Changing Health Behavior Through Games

Changing Health Behavior Through Games

Erin Edgerton (Centers for Disease Control and Prevention, USA)
Copyright: © 2009 |Pages: 18
DOI: 10.4018/978-1-59904-808-6.ch022
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This chapter discusses how proven health communication theories can be used in electronic games to affect behavior change. After discussing the need for effective health communication and reviewing the current trends in online health-seeking behavior, it argues that games provide a unique opportunity for users to interact with health information, practice health behaviors, and become immersed in meaningful content. Through exploration of the elaboration likelihood model, social cognitive theory, and stages of change theory, this chapter will discuss how games can be used to change perceptions, attitudes, and actions relating to health behaviors. Examples of how these health communication theories have been used in both public health research and games will be given. At the conclusion of this chapter, readers will have an understanding of several health communication theories and the related techniques that can be used to design persuasive games for behavior change.
Chapter Preview

Games As More Than Just Entertainment

Imagine if we were twenty-five years into the development of the American cinema, and the only thing the mainstream media said about film was that it was sometimes overly violent…in a few years we will look back at the media neglect of games with the same shock and wonderment. Henry Jenkins (cited inBeck & Wade, 2006)

While movies may always fall under the broad category of “entertainment,” films have been used to address the most serious of subjects in a thoughtful and influential manner. Looking beyond the thrill of competition and beauty of graphics, games have the potential to have as much impact on our society as film and the immersive nature of game-play provides a unique opportunity for education and persuasive communication.

The new genres of ‘serious games’, ‘games for health’, and ‘games for change’ can address issues affecting the health and well-being of players while still remaining fun. The gaming elements of challenge, risk, defeat, and success can be applied to content that conveys information, teaches a lesson, models an activity, and ultimately, changes a behavior. In addition, while printed materials, videos, and classroom instruction can provide a great deal of didactic content in a single sitting, persuasive and interactive video games have the potential to expose the player to meaningful content thousands of times (Lieberman, 2001). Games displayed at 2005 Serious Games Summit in Washington, DC, address a variety of topics, including participating in government and politics, conflict in the Middle East, genocide in Darfur, and public diplomacy (Musgrove, 2005). These topics, and countless others not named here, are reflective of important issues in today’s society and the movement to create games in this new serious games genre has created new possibilities for communicating persuasive messages. For persuasive games that aim to state an argument, affect an attitude, or change a behavior, health is an important and natural issue to address.

Health is a common thread in today’s media. It is one of few human conditions that is important to people of all ages, races, ethnicities, incomes, and geographical locations. The world, and particularly the U.S., is in need of health information that is accurate, relevant, and timely so that individuals can better prevent an illness, manage a disease, or treat a condition. Games as persuasive technologies may be a new concept but delivering health messages that are tailored to meet the needs and interests of target audiences, structured in accordance with proven health communication theories, and delivered in a format that is accessible and appropriate for the user are not. Using these elements of effective communication, virtually any medium can be used to elicit behavior change.

Through exploration of the growing need for effective health communication and the increasing prevalence of the Internet as the primary source of health information, this chapter will demonstrate the need for games for health. The elaboration likelihood model, social cognitive theory, and the stages of change model will be discussed and this chapter will demonstrate how games can be used to change perceptions, attitudes, and actions relating to healthy behaviors. Examples for how these theories have been applied both to public health campaigns and game designs will be given. In addition, the concluding sections on implications for game designers and forecasts of future trends in health communication will provide actionable steps to creating effective games for health. At the conclusion of this chapter, readers will have an understanding of several health communication theories and the related techniques that can be used to design persuasive games for behavior change.


The Right Time For Games

To understand how health and electronic games fit together, we must first explore the tremendous need for effective health communication in the United States and the growing use of the Internet to find accurate health information. As chronic diseases become more prevalent nationwide, people are increasingly turning to the Internet to get health information, and a growing segment of this population is looking to non-authoritative sources when making health decisions. The rise in electronic health information and the trend of using search to find ‘people like me’ is creating a culture more accepting of new interactive forms of health information, such as games.

Key Terms in this Chapter

Health Marketing: The science of creating, communicating, and delivering health information and interventions using customer-centered and science-based strategies to protect and promote the health of diverse populations.

