video games were played by three experimental groups to assess the video games’ capacity to educate about social issues. Jimoyiannis et al. (2022) [105] have carried out a study aiming to explore if a game-based intervention is effective in changing higher education students’ attitudes towards their EU identity.

Other examples include the work of Hawkins et al. (2019) [106], wherein the goal was to educate children about animal welfare, and thereby foster positive attitudes, as well as the more recent works of Sharratt et al. (2023) [88] and Gonzalez et al. (2022) [107] regarding use of a video game to prevent child marriage in Uganda and raise awareness of gender-based violence, respectively. Four studies [108,109,110,111] employed video games with the aim to explore their influence on pro-environmental attitudes. One study used simulation games to compare their effectiveness against traditional lecture-based education in teaching students about accessibility and changing their attitudes towards people with disabilities [112]. Change in attitude towards the use of video games as part of the curriculum has also been explored [113]. Ruggiero [114] has explored the extent to which a social impact game can influence change in attitude towards the homeless.

Important insight on the effects of video games on attitude change can be obtained from studies which speculate about the capacity of video games to trigger better decision-making, mostly regarding self-improvement through the adoption of a healthier lifestyle. In this respect, several works investigate video games as tools for increasing knowledge regarding healthy and nutritional food choices, decreasing the amount of alcohol consumption, and acquiring knowledge about the negative impact of drug and tobacco product use [115,116,117,118,119,120,121,122,123,124,125,126,127]. Along the same lines are studies that aim to increase awareness about medical issues, and use video games as prevention tools [128,129,130] or as a medium to educate in this field [131]. Similarly, one study used a video game to foster understanding about the seriousness of a pandemic [132].

4.3. Assessment Instruments

Various tools have been used for measuring empathy and attitude change. The purpose of this section is to identify tools that have already been checked in prior research for validity, reliability, and appropriateness for being used in video game intervention studies, hence compiling a useful repository of common tools and scales for interested scholars (Figure 2). A complete listing of available assessment instruments and tools for measuring each of these constructs (regardless of the method of intervention) is beyond the scope of this present work. Yet, we indicatively suggest the works of Neumann et al. [37], which focuses on three types of approaches to measuring empathy, and Goodall [133], offering insights into implicit attitude measures regarding these two topics.

Out of the 61 papers, 18 papers measured empathy, 36 measured attitude change, and 7 measured both. One intervention study explicitly measured historical empathy using a self-developed questionnaire [99] and one study derived a measure for historical awareness via association with attitude change outcomes [102]. Our findings highlight the need for more work towards establishing concrete evidence regarding gameplay and the fostering of historical awareness, as an antecedent of achieving historical empathy [63].

4.3.1. Empathy Assessment Tools

Out of the 26 studies in our integrative review measuring empathy (either alone or in tandem to attitude change), 19 employ/incorporate tools reported in the scientific literature, which have been used by other researchers in other studies, whereas in 5 works, researchers developed their own assessment instruments (in the form of questionnaires) for the purpose of their specific research [92,93,99,104,134]. In one (1) work, the researchers employed both a pre-existing evaluation tool and a self-developed one [94]. In Sharratt et al. (2023) [88], details regarding the employed instrument for measuring empathy are not provided.

Tools used across the 19 papers include the Basic Empathy Scale and the Empathy Quotient, which are popular measures for assessing empathy. The Interpersonal Reactivity Index (IRI) [135], a standardized measurement commonly used when assessing empathy, was also leveraged in four of the studies [87,94,97,136]. Such tools were utilized in either their original form or they were adapted to fit the specific nature of each study.

4.3.2. Assessment Tools for Attitude Change

Eighteen (18) out of the 43 studies assessing attitude used self-developed tools, i.e., questionnaires developed specifically for the purposes of each particular study. Hence, a different questionnaire was used in each study. Using statements where participants had to respond the extent to which they agree, or disagree, seems to be an effective way to measure change in attitude [126].

Eight (8) papers investigated the effect of video games on whether they trigger change in players’ explicit and/or implicit attitudes [6,23,102,109,110,111,119,124]. Six (6) of those employed indirect measures [6,102,109,110,111,119], such as Affective Misattribution Procedure Tasks (AMPs) [137], the Implicit Association Test (IAT) [138], and the Single Category Implicit Association Test (SC-IAT) [139], to assess change in implicit attitudes.

4.4. Reported Outcomes

4.4.1. Empathy Outcomes

Studies in our paper pool seem to lack consensus on whether empathy comprises both a cognitive and an affective component (see Section 2.2). We found that out of the 25 works where empathy elicitation is measured, about 32% take both the cognitive and the affective components into account [77,81,88,89,94,97,98,100]. Less than 9% of the collected works assess change using the affective component alone [82,93], whereas for the remainder of works, details on whether a distinction between components was made are not provided. Monitoring the change in both the cognitive and affective empathy components can lead to designing more effective interventions, especially when presented with serious social issues, such as violence against women or unfair treatment of immigrants. In fact, studies have shown that any one intervention may not have the same impact on these two aspects. For instance, Boduszek et al. (2019) [89] found that their video game intervention for battling gender violence had a stronger effect on affective empathy than cognitive empathy. Several works also refer to different forms of empathy (i.e., trait empathy, situational empathy, global empathy, victim-specific empathy, dispositional empathy), which depend on the purpose of their work, and the research questions or hypotheses they form. The correlation between two different forms of empathy may be examined, as in [78,94].

