Team Building Through Team Video Games: Randomized Controlled Trial

Background Organizations of all types require the use of teams. Poor team member engagement costs billions of US dollars annually. Objective This study aimed to explain how team building can be accomplished with team video gaming based on a team cohesion model enhanced by team flow theory. Methods In this controlled experiment, teams were randomly assigned to a team video gaming treatment or a control treatment. Team productivity was measured during both pretreatment and posttreatment team tasks. After the pretest, teams who were involved in the team video gaming treatment competed against other teams by playing the Halo or Rock Band video game for 45 minutes. After the pretest, teams in the control treatment worked alone for 45 minutes. Then, all teams completed the posttest team activity. This same experimental protocol was conducted on 2 different team tasks. Results For both tasks, teams in the team video gaming treatment increased their productivity significantly more (F1=8.760, P=.004) on the posttest task than teams in the control treatment. Our flow-based theoretical model explained team performance improvement more than twice as well (R2=40.6%) than prior related research (R2=18.5%). Conclusions The focused immersion caused by team video gaming increased team performance while the enjoyment component of flow decreased team performance on the posttest. Both flow and team cohesion contributed to team performance, with flow contributing more than cohesion. Team video gaming did not increase team cohesion, so team video gaming effects are independent of cohesion. Team video gaming is a valid practical method for developing and improving newly formed teams.

1a-i) Identify the mode of delivery in the title Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if offline products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms.

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Does your paper address subitem 1a-i? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Team Building through Team Video Games" 1a-ii) Non-web-based components or important co-interventions in title Mention non-web-based components or important co-interventions in title, if any (e.g., "with telephone support").

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Does your paper address subitem 1a-ii?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study We mention video games in the title, but do not specify whether they are online or console.

1a-iii) Primary condition or target group in the title
Mention primary condition or target group in the title, if any (e.g., "for children with Type I Diabetes") Example: A Web-based and Mobile Intervention with Telephone Support for Children with Type I Diabetes: Randomized Controlled Trial

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Does your paper address subitem 1a-iii? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Team Building through Team Video Games" (i.e., this is meant for a team)

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Does your paper address subitem 1b-i? * Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "In this experiment, teams were randomly assigned to a TVG treatment or a control treatment. Team performance was measured on basic tasks both pre-and post-treatment. 1b-ii) Level of human involvement in the METHODS section of the ABSTRACT Clarify the level of human involvement in the abstract, e.g., use phrases like "fully automated" vs. "therapist/nurse/care provider/physician-assisted" (mention number and expertise of providers involved, if any). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it)

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Does your paper address subitem 1b-ii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Human involvement was implied but not explicit in the abstract. This is covered in the main methods section, but not the abstract.
1b-iii) Open vs. closed, web-based (self-assessment) vs. face-to-face assessments in the METHODS section of the ABSTRACT Mention how participants were recruited (online vs. offline), e.g., from an open access website or from a clinic or a closed online user group (closed usergroup trial), and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment). Clearly say if outcomes were self-assessed through questionnaires (as common in web-based trials). Note: Conclusions/Discussions in abstract for negative trials: Discuss the primary outcome -if the trial is negative (primary outcome not changed), and the intervention was not used, discuss whether negative results are attributable to lack of uptake and discuss reasons. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it)

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Does your paper address subitem 1b-v?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "TVG did not increase team cohesion so TVG effects are independent of cohesion."

2a-i) Problem and the type of system/solution
Describe the problem and the type of system/solution that is object of the study: intended as stand-alone intervention vs. incorporated in broader health care program? Intended for a particular patient population? Goals of the intervention, e.g., being more cost-effective to other interventions, replace or complement other solutions? (Note: Details about the intervention are provided in "Methods" under 5) Does your paper address CONSORT subitem 2b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Our research questions are: RQ1: Can gamifying the team building process via team video gaming be an effective strategy to improve team performance? RQ2: Can team flow explain the effects of TVG on team performance above and beyond that of team cohesion alone? 3a) Description of trial design (such as parallel, factorial) including allocation ratio 3b) Important changes to methods after trial commencement (such as eligibility criteria), with reasons subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 3a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The study involved 1) a pretest of team task performance to establish a baseline, 2) a treatment, and 3) a posttest of team task performance, to measure performance improvement." Control group task 1 n=191 (51 teams; 3.75 per team), control group task 2 147 (38 teams; 3.87 per team). Treatment group task 1 n=112 (30 teams; 3.73 per team), treatment group task 2 n=136 (36 teams; 3.78 per team).
Does your paper address CONSORT subitem 3b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No changes were made to the methods after commencement.