Health Communication: An area of study that uses communication strategies to inform and influence individual and community decisions in an effort to enhance health.

Modeling: Gaining new knowledge or skills through doing, seeing, experiencing, or playing.

Central Route: A path for processing incoming messages where message elaboration occurs and the message is considered and/or evaluated by the receiver for some period of time; a component of the elaboration likelihood model.

Self-Efficacy: The belief in one’s ability to use one’s skills and knowledge to organize and carry out the course of actions necessary to achieve a goal or manage a situation.

E-Health: General term used to describe electronic health information, programs, and campaigns.

Avatar: A customized virtual representation of the player.

Perceived Facilitators: Social and structural elements that will help achieve a goal.

Digital Divide: A term used to describe the gap in access to the Internet and other technologies between groups of different socioeconomic status.

Message Elaboration: A component of the elaboration likelihood model in which a receiver of a message considers and evaluates that message.

Peripheral Route: A path for processing incoming messages where pre-existing cues are used to accept or reject the message without thoughtful consideration; a component of the elaboration likelihood model.

Perceived Impediments: Social and structural elements that will stand in the way of achieving a goal.

Outcome Expectations: The belief that the course of action will have a positive or negative effect on achieving a goal or managing a situation.

Complete Chapter List

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Editorial Advisory Board
Table of Contents
Mark J. P. Wolf
Richard E. Ferdig
Richard E. Ferdig
Reviewer Acknowledgment
Chapter 1
Fengfeng Ke
Drawing on grounded theory approach and a qualitative meta-analysis, this chapter intends to systematically review and synthesize the theories... Sample PDF
A Qualitative Meta-Analysis of Computer Games as Learning Tools
Chapter 2
Aroutis N. Foster, Punya Mishra
We offer a framework for conducting research on games for learning. Building on a survey of the literature on games, we suggest a categorization... Sample PDF
Games, Claims, Genres, and Learning
Chapter 3
Sara de Freitas, Mark Griffiths
This chapter explores whether massively multiplayer online role-play games (MMORPGs) can be used effectively to support learning and training... Sample PDF
Massively Multiplayer Online Role-Play Games for Learning
Chapter 4
Yufeng Qian
Electronic games are becoming an important part of many American children’s life today. Electronic educational gaming, as a new instructional... Sample PDF
An Investigation of Current Online Educational Games
Chapter 5
Cathy Cavanaugh
In augmented reality games, game experiences combining electronic game content take the form of narrative materials and game-play elements exchanged... Sample PDF
Augmented Reality Gaming in Education for Engaged Learning
Chapter 6
Michael A. Evans
This chapter proposes that the convergence of mobile devices and digital game-based learning may have profound implications for educational... Sample PDF
Mobility, Games, and Education
Chapter 7
David Parisi
This chapter discusses the way that new video game interfaces such as those employed by Guitar Hero™, Dance Dance Revolution, and the Nintendo Wii™... Sample PDF
Game Interfaces as Bodily Techniques
Chapter 8
Elhanan Gazit
This chapter presents an analysis of the dynamics of children’s digital games interactions, which take place in their home surroundings, based on... Sample PDF
A Window on Digital Games Interactions in Home Settings
Chapter 9
James Oliverio, Dennis Beck
We introduce the term ‘mixed social environments’ as a strategic learning construct to augment student interaction when utilizing virtual world... Sample PDF
Enhanced Interaction in Mixed Social Environments
Chapter 10
Andreas Breiter, Castulus Kolo
Electronic gaming in education remains a theoretical or at best marginal issue as long as it is not adopted in general educational settings. The... Sample PDF
Electronic Gaming in Germany as Innovation in Education
Chapter 11
Richard Van Eck
Many of the educational outcomes we seek to promote in public education, such as problem solving and critical thinking, are difficult to achieve... Sample PDF
A Guide to Integrating COTS Games into Your Classroom
Chapter 12
Shree Durga, Kurt Squire
This chapter examines the potential of video games as a learning tool given their productive capacity for content creation and dissemination. Based... Sample PDF
Productive Gaming and the Case for Historiographic Game-Play