For studies measuring the effect of video games on empathy, the results may depend on game-related variables (i.e., design features, or characteristics that the game obtains as a result of design choices), which may have mediation effect on empathy. For instance, Bachen et al. (2016) [78] report that presence (i.e., the psychological state of feeling like being inside the virtual world, and perceiving it, and all of its interaction affordances as real [2]) can positively influence empathy. In Wulansari et al. (2020) [97], a stronger correlation was found between empathy and immersion (i.e., the capacity of a video game to be both engrossing and engaging, often used interchangeably with the term flow [140]), rather than presence and empathy. The difference in the results could be attributed to the different questionnaires used, the size of the sample, the different age that participants of the studies belonged to, and the difference in the video games used (simulation game versus narrative-driven). This can also be a result of the type of sensation associated to the constructs of immersion and presence, where the former implies a temporary change in the player’s state of consciousness, whereas the latter does not [140]. Further work in this direction is therefore warranted.

Whether the game includes interactions with virtual characters, and visual characters’ impact on players’ empathy, is also investigated. In MacDorman (2019) [93], the influence of non-player characters (NPCs, e.g., a heroic doctor vs. a villainous doctor) on players’ emotional empathy was investigated. Rativa et al. (2020) [94] investigated the impact of different design features related to the virtual game character on situational empathy and immersion. Here, the results showed that the physical appearance alone did not affect situational empathy. However, the alignment between the physical appearance and the expressiveness of the virtual character impacted the level of situational empathy.

Other research directions explored in relation to empathy and video game-based interventions include characteristics and traits of the players themselves, and whether they contribute to the change (if any) in empathy after gameplay. For instance, Rativa et al. [94] measured dispositional empathy before the intervention, showing that it is related to the situational empathy towards a virtual character. In Bachen et al. (2016) [78], one of the hypotheses of the study is that baseline global empathy, which was measured before the game, will have a positive impact on game-specific empathy, with the results supporting this hypothesis. Finally, Sterkenburg & Vacaru (2018) [84] investigated the influence of personal distress on the change in empathy in a case of healthcare professionals working with people with disabilities. Although empathy did not increase significantly after the intervention, the researchers reported a decrease in personal distress in the experimental group.

In the studies included in this integrative review, not all the results were positive. Both Sterkenburg & Vacaru (2018) [84] and Chen et al. (2022) [80] reported that no significant improvement in empathy was shown. Participant characteristics (e.g., their age), alongside the different mechanics implemented in the video games used, might be reasons for this.

4.4.2. Attitude Change Outcomes

Results on whether video games can elicit attitude change towards issues have not reached consensus, both because of the few studies carried out (we found 8 papers investigating the effect of video games on change of participants’ explicit and/or implicit attitudes [6,23,102,109,110,111,119,124]), and because in some studies, video games were reported to be effective in achieving attitude change [126], whereas in others, attitude was maintained at the same levels as before the intervention [92]. Similar conclusions can be drawn from studies where video games were used for acquiring nutritional knowledge. Again, scholars reached different conclusions (e.g., positive effect in [121], and no effect [124]).

A factor which may impact attitude change is that of role-taking, which is reported to play an important part in perspective taking. The latter is a mechanic enabling video game players to understand other people’s mental states, and, consequently, contributing to decreases in prejudice and stereotyping [19]. However, the role assigned to the playable/perspective character is related to whether participants exhibit attitude change [6]. Further, this change occurred on the explicit rather than on the implicit level. These results are not surprising, considering that implicit evaluations towards an attitude object take more time to change because they are automatic, and thus more difficult to control [141]. This is further supported in the findings of Kolek et al. (2021) [102], where explicit and implicit attitudes towards a historical topic are measured immediately and one month after the intervention. The results of the study confirmed short-term and long-term explicit attitude change in the experimental group, but no significant change in short-term and long-term implicit attitude. Attitude change can also be influenced by the content of the game and personal closeness of players to the depicted subject matter [101]. When exposed to a video game that allows players to learn about different conflicts around the world, participants exposed to a scenario where both sides of the story were depicted acquired a more impartial point of view compared to participants exposed to a scenario that showed one side of the story.

In investigating attitude change, it is important to account for study participants’ pre-existing attitudes towards the subject matter. For instance, Alblas et al. (2018) [119] found that nutritional knowledge games can trigger change in the implicit attitudes of people who had a healthy implicit attitude towards food at baseline, whereas they can have an adverse effect on people with less healthy attitudes. The authors explain this by mentioning that people with pre-established negative beliefs may be more resistant to the game’s persuasive messages. Barwood et al. (2020) [123] also point to the ceiling effect affecting the outcomes of a study, where high pre-game attitude scores may account for attitudes of participants in the experimental group not changing significantly compared to those in the control group.