3b-i) Bug fixes, Downtimes, Content Changes
Bug fixes, Downtimes, Content Changes: ehealth systems are often dynamic systems. A description of changes to methods therefore also includes important changes made on the intervention or comparator during the trial (e.g., major bug fixes or changes in the functionality or content) (5-iii) and other "unexpected events" that may have influenced study design such as staff changes, system failures/downtimes, etc.
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study There were no downtimes or unexpected failures.
Does your paper address CONSORT subitem 4a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Participants had to be adults who could communicate with team members.

4a-i) Computer / Internet literacy
Computer / Internet literacy is often an implicit "de facto" eligibility criterion -this should be explicitly clarified.
Does your paper address subitem 4a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No requirement here. Even participants without video gaming experience were welcome. 4a-ii) Open vs. closed, web-based vs. face-to-face assessments: Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. offline), e.g., from an open access website or from a clinic, and clarify if this was a purely webbased trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasi-anonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email confirmation, phone calls) were used to detect/prevent these.
Does your paper address subitem 4a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Participants recruited online via university research lab website. Participants came to a lab to complete the tasks. Participant total time with the research team was around one hour.

4a-iii) Information giving during recruitment
Information given during recruitment. Specify how participants were briefed for recruitment and in the informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results. Does your paper address subitem 4a-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Consent was given expressly in person by signing a consent document upon entering the lab. Instructions were given to teams orally and in person.

Does your paper address CONSORT subitem 4b? *
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Teams started in a research lab. For Task 1 they engaged with each other all over a university campus. For Task 2, they were in small rooms in a lab, isolated from other teams.
4b-i) Report if outcomes were (self-)assessed through online questionnaires Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise.
Does your paper address subitem 4b-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study An online survey was administered before, between, and after tasks. Does your paper address subitem 4b-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No institutional affiliation was presented to participants.