Chapter 13
Erik Malcolm Champion
Serious games research typically uses modified computer games as virtual learning environments. Virtual heritage projects typically aim to provide... Sample PDF
Game-Based Historical Learning
Chapter 14
Phillip J. VanFossen, Adam Friedman, Richard Hartshorne
In this chapter, the authors will report evidence for the potential of MMORPGs for social studies education by providing a detailed review of... Sample PDF
The Role of MMORPGS in Social Studies Education
Chapter 15
Brock Dubbles
In this qualitative study, literacy practices of “struggling” seventh and eighth graders were recorded on videotape as they engaged in both... Sample PDF
Video Games, Reading, and Transmedial Comprehension
Chapter 16
Carol Luckhardt Redfield, Diane L. Gaither, Neil M. Redfield
This chapter looks at the effectiveness of commercially available educational computer games. It defines what a game is from game theory and what an... Sample PDF
COTS Computer Game Effectiveness
Chapter 17
Christopher L. James, Vivan H. Wright
The purpose of this study was to identify secondary teachers with video game-play experience and determine if perceived levels of comfort in regard... Sample PDF
Teacher Gamers vs. Teacher Non-Gamers
Chapter 18
Brian Ferry, Lisa Kervin
This chapter describes how we used an authentic learning framework (Herrington & Oliver, 2000) to inform the design of an online simulation that... Sample PDF
Using Online Simulation to Engage Users in an Authentic Learning Environment
Chapter 19
Zahide Yildirim, Eylem Kilic
This chapter explores prospective computer teachers’ perceptions of and experiences in goal-based scenario (GBS) centered 3D educational game... Sample PDF
Pre-Service Computer Teachers as 3D Educational Game Designers
Chapter 20
Kathy Sanford, Leanna Madill
This chapter describes a study conducted with nine adolescents hired to instruct week-long video game making camps over the course of one summer and... Sample PDF
Adolescents Teaching Video-Game Making—Who is the Expert Here?
Chapter 21
Richard T. Cole, Elizabeth Taylor Quilliam
As Internet marketing has evolved, customized online games created to promote specific brands or products have been embraced by food marketers. At... Sample PDF
Online Games as Powerful Food Advertising to Children
Chapter 22
Erin Edgerton
This chapter discusses how proven health communication theories can be used in electronic games to affect behavior change. After discussing the need... Sample PDF
Changing Health Behavior Through Games
Chapter 23
Wei Peng, Ming Liu
This chapter aims to provide an overall picture of the applications of electronic games for various health-related purposes, particularly for health... Sample PDF
An Overview of Using Electronic Games for Health Purposes
Chapter 24
Yong Zhao, Chun Lai
This chapter provides an overview of the potential of massively multiplayer role-playing games (MMORPGs) for foreign language education and... Sample PDF
MMORPGS and Foreign Language Education
Chapter 25
Kim Feldmesser
It is a buyers market for employers in todays global village, where having another language under your belt could make the difference at an... Sample PDF
A Video Game, a Chinese Otaku, and Her Deep Learning of a Language
Chapter 26
Ahmed BinSubaih, Steve Maddock, Daniela Romano
The design of serious games based on sound learning and instructional principles is important to ensure learning is integrated in the ‘game-play’.... Sample PDF
Developing a Serious Game for Police Training
Chapter 27
Barbara Martinson, Sauman Chu
Games are increasingly being used to teach content in a variety of courses from elementary to graduate education. This study investigates the... Sample PDF
Game-Based Learning in Design History
Chapter 28
Martha Garcia-Murillo, Ian MacInnes
Advances in computing and telecommunications make it possible to take advantage of immersive electronic environments to deliver content. In this... Sample PDF
A Policy Game in a Virtual World
Chapter 29
Chong-wei Xu
This chapter introduces an innovative pedagogical method for teaching object-oriented programming (OOP) and component-oriented programming (COP) via... Sample PDF
Teaching OOP and COP Technologies via Gaming
Chapter 30
Pollyana Notargiacomo Mustaro, Luciano Silva, Ismar Frango Silveira
This chapter discusses some possibilities of using computer games to effectively reach didactic goals in undergraduate teaching. Nowadays... Sample PDF
Using Games to Teach Design Patterns and Computer Graphics
Chapter 31
Paul A. Fishwick, Yuna A. Park
Multimedia technology for personal computers has undergone a radical transformation over the past two decades with significant changes made in... Sample PDF