Because of such prior dispositions, the possibility of a game to have a negative rather than a positive effect is not to be understated. In Roussos & Dovidio (2016) [92], a persuasive video game was used as a means to change the beliefs towards the poor. Meritocracy beliefs of the participants were measured before playing the game. The results showed that in the experiment condition, meritocracy had no effect on attitudes, whereas the game actually had a negative effect on those with a lower score in meritocracy compared to the control group. In Ruggiero (2015) [114], where the same game was used, the effect of the game on attitude change in the experiment group was not significantly higher compared to the control group. However, after three weeks, the level of attitude was maintained in contrast to the control group. One factor that mediated the results in Roussos & Dovidio (2016) [92] was the fact that emphasis was placed on the aspect of personal control. Thus, the authors suggest that different elements may affect attitude change towards other social groups. Also, placing emphasis on one side of the story can potentially lead to undesirable outcomes. In Peña & Hernández Pérez (2020) [19], during which participants played the role of an immigrant inspector, results showed that attitude towards helping immigrants decreased compared to baseline scores. These findings support those in Cuhadar & Kampf (2015) [101], and highlight the emphasis that must be placed on the importance of depicting all sides of a story and on an equal manner, particularly when the scope is to promote peace-building, thus contributing to a more balanced perspective.

In conclusion, results from these studies are contradictory, pointing to the fact that, if attitude change indeed occurs, this happens under certain conditions [23].

4.5. Moderating Factors

4.5.1. Gender

According to traditional assumption, females possess a higher capacity for empathy in comparison to males [142]. This aspect is explored in 23 out of 61 studies in our paper pool, where researchers examined whether players’ gender factored into the outcomes of the interventions, with contrasting conclusions. On the one hand, several studies seem to confirm the hypothesis that females exhibit a higher level of empathy before and after the intervention. In Bachen et al. (2012) [77], where global empathy was measured, females scored higher than males. Further, higher empathy in females was shown after an intervention through the use of a VR game in the context of environmental education [96]. In Mukund et al. (2022) [81], females scored higher in affective empathy than male participants before the intervention. However, no significant increase was observed after the intervention for either gender. In Wulansari et al. (2023) [98], females scored higher in the measurement of empathy after gameplay compared to males, but the increase was higher in males compared to the pre-test scores. Interestingly, this latter analysis showed that males scored higher in the cognitive empathy scale, which does not align with the results of Davis (1980) [143], where women scored higher in both cognitive and affective empathy. In Li et al. (2023) [100], where effects were measured on children aged 4–6, the study found that the link between empathy and subsequent sharing behavior measured by means of the dictator game was more evident for girls rather than boys, although the game had a similar direct impact on their Basic Empathy Scale levels. Contrastingly, in Smith et al. (2017) [86], Hilliard et al. (2018) [136], and Chen et al. (2022) [80], no significant difference is noted between females and males with respect to their empathy after the intervention.

Contrary to the aspect of empathy, findings regarding the attitude change across genders show a similarity. Out of the 15 studies assessing attitude change, where the effect of gender is analyzed, 13 showed no significant difference regarding gender. This aligns with the findings of the meta-analysis by Kolek et al. (2023) [23]. Gonzalez et al. (2022) [107] found that their video game managed to raise awareness on sexist behaviors overall, and that participants’ responses to specific statements regarding violence against women differed between males and females. One potential reason for this could be that women are afraid of the social stigma that may be attached if abuse against them is disclosed [144]. Alblas et al. (2018) [119] revealed a difference in the results of the implicit-association test (IAT) between males and females. Although a decrease in IATs was noticed in participants after the video game intervention, it was predicted that females were more likely to choose an unhealthy snack compared to males. Females had a lower healthy IAT score compared to males before the intervention.

4.5.2. Duration of the Intervention

There appears to be no uniform strategy regarding the length of the intervention, either in terms the study duration, the length of the gameplay intervention session, or the number of gameplay sessions.

Thirty-one (31) of the studies report that gameplay lasted between 10 min and two hours in one game play session. In 10 studies, exposure to the intervention lasted no more than three weeks [19,77,89,91,108,116,122,124,125,136], allowing multiple sessions, whereas in 5 studies, participants played the video game several times between 1 and 4 months [81,87,120,121,128]. In Garaigordobil & Martínez-Valderrey (2018) [90], participants played the video game for one hour once a week throughout an entire (Spanish) school year. Concrete data is missing in 14 of the studies in our paper pool [82,83,85,88,93,97,101,104,107,123,126,130,131,132] (Figure 3).

Regarding the duration of the study, 40 employ a cross-sectional approach, where potential outcomes of the intervention on participants’ empathy and/or attitude change are analyzed at a single point in time, usually immediately after the gameplay session, or the day after the completion of the intervention. Seventeen (17) studies observe changes in participants with the assessments varying between two days and 9 months after the completion of the intervention, employing posttests and delayed posttests, with the exception of Olivet et al. (2019) [128], who administered assessments 2 weeks after the intervention. In three studies, the time when the assessment took place is not stated explicitly [81,94,123] (see Figure 4).