5-i) Mention names, credential, affiliations of the developers, sponsors, and owners
Mention names, credential, affiliations of the developers, sponsors, and owners [6] (if authors/evaluators are owners or developer of the software, this needs to be declared in a "Conflict of interest" section or mentioned elsewhere in the manuscript). Does your paper address subitem 5-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The study involved 1) a pretest of team task performance to establish a baseline, 2) a treatment, and 3) a posttest of team task performance, to measure performance improvement.
The tasks in the experiment were designed to replicate the context of a newly formed work team under time pressure. Therefore, the task met the following criteria: 1) it was time sensitive-there was a limited amount of time available to complete the task, 2) it had objective performance measures that were readily calculable-this allowed teams to evaluate their own performance and compare their performance to other teams, 3) the teams selected their own strategies and division of labor-this allowed team members to benefit from their own creativity and ingenuity, and 4) the task required teams to coordination and collaborate to achieve the best results. We implemented two distinct tasks that allowed us to collect objective measures of team performance. Using two different tasks allowed us to measure the influence of the tasks on the results. Task 1 was based on a mobile application called "Findamine" (pronounced "find a mine") that was created for research purposes and has been successfully used in prior field experiments in IS research [26,76], but with modifications made for our context. Findamine is a geocaching mobile application that generates clues for finding specific landmarks. Rather than giving GPS-based latitude/longitude coordinates, the application gives players short, text-based clues (e.g., "This statue depicts the founder of this university") which help participants identity the specific location. The destination locations were distributed across the large campus. Teams earned points by successfully deciphering the clue, travelling to the location, and taking a picture of themselves at the location. The pictures of subjects in front of the landmark were automatically uploaded through the mobile application. Participants could identify and visit more locations by dividing into pairs. So, division of labor, communication between the team members, and collaboration were rewarded. However, the application tracks the total time elapsed from opening a clue until the correct picture (verified by the GPS coordinates embedded in the photo) is submitted through the application. The natural log of the minutes elapsed was deducted from the possible clue points to reward teams for the speed of their performance in addition to accuracy. At the conclusion of the task, teams returned to the start location where their performance was displayed in a "leaderboard" so that they could compare their results to other teams. In summary, this task enabled all three pre-conditions for flow, namely 1) a clear goal, 2) performance feedback, and most importantly, 3) a challenge that is commensurate with their skills [50,51]. However, given that this geocaching task is somewhat "game-like" itself, and may be correlated to the characteristics of team video gaming, we created a second task (teams only completed one of the two tasks). Task 2 was drawn from prior laboratory research on team tasks and performance [77]. It included a timed task of building a tower out of spaghetti and marshmallows. However, there was no leaderboard or real-time feedback about how they were performing relative to other teams-thus, minimizing the competitive element. Like the geocaching task, participants were divided into teams of four (while minimizing the likelihood of prior relationships among team members). Teams were given seven minutes to build the tallest tower possible that would remain standing Performance was measured as the height in https://docs.google.com/forms/d/e/1FAIpQLSfZBSUp1bwOc_OimqcS64RdfIAFvmrTSkZQL2-3O8O9hrL5Sw/viewform?hl=en_US&formkey=dGlKd2… 22/58 tower possible that would remain standing. Performance was measured as the height in inches of the tower. Table 1 shows the number of teams in each treatment assigned to each task.
After all data was collected, z-scores were calculated for both Task 1 and 2 performance in order to make the results comparable. We also include task type (Task 1 coded as 1 and Task 2 as 0) as covariate in our hypothesis testing. After being assigned to teams, participants performed either Task 1 or Task 2 (depending on the date of the study) as a baseline measurement of team performance. Similar to prior research [26], those assigned to Task 1 (geocaching) downloaded the app on only two of the phones possessed by team members. The app had six clues ready with a 25-minute time limit. The team's total score was the combined total of the points on both phones. The phones of the other team members could still be used for communication. Teams were given five minutes to plan a strategy. Immediately at the five-minute mark, the 25-minute timer began in which they could find the clues. As an incentive, teams were notified that the highest-scoring team from each day's participants would earn $20 Visa cash cards for each member. As locations were found, the results were loaded into a website leaderboard in real-time. Upon returning, each team was shown their standing on the leaderboard and their performance was recorded. Teams assigned to Task 2 (tower) were placed in a dedicated room that was not visible to any other participant teams. They were given a standard number of marshmallows and dry spaghetti noodles. They were also given a brief review of the rules: (1) build free-standing towers not adhered to any furniture or walls, (2) no using smartphones for ideas or tips, and (3) total score is the combined height of the two tallest towers (to give teams the opportunity to determine how to divide roles). Finally, a seven-minute timer was started and left in the room with the team. Similar to Task 1, participants were notified beforehand that the highest-scoring team of that day would earn $20 Visa gift cards. Team Intervention: Treatments Upon completing the pretest, teams were randomly assigned to one of two treatments: 1) team video gaming or 2) control (no team video gaming). Those assigned to the control treatment were asked to spend the next 45 minutes by themselves. Team members were instructed to not speak with each other until the posttest began. This was intended to replicate the practical context where no team building occurs. However, they were left at liberty to work individually on homework or any other pursuit unrelated to the experiment. In the team video gaming treatment, participants played Rock Band 3 or Halo 4. These two games were selected primarily because of the interdependent nature of the team tasks. In Rock Band, the players must coordinate their activities to perform the songs correctly. In Halo, the players must coordinate their attacks and defensive strategies to beat the other team. Teams in the Rock Band condition were tasked to earn the highest possible score across any four songs of their choosing. The team that earned the highest score earned large candy bars for each member. Those in the Halo 4 condition played three rounds of the team-based "capture the flag" sub-game against the other team in their cohort. The team winning at least two out of three matches earned large candy bars. Both treatments lasted 45 minutes. Figures 3 and 4 visualize gameplay of both games.
Importantly, those in the team video gaming treatment were not simply left to themselves. Rather, they were playing in a cooperative-competitive environment in which the team they were competing against was in a nearby, but separate, room. A facilitator was assigned to handle technical problems and ensure that the teams played the games according to instructions and fully participated subitem not at all important 1 2 3 4 5 essential instructions and fully participated. Post-task: Measuring Change in Team Performance After the treatment, teams were again assigned to complete another round of the same pretest task so that team performance could be measured as the relative percent improvement from the pretest. For Task 1 (geocaching), the study administrators downloaded seven new clues for new locations on campus to the two phones on each team running the application. The increase from six to seven clues in Task 2 was because pilot tests revealed that participants gained experience and skill from Task 1 that translated into faster task completion times. Therefore, to even out the total time required by Task 1 and Task 2, the number of clues was increased for Task 2. Once again, the teams had 5 minutes to strategize, and then 25 minutes to find and photograph themselves at as many of the locations as possible. Upon finishing this task, the teams viewed their standing on the leaderboard and completed another survey measuring flow and the other key variables. For Task 2 (tower), participants were placed back into the same room with a fresh set of spaghetti and marshmallows and a clean workspace. They were given another seven-minute timer and set to work. After the task, each team member took a survey measuring flow and several other covariates. It is important to note that the survey measures referred to the participants' flow state during the geocaching or tower-building task-not the team video gaming treatment. This is significant because an important assumption of our research is that achieving a flow state during a team intervention (i.e., team video gaming) can increase the likelihood of entering a state of flow on subsequent team tasks as with the geocaching task."