A 3D Environment for Exploring Algebraic Structure and Behavior
Chapter 32
Surviving the Game  (pages 560-575)
Linda van Ryneveld
A large body of research exists on the topics of computer-based educational gaming on the one hand and the role of playing traditional games in... Sample PDF
Surviving the Game
Chapter 33
David William Shaffer
In this chapter, I look at the relationship between games and assessment—and more broadly at what that tells us about the relationship between... Sample PDF
Wag the Kennel: Games, Frames, and the Problem of Assessment
Chapter 34
Melissa L. Lewis, René Weber
The Entertainment Education Paradigm (EEP) offers a new way to think about education by blending entertainment with educational experiences. Video... Sample PDF
Character Attachment in Games as Moderator for Learning
Chapter 35
Joseph C. DiPietro, Erik W. Black
A better understanding of virtual character avatars is needed in order to explore the underlying psychology that the avatar represents to the user.... Sample PDF
Visual Analysis of Avatars in Gaming Environments
Chapter 36
Matthew Thomas Payne
This chapter introduces and operationalizes an innovative interpretive strategy called “existential ludology” to explain how the game-play mechanics... Sample PDF
Interpreting Game-Play Through Existential Ludology
Chapter 37
Katrin Becker, James R. Parker
This chapter will discuss the growing importance of applying considered rationales to which games are chosen for study, whether it be for... Sample PDF
On Choosing Games and What Counts as a "Good" Game
Chapter 38
Teddy Moline
Quality teachers and quality digital games (video and computer) are dynamic resources that experience ongoing changes based primarily on their... Sample PDF
Descriptors of Quality Teachers and Quality Digital Games
Chapter 39
David Gibson
What would a game or simulation need to have in order to teach a teacher how people learn? This chapter uses a four-part framework of knowledge... Sample PDF
Designing a Computational Model of Learning
Chapter 40
Clint Bowers, Peter A. Smith, Jan Cannon-Bowers
The use of computer games and especially online games for educational purposes is growing in popularity. In this chapter we attempt to summarize... Sample PDF
Social Psychology and Massively Multiplayer Online Learning Games
Chapter 41
Slava Kalyuga, Jan L. Plass
This chapter provides an overview of our cognitive architecture and its implications for the design of game-based learning environments. Design of... Sample PDF
Evaluating and Managing Cognitive Load in Games
Chapter 42
Nicholas Zap, Jillianne Code
Video games engage players in rapid and complex interactions of self-regulatory processes. The way individuals regulate their cognitive, affective... Sample PDF
Self-Regulated Learning in Video Game Environments
Chapter 43
Johannes Fromme, Benjamin Jörissen, Alexander Unger
The goal of this chapter is to emphasize a certain notion of self-induced education, to discuss it in the context of digital games and to provide... Sample PDF
(Self-) Educational Effects of Computer Gaming Cultures
Chapter 44
Meredith DiPietro
There is current interest from the field of education into the value of video games to support learning. Research investigating outcomes associated... Sample PDF
Experience, Cognition and Video Game Play
Chapter 45
P. G. Schrader, Kimberly A. Lawless, Michael McCreery
This chapter describes the manner in which gamers engage in multiple text comprehension and intertextual practices within the context of the World... Sample PDF
Intertextuality in Massively Multi-Player Online Games
Chapter 46
Yam San Chee, Kenneth Yang Teck Lim
This chapter considers the use of computer games to help students construct their personal identity and develop dispositions that become active and... Sample PDF
Development, Identity, and Game-Based Learning
Chapter 47
Play Styles and Learning  (pages 826-846)
Carrie Heeter
This chapter reviews player types found in commercial MMOs and educational games and a palette of play styles and learning is proposed from which... Sample PDF
Play Styles and Learning
Chapter 48
Martin Oliver
This chapter explores the roles players created, and how these structured their online relationships, in an online massively multi-player... Sample PDF
Playing Roles in the MMORPG Kingdom of Loathing
Chapter 49
Vasa Buraphadeja, Kara Dawson
Many game scholars claim that the emergent authorship opportunities provided within The Sims may lead to positive game play outcomes. This study... Sample PDF
Exploring Personal Myths from The Sims
Chapter 50
Edward L. Swing, Douglas A. Gentile, Craig A. Anderson