The results of the studies employing delayed posttests are inconclusive. Herrera et al. (2018) [87] investigated the short and long-term effects of perspective-taking on homelessness, comparing mental imagery (via narrative) with VR perspective manipulation. They found that VR perspective-taking improved empathy immediately after the intervention, but there was no difference two, four, or eight weeks after the intervention. However, whilst the level of attitude was similar in both conditions, in the VR perspective-taking condition, attitude was shown to improve over time. Continuing on the subject of homelessness, Ruggiero (2015) [114] compared the effects of the video game Spent to a textual description using the Attitude Towards Homelessness Inventory (ATHI) [145], immediately and three weeks after the intervention. Whereas a change in attitude in the video game condition was not immediately evident, the researchers noted the video game’s effect after three weeks.

In Boduszek et al. (2019) [89], the results on empathy were different to those in Herrera et al. (2018) [87], as the affective responsiveness did not change between the two post-intervention time points (after the game intervention and one week later). This suggests that video games may have a sustained effect over a longer period of time. However, this was not the case for cognitive empathy, where the effect of the intervention was not significant.

Smith et al. (2017) [86] found that the video game had a positive impact on attitude towards the poor immediately after the intervention, which was sustained after 9 months. The possibility of attitude change being sustained over a longer period of time was also shown in Kletenik & Adler (2023) [112], where the researchers compared the effect of five games that simulate various audio/visual and physical/motor disabilities against watching a video and reading about them. The authors measured attitude before and after the interventions and several weeks later (4–6 weeks interval), with results showing that in the case of the simulation game a change in attitude was observed in the final survey, in contrast to the control group.

In Olivet et al. (2019) [128], participants played a video game for one hour to test if it manages to improve the attitude of people experiencing first episode psychosis (FEP) towards treatment and recovery. The participants completed a number of questionnaires, including the Recovery Attitude Questionnaire [146], before and two weeks after the intervention. The game had a positive impact on improving participants’ attitude towards recovery. Jimoyiannis et al. (2022) [105] investigated if an educational game can contribute to participants’ understanding and perceptions of socio-political issues regarding European identity, over an assessment carried out one week after the intervention. In both studies, attitudes towards the investigated topics showed improvement. However, the questionnaires were not administered immediately after the intervention, so a comparison between immediate and longer-term effect cannot be estimated.

In Espinosa-Curiel et al. (2020) [121], a measurement assessing food frequency intake of healthy food four days after the video game intervention had to be filled by participants, supplemented by the parent perception questionnaire, which aimed to examine if participants’ parents noticed a positive change in their children’s attitudes toward healthy eating behaviors within 1 week. The students reported an increase in the frequency of consuming healthy foods compared to baseline, while their parents reported that the video game positively impacted the eating behavior of their children. However, a longer interval between the intervention and the measurement is needed to evaluate the long-term effects of the video game.

Kolek et al. (2021) [102], who explored the impact of a historical video game on explicit and implicit attitudes, administered implicit and explicit measurements immediately and one month after the intervention to investigate a change in the explicit and implicit attitudes, with results showing an improvement in the explicit (but not in the implicit) attitude after one month.

In Diehl et al. (2017) [131], a subscale of “attitudes” assessing beliefs and attitudes towards diabetes and insulin had to be completed by primary care physicians immediately after and three months after the intervention. The results showed that the difference was significant mostly between the pretest and the immediate posttest, but not between the pretest and the assessment after three months, indicating a moderate impact of the video game in the long term. However, the low internal consistency of the attitude subscale might explain this result.

4.5.3. Entertainment

In a considerable number of studies, the aspect of enjoyment is not measured at all, although it is emphasized that the more a player enjoys a video game, the more likely they will retain information in it [147].

There is extremely limited structured research into how enjoyable qualities of video games mediate empathy and attitude change to produce meaningful outcomes. Tools measuring the game’s entertainment value (if at all) once again vary. In six studies, the extent to which participants enjoyed the video game is measured via questionnaires developed by the researchers themselves [104,107,120,123,125,131]. Qualitative methods, such as via (semi-structured) interviews have also been employed [88,129,148]. Validated tools are used in seven studies. More specifically, the Intrinsic Motivation Inventory [149] is used in two studies [118,129] to measure dimensions of experience, including enjoyment, effort, and competence. In Chan et al. (2023) [99] the Flow Scale for Games (FSG) [150] was used. In two studies [94,95], a game immersion questionnaire developed by Jennett et al. (2008) [151] was administered. In Wulansari et al. (2020) [97], the employed tools include the Immersive Tendencies Questionnaire (ITQ) and the Presence questionnaire (PQ). The IMI, the FSG, the game immersion questionnaire, the ITQ, and the PQ are validated [151,152,153]. Klisch et al. (2012) [116] employ a satisfaction scale, which is reported to have been validated in previous studies. MacDorman (2019) [93], who assessed narrative enjoyment with different in-game characters, found that empathy was a predictor of this aspect.