5-ii) Describe the history/development process
Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results.
Does your paper address subitem 5-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The study utilized consumer video games on the XBOX as a treatment. Therefore, the development history is not pertinent to this study.

5-iii) Revisions and updating
Revisions and updating. Clearly mention the date and/or version number of the application/intervention (and comparator, if applicable) evaluated, or describe whether the intervention underwent major changes during the evaluation process, or whether the development and/or content was "frozen" during the trial.
Describe dynamic components such as news feeds or changing content which may have an impact on the replicability of the intervention (for unexpected events see item 3b).
Does your paper address subitem 5-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-iv) Quality assurance methods
Provide information on quality assurance methods to ensure accuracy and quality of information provided [1], if applicable.
Does your paper address subitem 5-iv?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer -v) Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing flowcharts of the algorithms used Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing flowcharts of the algorithms used. Replicability (i.e., other researchers should in principle be able to replicate the study) is a hallmark of scientific reporting.

Does your paper address subitem 5-v?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-vi) Digital preservation
Digital preservation: Provide the URL of the application, but as the intervention is likely to change or disappear over the course of the years; also make sure the intervention is archived (Internet Archive, webcitation.org, and/or publishing the source code or screenshots/videos alongside the article). As pages behind login screens cannot be archived, consider creating demo pages which are accessible without login. Does your paper address subitem 5-vi?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-vii) Access
Access: Describe how participants accessed the application, in what setting/context, if they had to pay (or were paid) or not, whether they had to be a member of specific group. If known, describe how participants obtained "access to the platform and Internet" [1]. To ensure access for editors/reviewers/readers, consider to provide a "backdoor" login account or demo mode for reviewers/readers to explore the application (also important for archiving purposes, see vi).
Does your paper address subitem 5-vii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Participant teams were taken to gaming rooms near the lab. Does your paper address subitem 5-viii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The gaming intervention occurred on site in gaming rooms.