Though video games can produce desirable learning outcomes, such as improved performance in school subjects, they also can produce undesirable... Sample PDF
Learning Processes and Violent Video Games
Chapter 51
Patrick Felicia, Ian Pitt
This chapter explains the importance of acknowledging users’ personalities, learning styles, and emotions in the design of educational games. It... Sample PDF
Harnessing the Emotional Potential of Video Games
Chapter 52
Diane Carr, Caroline Pelletier
The issue of gender reoccurs in debates about the introduction of computer games into formal learning contexts. There is a fear that girls will be... Sample PDF
Gamers, Gender, and Representation
Chapter 53
Yi Mou, Wei Peng
While the violent content of video games has caused wide concern among scholars, gender, and racial stereotypes in video games are still an... Sample PDF
Gender and Racial Stereotypes in Popular Video Games
Chapter 54
David J. Leonard
This chapter examines and responds to the silencing, resistance to any intrusion of questions about race and racism, and overall erasure of race... Sample PDF
Can the Subaltern Play and Speak or Just be Played With?
Chapter 55
Colleen Swain
Electronic games and simulations are powerful learning tools for many learners; yet, the learning environments in these games and simulations... Sample PDF
Culturally Responsive Games and Simulations
Chapter 56
Robert Jones
Due to its nature as an interactive medium, the video game offers uniquely different approaches to the project of activism. Unlike other... Sample PDF
Saving Worlds with Videogame Activism
Chapter 57
Conceptual Play Spaces  (pages 989-1009)
Sasha A. Barab, Adam Ingram-Goble, Scott Warren
In this chapter we provide a framework for designing play spaces to support learning academic content. Reflecting on our four years of design... Sample PDF
Conceptual Play Spaces
Chapter 58
Brian M. Winn
This chapter introduces a framework for the design of serious games for learning, called the design, play, and experience framework. The author... Sample PDF
The Design, Play, and Experience Framework
Chapter 59
Youngkyun Baek
This chapter examines hidden curricula and pedagogy of digital games in order to clarify their educational meaning and importance. The experiences... Sample PDF
Revealing New Hidden Curriculum and Pedagogy of Digital Games
Chapter 60
Wei Qiu, Yong Zhao
This study explored the nature and design of a compelling experience: game design. Thirty-six college juniors in the software engineering major... Sample PDF
Game Design as a Compelling Experience
Chapter 61
Laurie N. Taylor
This chapter explains the significance of informal and unwritten rules in order to show the connections among formal rules of play, formalized... Sample PDF
Gaming Ethics, Rules, Etiquette, and Learning
Chapter 62
Penny de Byl
This chapter presents the embedded authentic serious game-based learning experiences (EASLE) architecture which has been developed to assist in the... Sample PDF
Designing Games-Based Embedded Authentic Learning Experiences
Chapter 63
James Belanich, Karin B. Orvis, Daniel B. Horn, Jennifer L. Solberg
Instructional video game development is occurring in both the commercial game development and the instructional design/development communities, but... Sample PDF
Bridging Game Development and Instructional Design
Chapter 64
Debbie Denise Reese
Game-based, metaphor-enhanced (GaME) design is a process for engineering instructional games to prepare learners with the prior knowledge they need... Sample PDF
GaME Design for Intuitive Concept Knowledge
Chapter 65
Yuxin Ma, Douglas Williams, Charles Richard, Louise Prejean
Electronic games have the potential to support learning by doing and enhance student motivation. However, there is little guidance in the literature... Sample PDF
Leveraging the Affordances of an Electronic Game to Meet Instructional Goals
Chapter 66
Wenhao David Huang, Tristan Johnson
This chapter proposes an instructional game design framework based on the 4C/ID-model and cognitive load theory, its associated theoretical... Sample PDF
Instructional Game Design Using Cognitive Load Theory
Chapter 67
Mahboubeh Asgari, David Kaufman
While there are thousands of educational computer and video games in the market today, few are as engaging and compelling as entertainment games.... Sample PDF
Motivation, Learning, and Game Design
Chapter 68
Designing Games for Learning  (pages 1183-1203)
Scott J. Warren, Mary Jo Dondlinger
This chapter discusses two games that were designed to target learning as well as implications for the design of future games intended for this... Sample PDF
Designing Games for Learning
Chapter 69
Panagiotis Zaharias, Anthony Papargyris