The results indicate that the researchers measure specific aspects of the video game experience (e.g., immersion, presence, satisfaction) and not the aspect of video game experience and entertainment as a whole. In some of the studies where aspects of enjoyment are measured through questionnaires, the impact of these on empathy or attitude is not explored to identify if there is a correlation between these two elements [99,107,118,120,125,131]. This occurs in Shliakhovchuk (2024) [104], where the researcher explores the correlation of enjoyment with attitude, with results showing a positive correlation. More specifically, enjoyment had a positive impact on empathy and denial, but not on knowledge and willingness to help.

5. Discussion

Key takeaways point to several interesting future research directions, towards grasping video games’ untapped and underexplored potential for delivering meaningful experiences, which can have a positive impact on players’ attitudes. Additional work is warranted to complement the current discourse, and concretely establish the psychological-influencing properties of video games, in terms of whether they can foster empathy or elicit attitude change. First of all, the diversity in methodological design, conceptual inconsistencies, and the employment of different video games make the comparison of results difficult. Methodological flaws such as incorrect choice of a measurement tool or administration of non-standardised tools, lack of delayed posttest measurement, and not taking into consideration the fact that specific measurement tools may favor a particular group of participants over others may influence the reliability of the results.

In addition, video games have been inspired by, and have incorporated, historical themes in their content for decades. However, their potential to foster historical consciousness, along with the design elements that can influence this outcome, has been limited. Indeed, Spring [154] argues that the popularity of incorporating historical content in a video game provides historians with the opportunity to create scholarly games by leveraging attractive video game features to convey ‘detailed historical information’. Further, video games can be an engaging tool for teaching history in the classroom [155], or generating authentic representations of the past [12]. However, historical consciousness, which is a process more involved and complex than the memorization of mere historical facts, has been given much less attention in the scientific literature examining video games. Thus, it requires further scientific contributions.

Prior works acknowledge video games’ ability to encourage historical thinking and foster memory-making [154,156], including those primarily developed for entertainment [157]. Potzsch and Sisler (2019) [156] investigate the potential of two video games in memory making by adapting the framework by Rosenstone [158] for categorizing historical films and the methodological framework by Erll [159] for historical film analysis to the field of video games. Within these frameworks the authors assess whether the mechanics of the two analyzed games contribute to memory-making, pointing out that memory-making potentials is present in both video games. For games to function as tools for historical inquiry, Bazile [11] proposes drawing parallels to historiography. More specifically, he suggests that ‘historiographical’ video games should strike a balance between (a) hisorical vs. ludic mediation; (b) linearity vs. interactivity; (c) the choice to integrate external reference material vs. maintaining the game’s immersiveness; and (d) concealing vs. revealing the historiographer’s presence in the game’s design. For video games to foster historical consciousness, this stresses the importance of carefully thinking about what design elements to incorporate and how to strike a balance between the educational and entertainment value.

Finally, in addition to conceptualizing and designing new game experiences, the ability to critically assess and evaluate the extent to which video games can foster historical consciousness will become equally important for game and heritage scholars alike, much like how scholars in behavioral studies examine the effects of games on empathy and attitude change. This could be addressed by developing validated or standardized questionnaires, which would allow researchers to examine the capacity of games to stimulate reenactive historical empathy as a source of attitude change on contemporary social justice issues [160].

In the following sections, we delve deeper into the insights derived from our analysis, discussing the results, and proposing outlets for future research for each of the thematic areas explored.

5.1. Video Games Used

As stated in Section 4.1, in most studies, the video games used were developed for the specific purposes of each study, and rarely have these games been re-examined in subsequent research. This is a common practice considering that existing commercial/leisure video games, developed without the specific scientists’ input, may not be suitable for the objective of the study [161]. However, when such video games are not shared, or otherwise reused in more than one study, validity of results might be threatened, as researchers cannot compare their results with other similar studies [162]. There is also the problem of researcher bias, meaning that researchers may subconsciously introducing a condition that they unconsciously prefer [161].

To facilitate the research landscape, scholars could agree on a list of games that are easy to acquire, such as leisure games commercially available off-the-shelf, without implying that all such video games are indeed suitable for use as scientific instruments, since the impact of a video game may depend on factors such as their genre [163]. Leisure off-the-shelf games offer researchers verified, pre-made tools, specifically tailored to conveying particular messages and historical arguments, making them easier to incorporate in the context of an intervention study around a particular topic [81]. Leveraging such games will spare a considerable amount of time from the study preparation phase, allowing researchers to focus on the design of the intervention, rather than that of the games themselves, also alleviating pain points, such as researcher bias.

Although there is skepticism around adopting commercially available leisure video games as interventions, because they are mainly created for profit, their high production quality should not be overlooked, since more money is invested in the development of such video games than in research [164]. In addition, commercially successful video games have been created in collaboration with non-gaming disciplinarians, researchers, and individuals, such as Hellblade: Senua’s Sacrifice, which addresses the serious and often contradictory topic of mental illness in a respectful way [165], despite being a commercial hit. In our review, although the number of commercial, off-the-shelf leisure games is low, the results of the studies showed a positive impact on empathy improvement and change in attitude.