5-ix) Describe use parameters
Describe use parameters (e.g., intended "doses" and optimal timing for use). Clarify what instructions or recommendations were given to the user, e.g., regarding timing, frequency, heaviness of use, if any, or was the intervention used ad libitum. Does your paper address subitem 5-ix?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-x) Clarify the level of human involvement
Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability).
Does your paper address subitem 5-x?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-xi) Report any prompts/reminders used
Report any prompts/reminders used: Clarify if there were prompts (letters, emails, phone calls, SMS) to use the application, what triggered them, frequency etc. It may be necessary to distinguish between the level of prompts/reminders required for the trial, and the level of prompts/reminders for a routine application outside of a RCT setting (discuss under item 21 -generalizability). subitem not at all important 1 2 3 4 5 essential 6a) Completely defined pre-specified primary and secondary outcome measures, including how and when they were assessed Does your paper address subitem 5-xi? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Lab assistants checked in on gaming teams to make reminders about the time and objectives.

5-xii) Describe any co-interventions (incl. training/support)
Describe any co-interventions (incl. training/support): Clearly state any interventions that are provided in addition to the targeted eHealth intervention, as ehealth intervention may not be designed as stand-alone intervention. This includes training sessions and support [1]. It may be necessary to distinguish between the level of training required for the trial, and the level of training for a routine application outside of a RCT setting (discuss under item 21 -generalizability. Does your paper address subitem 5-xii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No additional interventions were involved. Does your paper address subitem 6a-i?

Copy and paste relevant sections from manuscript text
Your answer 6a-ii) Describe whether and how "use" (including intensity of use/dosage) was defined/measured/monitored Describe whether and how "use" (including intensity of use/dosage) was defined/measured/monitored (logins, logfile analysis, etc.). Use/adoption metrics are important process outcomes that should be reported in any ehealth trial.

Does your paper address subitem 6a-ii?
Copy and paste relevant sections from manuscript text Your answer subitem not at all important 1 2 3 4 5 essential 6b) Any changes to trial outcomes after the trial commenced, with reasons 7a) How sample size was determined NPT: When applicable, details of whether and how the clustering by care provides or centers was addressed 6a-iii) Describe whether, how, and when qualitative feedback from participants was obtained Describe whether, how, and when qualitative feedback from participants was obtained (e.g., through emails, feedback forms, interviews, focus groups).

Does your paper address subitem 6a-iii?
Copy and paste relevant sections from manuscript text

Your answer
Does your paper address CONSORT subitem 6b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No changes were made to the intervention after the trial. subitem not at all important 1 2 3 4 5 essential 7b) When applicable, explanation of any interim analyses and stopping guidelines 8a) Method used to generate the random allocation sequence NPT: When applicable, how care providers were allocated to each trial group 7a-i) Describe whether and how expected attrition was taken into account when calculating the sample size Describe whether and how expected attrition was taken into account when calculating the sample size.

Does your paper address subitem 7a-i?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
Does your paper address CONSORT subitem 7b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Not applicable to this study. 8b) Type of randomisation; details of any restriction (such as blocking and block size) 9) Mechanism used to implement the random allocation sequence (such as sequentially numbered containers), describing any steps taken to conceal the sequence until interventions were assigned 10) Who generated the random allocation sequence, who enrolled participants, and who assigned participants to interventions Does your paper address CONSORT subitem 8a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study We used a random function in MS Excel to assign participants to groups.

Does your paper address CONSORT subitem 8b? *
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Team size was restricted to 3-4 members. Once 4 members were assigned to a team, that team was removed from additional allocations.
Does your paper address CONSORT subitem 9? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study We just used Excel's random function. Does your paper address CONSORT subitem 10? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The primary author conducted the randomization.

11a-i) Specify who was blinded, and who wasn't
Specify who was blinded, and who wasn't. Usually, in web-based trials it is not possible to blind the participants [1, 3] (this should be clearly acknowledged), but it may be possible to blind outcome assessors, those doing data analysis or those administering co-interventions (if any).

Does your paper address subitem 11a-i? *
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The participants knew whether they were control or treatment, since the treatment was a videogaming activity. The researchers conducting the experiment also knew which teams were receiving the treatment. Therefore, no blinding was involved in this study. 12a) Statistical methods used to compare groups for primary and secondary outcomes NPT: When applicable, details of whether and how the clustering by care providers or centers was addressed 11a-ii) Discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator" Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator".
Does your paper address subitem 11a-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
Does your paper address CONSORT subitem 11b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The control and treatment were completely different.