E-learning is emerging as one of the fastest organizational uses of the Internet as a supplementary or alternative mode for corporate training.... Sample PDF
Interaction with MMOGs and Implications for E-Learning Design
Chapter 70
Douglas Williams, Yuxin Ma, Charles Richard, Louise Prejean
This chapter explores the challenge of balancing narrative development and instructional design in the creation of an electronic game-based learning... Sample PDF
Narrative Development and Instructional Design
Chapter 71
Lloyd P. Rieber, Joan M. Davis, Michael J. Matzko, Michael M. Grant
We have long worked collaboratively with middle school students to help them design their own educational computer games. An interesting question... Sample PDF
Children as Critics of Educational Computer Games Designed by Other Children
Chapter 72
Leanna Madill, Kathy Sanford
This chapter explores changing conceptions of learning brought about by technological changes and opportunities and examines more closely the... Sample PDF
Video-Game Creation as a Learning Experience for Teachers and Students
Chapter 73
Brian Magerko
This chapter discusses the potential future of games for learning through the lens of current advantages of real-world education that are thus far... Sample PDF
The Future of Digital Game-Based Learning
Chapter 74
Artists in the Medium  (pages 1289-1302)
Kurt Squire
This chapter discusses emerging trends in games and learning. It argues for an approach that examines games as a new medium. With the increased... Sample PDF
Artists in the Medium
Chapter 75
Rusel DeMaria
What is the future of video games? Is it more realism? More violence? Better physics? Artificially intelligent characters? More social networking... Sample PDF
The Positive Impact Model in Commercial Games
Chapter 76
Chad M. Harms
By retracing the tracks of the popular educational game, the Oregon Trail, this chapter presents both positive and negative realities of the... Sample PDF
Education and Exploitation Off the Virtual Train to Oregon
Chapter 77
Clark Aldrich, Joseph C. DiPietro
This appendix introduces and defines commonly used terms and phrases from the world of video gaming. It seeks to bridge the gaps between... Sample PDF
An Overview of Gaming Terminology: Chapters I-LXXVI
Chapter 78
Göknur Kaplan Akilli
Computer games and simulations are considered powerful tools for learning with an untapped potential for formal educational use. However, the lack... Sample PDF
Games and Simulations: A New Approach in Education?
Chapter 79
Chee Siang Ang, Panayiotis Zaphiris
This chapter attempts to examine computer game theories — ludology and narratology — that explain computer games as play activities and storytelling... Sample PDF
Developing Enjoyable Second Language Learning Software Tools: A Computer Game Paradigm
Chapter 80
Elizabeth Fanning
A game mod describes a modification within an existing commercial, computer-based game that has been created by a user. By game modding, a user can... Sample PDF
Game Mods: Customizable Learning in a K16 Setting
Chapter 81
Lisa Galarneau, Melanie Zibit
20th century visionaries foresaw that mastery of the dynamic processes underpinning the acquisition and manipulation of knowledge would be critical... Sample PDF
Online Games for 21st Century Skills
Chapter 82
Nancy Sardone, Roberta Devlin-Scherer, Joseph Martinelli
The last 20 years have brought an increase of computers into educational and home environments, generating an explosion of available educational... Sample PDF
Game-Based Instruction in a College Classroom
Chapter 83
Renee Hobbs, Jonelle Rowe
This chapter explores how media literacy education may continue to be responsive and relevant to the continually changing nature of popular culture... Sample PDF
Creative Remixing and Digital Learning: Developing an Online Media Literacy Learning Tool for Girls
Chapter 84
Kalle Jegers, Carlotte Wiberg
This chapter reports on the initial results of a study conducted in the project FunTain. The main purpose was to identify general... Sample PDF
Learning While Playing: Design Implications for Edutainment Games
Chapter 85
Karen Schrier
Students need to learn the critical thinking of history, yet they rarely have opportunities to authentically simulate historic inquiry. Research has... Sample PDF
Reliving History with "Reliving the Revolution": Designing Augmented Reality Games to Teach the Critical Thinking of History
Chapter 86
Katia Sycara, Paul Scerri, Anton Chechetka
In this chapter, we explore the use of evolutionary game theory (EGT) (Nowak & May, 1993; Taylor & Jonker, 1978; Weibull, 1995) to model the... Sample PDF
Insights into the Impact of Social Networks on Evolutionary Games
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