Researchers should take into account a list of criteria before choosing a video game to center an intervention study around. Existing models for choosing commercial off-the-shelf games for use in classroom settings [166] could offer insight into this aspect. To ensure high levels of participant engagement and motivation, games can be selected by taking into account quality criteria for serious games [167], design aspects driving the game characteristics specifically associated with meaningful play, such as competent emotion-eliciting storytelling and high-quality production values [168], or whether the games are generally/universally considered to be ‘good’ by gamer standards [81,85]. On the other side of the scale, age-appropriateness of the game content in a leisure game might come into play as an ethical barrier, as some games might not be suitable for a particular target audience [97]. In such cases, a thorough selection process similar to Li et al. (2023) [100], where 120 qualified participants were asked to rate six leisure games for their suitability to be used as the “prosocial” and “neutral” game, based on their perceived Enjoyment, Difficulty, Prosocial Content, Prosocial Scene, and Engagement and Action, could be employed.

We offer a list of leisure off-the-shelf game references in our ludography (Supplementary Materials, Table S1), with the added benefit of each item on that list having already been used in at least one prior study, for the sake of replicability. We hope this will encourage interested scholars to fast-track their research, and allow them to compare their results to antecedent work. Table S2 in the Supplementary Materials overviews the synthesis of our literature review, associating also each study with its corresponding intervention game. When games are marked as “own work”, the study is referred so that interested scholars can gather the necessary information about the original research team’s design goals and methodology, in hopes of driving the development of new and advanced game prototypes to be added to this pool.

Considering user behavior can be influenced by specific game aspects, we also outline a list of game mechanics, elements, and design considerations proposed as drivers of behavioral effects in the reviewed studies. Affordances, such as perspective-taking, role-playing, interaction with non-player characters (NPCs), and multiple-choice decision-making are cited more often as pathways through which games may foster empathy, shape attitudes, and influence historical consciousness, but thorough mapping of such elements (or the effects of their combination) is not explored by all the researchers. We believe a more systematic framework for understanding how specific design features (i.e., mechanisms, preconditions, game mechanics, features, elements, and goals) can be used to achieve these outcomes would constitute a more significant contribution, and one we aim to address in future work.

5.2. Assessment Instruments

Based on our findings, researchers have implemented a variety of tools to measure empathy and change in attitude.

5.2.1. Empathy Assessment Tools

In terms of empathy, our results remain consistent with those in Neumann et al. (2015) [37], who provided an overview of measures for assessing empathy. Results confirm the abundance and diversity in approaches to measuring empathy. There are reasons for this. For one, prolonged interest in empathy assessment in diverse fields has led to a lack of consensus regarding its definition, or on the conceptualization of empathy [22]. In the current review, we found at least eight different types of empathy, three of which not mentioned in Schrier & Farber (2021) [22], namely situational empathy, victim-specific empathy, and dispositional empathy, whereas only a few studies make a distinction between affective and cognitive empathy components. Also in one case, empathy was used as an alternative to other terms, such as empathic concern [79]. Agreeing on a definition for empathy is a long-standing challenge, since the concept of empathy is quite complex in itself [38]. Relevance of empathy in a variety of disciplines also factors into this challenge. Due to empathy being considered a desired trait for developing healthy human relationships, and the fact that it can be applied to many contexts, it has attracted the attention of professionals representing disparate fields, from philosophy to neuropsychology [169], with each field approaching the concept differently. As proposed by Schrier & Farber (2021) [22], standardization regarding the definition of empathy should take place, which will be done with the collaboration of experts from different fields, something that will provide a fertile ground for a common understanding between them.

Another issue stems from the inherent differences in the situations in which empathy is exhibited [37]. For example, assessing empathy increase towards victims of gender-based violence may require a different tool from assessing empathy fostered towards minority groups. Additionally, characteristics of the population assessed in the research sample (such as age) may influence the type of empathy tool to be administered. For instance, assessing empathy in young children requires a questionnaire that should be short and clear [170]. Future researchers should also consider finding means to assess empathy by including items in self-reports that would potentially minimize response bias [171].

5.2.2. Assessment Tools for Attitude Change

Much like empathy, attitude is an inherently difficult concept to grasp and quantify. This is reflected in the included works, where self-developed questionnaires were deployed in a considerable number of studies. Furthermore, the studies exploring attitude rarely use questionnaires that have been validated in previous studies. As is the case with self-report measures, direct measures for evaluating attitude are subject to response bias, such as exaggeration or denial [172].

Interestingly, very few studies consider the implicit and explicit aspects of attitude, so researchers may not have acquired all the necessary evidence about participants’ perceptions. Something as subtle as implicit attitudes can be captured via indirect measures. Indirect measures reveal information regarding a person’s beliefs that the person may not know they hold [173]. Such indirect measures differ from self-reporting measures in that they assess automatic evaluations [45]. Thus, future research studies could supplement direct with indirect measurements with the aim to have a broader picture about an individual’s evaluations towards the attitude object.