12b) Methods for additional analyses, such as subgroup analyses and adjusted analyses
Does your paper address CONSORT subitem 12a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study We used t-tests to compare treatment and control groups.

12a-i) Imputation techniques to deal with attrition / missing values
Imputation techniques to deal with attrition / missing values: Not all participants will use the intervention/comparator as intended and attrition is typically high in ehealth trials. Specify how participants who did not use the application or dropped out from the trial were treated in the statistical analysis (a complete case analysis is strongly discouraged, and simple imputation techniques such as LOCF may also be problematic [4]).
Does your paper address subitem 12a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Since the experiment was live, contiguous, and in person, there was no attrition, and therefore no need to attend to imputation. Does your paper address CONSORT subitem 12b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study We used ANOVA to examine additional covariates and potential confounds (e.g., age, gaming experience, gender).

X26-i) Comment on ethics committee approval
Does your paper address subitem X26-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

x26-ii) Outline informed consent procedures
Outline informed consent procedures e.g., if consent was obtained offline or online (how? Checkbox, etc.?), and what information was provided (see 4a-ii). See [6] for some items to be included in informed consent documents.

RESULTS
13a) For each group, the numbers of participants who were randomly assigned, received intended treatment, and were analysed for the primary outcome NPT: The number of care providers or centers performing the intervention in each group and the number of patients treated by each care provider in each center Does your paper address subitem X26-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

X26-iii) Safety and security procedures
Safety and security procedures, incl. privacy considerations, and any steps taken to reduce the likelihood or detection of harm (e.g., education and training, availability of a hotline)

Does your paper address subitem X26-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Does your paper address CONSORT subitem 13a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Control group task 1 n=191 (51 teams; 3.75 per team), control group task 2 147 (38 teams; 3.87 per team). Treatment group task 1 n=112 (30 teams; 3.73 per team), treatment group task 2 n=136 (36 teams; 3.78 per team).
Does your paper address CONSORT subitem 13b? (NOTE: Preferably, this is shown in a CONSORT flow diagram) * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No attrition was experienced for this study.

13b-i) Attrition diagram
Strongly recommended: An attrition diagram (e.g., proportion of participants still logging in or using the intervention/comparator in each group plotted over time, similar to a survival curve) or other figures or tables demonstrating usage/dose/engagement. Does your paper address subitem 13b-i?
Copy and paste relevant sections from the manuscript or cite the figure number if applicable (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
Does your paper address CONSORT subitem 14a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Data was collected between 2016 and 2018.

14a-i) Indicate if critical "secular events" fell into the study period
Indicate if critical "secular events" fell into the study period, e.g., significant changes in Internet resources available or "changes in computer hardware or Internet delivery resources" Does your paper address subitem 14a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Does your paper address CONSORT subitem 14b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study We stopped the experiment once we had sufficient statistical power to detect effects.
Does your paper address CONSORT subitem 15? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "A total of 586 individuals across 155 teams. However, only 444 participants completed all survey responses measuring latent constructs used to estimate the theoretical model. A few teams had only three participants due to no-shows at the lab. Comparative tests showed few differences between 3 and 4 person teams as noted in the results section. Of those who chose to report, 141 (24%) were female, 469 (80%) were Caucasian, 59 (10%) were Asian, and 41 (7%) were Hispanic. The average age of

15-i) Report demographics associated with digital divide issues
In ehealth trials it is particularly important to report demographics associated with digital divide issues, such as age, education, gender, social-economic status, computer/Internet/ehealth literacy of the participants, if known. Does your paper address subitem 15-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "To control for video game ability (and thereby balance appropriate challenge and skill), we asked subjects regarding their level of experience with the game and then balanced the level of video game experience across teams so that teams were competing against other teams of roughly equivalent skill."