5.3. Reported Outcomes

Our results in terms of types of empathy align with the results of the systematic literature review of ‘empathy’ and ‘games’ by Schrier & Farber (2021) [22], who also found that there is not an alignment in the type of empathy examined in the literature. Our analysis of the included studies’ results and outcomes points to the need to examine both the affective and cognitive dimension of empathy, when designing a video game intervention study, since the two elements appear to be independent from each other, and change in them may not happen on the same time or on the same level [89]. The difference in the effect of the intervention on affective and cognitive empathy might stem from the fact that affective and cognitive empathy are two independent systems, requiring different processes to be developed [88]. Hence, a more repeated and longer-period intervention may be needed to achieve significant change in cognitive responsiveness [89]. This aligns with the findings of Sharratt et al. (2023) [88], who showed that the mediating effect of the game was significant neither after the completion of the intervention nor one week after its completion on the affective and cognitive responsiveness.

In a similar light for the attitude change case, there are sparse studies taking into consideration implicit and explicit attitudes. Studies reveal that different processes are involved in these two different kinds of attitudes, and through implicit measurement researchers unlock access to participants’ beliefs that participants are not aware they possess. The different processes involved in the implicit and explicit attitudes may also explain the fact that implicit attitudes were more difficult to change than explicit ones in the studies that measured both of them. In addition, certain gameplay elements considered to influence shifts in attitudes were shown not be always effective, which was particularly prevalent in the case of perspective taking. The characteristics of a player’s beliefs towards a subject matter may also play a role in the extent to which a video game will have the desired results. All these aspects should be considered when researchers design their study.

In some works, researchers posed the question if video games can create empathy towards specific groups of people, but a tool to measure attitude was used instead (e.g., [86,112]). This may be an indication that some kind of increase in empathy has occurred, as empathy has been shown to foster positive attitudes both in children and adults [48,174]. When attitude is assessed towards specific subject matters, such as poverty or disability, and the aim is to use video games as training tools in specific fields (e.g., in healthcare [84]), this could be accompanied by also administering an empathy measurement. However, future research should make a clear distinction between these two terms. This will result in the successful choice or design of instruments that accurately measure empathy and attitude change.

This leads to another finding relating to the limited number of works examining empathy and attitude change in tandem. The role of empathy in decreasing prejudice and changing attitudes has been well researched in the field of social psychology. As already mentioned, empathy-inducing techniques have been implemented in workshops focusing on conflict resolution and peace with the aim to improve attitudes towards outgroup members [38]. Empathy-building has also been shown to be a strong antecedent to advocating for social justice [160]. This is contrasted in Roussos & Dovidio (2016) [92], exploring the influence of video games on empathy and attitudes, where the results showed that although empathy increased, an effect on attitude was not found. Despite evidence showing that empathy can play an important part in reducing prejudice, findings from video-game research, where increased empathy does not always result in attitude change, highlight the need for further investigation into whether games can effectively foster empathy that leads to meaningful attitude change.

5.4. Moderating Factors

5.4.1. Gender

Several interesting conclusions have been derived from examining empathy outcomes regarding gender, which warrant further inspection. For one, the choice of measurement tools could introduce some level of bias. For example, the IRI, which was used in the study for the assessment of empathy in Wulansari et al. (2023) [98], has been found to be a questionnaire in which women tend to score higher than males in all subscales [175]. Furthermore, the higher score in empathy measurement by females may be attributed to social desirability [176], meaning that people may respond to questionnaires based on social expectations [177] and the fact that empathy is believed to be an attractive trait, based on stereotypical beliefs regarding gender roles [142]. One of the more interesting aspects relating to this topic was reported in [77], who found that empathy can be induced in males and females by different design elements. Their study on the extent to which flow, presence, and character identification affect players’ empathy revealed that the female participants’ game-specific empathy was influenced by presence, while the male participants’ game-specific empathy was influenced by flow. Consequently, different aspects can be considered when designing a video game, ensuring that empathetic experiences can be offered to players regardless of their gender.

5.4.2. Duration of the Intervention

Despite being a more practical approach, cross-sectional studies prevent researchers from establishing whether changes in empathy or attitude change after playing a video game (if any) are sustained over a longer period of time, since related tools are not administered at a later time point. Particularly, the effect of video games on attitude change may become visible after a significant period of time, and not immediately after the intervention [87,114].

Although playing a video game in one session comprises a limitation, it is a common practice when using video games as an intervention, since our findings show that in a significant number of studies, participants were exposed to the video game only once. Also, researchers in most such cases have not measured the effect of the intervention at a much later point in time. This has been shown to reveal useful insights into the impact of gameplay interventions, since, according to some studies, change in attitude or behavior may not persist ‘in the long term’ [178,179]. We also observed heretogeneity in the gameplay session length. This may be attributed to lack of resources, and the fact that in longitudinal studies there is the threat of attrition [180], which constitutes one of the main difficulties when conducting a longitudinal study.