16-i) Report multiple "denominators" and provide definitions
Report multiple "denominators" and provide definitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at specific pre-defined time points of interest (in absolute and relative numbers per group). Always clearly define "use" of the intervention.
Does your paper address subitem 16-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study subitem not at all important 1 2 3 4 5 essential 17a) For each primary and secondary outcome, results for each group, and the estimated effect size and its precision (such as 95% confidence interval)

16-ii) Primary analysis should be intent-to-treat
Primary analysis should be intent-to-treat, secondary analyses could include comparing only "users", with the appropriate caveats that this is no longer a randomized sample (see 18-i).

Does your paper address subitem 16-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 17a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The team video gaming treatment in Task 1, geocaching, resulted in a 49.6% average improvement compared to 20.3% for the control teams, for a difference of 29.3% (t-test, P<.001). The tower building task (Task 2) produced greater variance in term performance than Task 1 and a clear "ceiling" effect-meaning that teams who build a very tall tower during the pretest were not able to improve their score by as great a percentage like the geocaching task.

17a-i) Presentation of process outcomes such as metrics of use and intensity of use
In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational definitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is defined (e.g., timeout after idle time) [1] (report under item 6a).

18-i) Subgroup analysis of comparing only users
A subgroup analysis of comparing only users is not uncommon in ehealth trials, but if done, it must be stressed that this is a self-selected sample and no longer an unbiased sample from a randomized trial (see 16-iii).

Does your paper address subitem 18-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer We did not detect any harms or unintended effects.

19-i) Include privacy breaches, technical problems
Include privacy breaches, technical problems. This does not only include physical "harm" to participants, but also incidents such as perceived or real privacy breaches [1], technical problems, and other unexpected/unintended incidents. "Unintended effects" also includes unintended positive effects [2].

Does your paper address subitem 19-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer 22-i) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use). Does your paper address subitem 22-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "In response to our two research questions, the primary findings of this research are: 1) the team-building process can be implemented with team video gaming. Unlike traditional team building exercises, which focus the attention of team members on specific team building objectives, these objectives are met naturally as the teams focus on cooperating to play the game. Existing features in the games used in this research supported cooperation and competition through enjoyable and challenging game scenarios, thereby effectively accomplishing the team building process. 2) Teams that played team video gaming experienced greater flow and exhibited greater performance on subsequent team tasks. This effect was found with two different video games and with two different post-play work tasks; thus, the positive effects of team building with team video gaming are not limited to one video game or one post-play task. Team video gaming provides some benefits traditionally attributed to team cohesion: a limited form of team attraction, attraction to the task, and roles and scenarios embodied in the game serve to facilitate effective division of labor and cooperation within the team. But team video gaming does not manipulate team cohesion. The effects of team cohesion on team performance are independent of team video gaming. Team cohesion has a small, positive impact on team performance, but is not affected by team video gaming. Instead, team video gaming improves performance by increasing appropriate challenge which increases flow. The positive effect of flow on performance is stronger than the positive effect of team cohesion on performance. Focused immersion is the component on flow that increases team performance. Heightened enjoyment is a component of flow that decreases team performance. These findings constitute a better explanation of how team video gaming increases team performance than prior research. We found a much stronger effect size for team performance. In particular, our model explained 62.3% of the variance (R2) in team performance across two distinct types of team tasks compared to 18.5% explained by Keith et al. 2018 [50]."

20-i) Typical limitations in ehealth trials
Typical limitations in ehealth trials: Participants in ehealth trials are rarely blinded. Ehealth trials often look at a multiplicity of outcomes, increasing risk for a Type I error. Discuss biases due to non-use of the intervention/usability issues, biases through informed consent procedures, unexpected events. Does your paper address subitem 20-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "A few limitations of this research are worth noting. First, this was a laboratory experiment. Although laboratory experiments are a necessary and useful first step in establishing a phenomenon, future research is needed to ensure the results of this study are generalizable to practical workplace settings. One limitation arising from the experimental setting is the artificial time pressure to which we attributed mixed effects of some aspects of flow on team performance. Managers should not assume all team video gaming will be beneficial. Each team had a facilitator that encouraged them to participate fully and the participants may have been motivated by knowing that their cooperation would help the researchers. Therefore, the positive effects of team video gaming may not be replicated in actual settings if the teams do not engage in the video games. Our geocaching and tower-building tasks were designed to be enjoyable. The geocaching task was somewhat game-like in that it included a leaderboard and real-time feedback about competitive performance. This may have contributed to the carryover effects of challenge and flow from the team video gaming treatment to the subsequent tasks. However, we included it to keep our results comparable to prior research on team video gaming [26]. In contrast, the tower-building task was selected to avoid this bias. There was no leaderboard or competitive feedback making it more distinct from the team video gaming treatment. Nevertheless, neither of the tasks were particularly representative of common business work tasks. Therefore, future research should replicate our findings using more generalizable business-oriented tasks. Another limitation concerns our use of two video games. While the video games used represented very different genres, these games have feature sets that represent only some video game characteristics that could be useful as team building interventions. Future research could map the characteristics of other game features to the traditional team building treatments (interpersonal relations, goal setting, role clarification, problem solving) to see which game types are most effective for each team building treatment.
Our results were found specifically with participants who were previously unfamiliar with each other, yet interdependent in terms of accomplishing a team task. The team video gaming treatment may not have the same effect on preexisting teams who have already established norms, biases, and opinions about other team members. In these settings, competitive video gaming may reinforce existing negative biases in relationships that already exist. Additionally, our participants were college-age students who were generally familiar with video games. The advantage of using student subjects is that 1) it allowed us to replicate the context of new teams and 2) students are typically younger and may be more interested in video gaming than older employees [91]. So, students do not represent all types of employees and some employees may have negative attitudes toward team video gaming. Moreover, these students had experience with the games studied in this research. Future research could explore how team video gaming might work with those who are not familiar with video games. Similarly, if a workplace is not characterized by time critical objectively measured tasks then team video gaming may 10/13/21, 9:49 AM CONSORT-EHEALTH (V 1.6.1) -Submission/Publication Form https://docs.google.com/forms/d/e/1FAIpQLSfZBSUp1bwOc_OimqcS64RdfIAFvmrTSkZQL2-3O8O9hrL5Sw/viewform?hl=en_US&formkey=dGlKd2… 53/58 21) Generalisability (external validity, applicability) of the trial findings NPT: External validity of the trial findings according to the intervention, comparators, patients, and care providers or centers involved in the trial subitem not at all important 1 2 3 4 5 essential characterized by time-critical, objectively measured tasks, then team video gaming may become more of a distraction than a team-building activity. Future research should examine how flow works in settings without time pressure. Finally, although our operationalization of the control group treatment represented a practical example of companies that do not facilitate any sort of team building activity, it also allowed the opportunity for many possible explanations for the difference with the TVG treatment. For example, not only did participants in the TVG treatment get to play video games together, they also had the opportunity to develop communication skills and get rewards whereas the control treatment participants were not allowed to interact in any way. Therefore, we cannot definitively conclude that it was the TVG treatment that caused the performance improvements and not simply the communication or candy rewards. Future research should include additional control treatments that allow basic socializing and communication in between tasks as well as break apart the elements of 1) id i 2) ti d 3) titi t d t d th d t hi h

21-i) Generalizability to other populations
Generalizability to other populations: In particular, discuss generalizability to a general Internet population, outside of a RCT setting, and general patient population, including applicability of the study results for other organizations Does your paper address subitem 21-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Discuss if there were elements in the RCT that would be different in a routine application setting (e.g., prompts/reminders, more human involvement, training sessions or other co-interventions) and what impact the omission of these elements could have on use, adoption, or outcomes if the intervention is applied outside of a RCT setting.

Does your paper address subitem 21-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
Does your paper address CONSORT subitem 23? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Does your paper address CONSORT subitem 24? * Cite a Multimedia Appendix, other reference, or copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study In the main manuscript and appendices.
Does your paper address CONSORT subitem 25? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No external funding was used for this study. The authors used faculty research budgets provided by their college to fund this study.

X27-i) State the relation of the study team towards the system being evaluated
In addition to the usual declaration of interests (financial or otherwise), also state the relation of the study team towards the system being evaluated, i.e., state if the authors/evaluators are distinct from or identical with the developers/sponsors of the intervention.