In addition, longer-term assessments should be implemented to fully understand if the impacts of a video game on empathy and attitude change are long-lasting. Exposure to the video game multiple times over a longer period of time may positively affect a change in attitude and behavior [124], and may sustain the increase in empathy and attitude [126]. Initial evidence is provided by the 2023 meta-analysis of Kolek et al. [23], who found that repeated exposure to a video game may not influence explicit attitudes, but may have an effect on implicit ones. However, the authors state that further examination is required on this issue. Future studies could also benefit from simulating real-life gameplay, with sessions lasting the same amount of time as the average game play [181]. It would also be interesting to explore if there is a threshold when it comes to the length that an intervention should last, after which the video game has no effect on empathy or attitude change, and the intervention no longer benefits individuals. In this case, several factors should be taken into consideration, such as individual differences (e.g., how empathetic a person is pretest, or individual beliefs towards the topic explored in the video game).

5.4.3. Entertainment

Universally, video games are considered an outlet for entertainment. However, studies have shown that entertainment qualities of video games (related mostly to how the game is played, i.e., gameplay) are not necessarily intertwined with those qualities considered important for making players have meaningful experiences (i.e., offering a deeper understanding of the human experience) when playing video games (related mostly to story and characters) [182,183]. Whereas serious games, by definition, do not prioritize entertainment [75], offering an enjoyable experience is an important quality aspect to be considered in the design of such games [167]. Also, leisure games hold strong potential to impart meaningful life lessons, which players can apply outside of the game environment [184].

Enjoyment is a vital part of entertainment [185]. If a video game does not offer enjoyment, people may not be motivated to continue playing it, leading to a decreased potential on their affirmative impact. Despite this, our analysis showed that the entertainment aspect is not investigated in the majority of studies, although the enjoyment aspect is of significant importance, because it can contribute to attaining the serious goal in a video game [167]. One interesting future direction is to further examine the interplay between enjoyment and gratification from playing video games, and the mediating effect on empathetic and attitude change outcomes, thereby understanding how to facilitate truly meaningful experiences that are still fun and appreciated for their quality of experience.

Furthermore, those researchers who accounted for the game’s entertainment value used measurement instruments and questionnaires devoted to specific aspects of entertainment (i.e., presence, immersion, flow). Using tools that only devote few items to measure enjoyment or that are self-developed may not assist researchers in coming to reliable conclusions, although the latter is common in the literature [2]. In future studies, measurements assessing enjoyment as a whole can be used to enable researchers to shape a better opinion. In the literature, validated measurements for this purpose exist [2].

In this respect, recent work by Schaffer (2022) [186], which identifies no less than thirty-four (34) sources of enjoyment derived from playing video games, can be employed towards establishing more concrete evidence on whether and which aspects of video games can be leveraged to achieve psychological-influencing impacts on players. Also, more researchers could consider measuring the enjoyment aspect when using a video game as an intervention.

6. Conclusions

In their goal to instill empathy and alter attitudes in an engaging and multimodal way, researchers have incorporated video games in their research methods, steering away from more traditional ones, such as showing short videos, or requiring participants to read texts. In the current integrative review, we examined works where empirical evidence was gathered to inquire whether video games can positively contribute towards this purpose. This seems to hold true, at least in the short term, as there is a dearth of studies applying long-term interventions or administering assessments after a prolonged period of time (e.g., after one year), which would allow us to determine if their effect is lasting.

There still exists scientific debate regarding the confidence researchers can have in video game effects, whether positive or negative, and our review further suggests that more researchers incorporate video games in their studies with the aim to shed light on this. More specifically, it would be of interest if leisure off-the-shelf video games were leveraged for this purpose, or the video games developed for the purpose of the study become available, if possible. In addition, more attention and effort should be given to investigating the impact of video games on raising historical consciousness (and, through it, historical empathy, which then fosters attitude change toward people in the past and their descendants, particularly in an outgroup context), since work in this field is extremely limited.

The outcomes of this integrative review point to an interesting future research direction, where multidimensional models of empathy are taken into account together with the dual nature of attitudes, to determine under what conditions video games can become vehicles of emotional engagement within historical or socially charged contexts.

As is the case with all research works, the current review holds some limitations. We carried out our integrative review by using two databases (albeit ones considered top bibliographic repositories [73]), and we only included quantitative and mixed-method design studies. Works that may be available on other databases, or follow a qualitative method, which could contribute insight into the capability of video games to induce empathy and instill attitude change, may have been left out as a result. Also, we have to acknowledge that some studies have methodological weaknesses (e.g., lack of control groups, small sample, low reliability of measures), which may have affected the results of the studies—further highlighting the need for more meticulous and standardized research designs.

As the purpose of an integrative review is neither to exhaust every reference available, nor to calculate a single average effect size, but rather to point out research trends, gaps and relationships across the interdisciplinary literature, we believe to have formulated valid arguments for both the importance of this scientific topic, and the benefits of carrying out further work in the directions identified. In addition, it was important to be able to identify scientific instruments and tools which researchers can employ in other studies. For example, when measuring empathy and attitude, researchers should bear in mind that these two should be measured by leveraging distinct tools. The results of our work emphasize the fact that more research in this field is needed.

We hope to have compiled a useful compendium of methodological approaches and research materials and instruments to add to the scientific literature, and contribute towards a better understanding of video games as agents for social change, particularly when they can leverage historical narratives to foster reflection, provoke empathy and awareness, and inform collective memory.