Monday, 18 November 2019: 3:45 PM
Introduction: African Americans adolescents are disproportionately affected by HIV morbidity and mortality (Centers for Disease Control and Prevention [CDC], 2017). It is particularly critical to prevent HIV infection among African American youth given the inadequate access to care for African American youth living with HIV. This is exemplified by the fact that although African American adolescents (ages 13-19) represent 14% of the U.S. adolescent population, they accounted for 61% of new HIV infections and 61% of HIV deaths in 2017(CDC, 2018). In comparison to other areas of the U.S., the rural Deep South has the highest number of adults and adolescents living with HIV and dying from AIDS and the highest percentage of new AIDS cases among people living in rural areas (CDC, 2017). Capitalizing on the ubiquitous nature of emerging technologies; the search for new risk reduction interventions appropriate for young adolescents has recently led to the use of electronic video games (Baranowski et al., 2013; Enah, Piper, & Moneyham, 2015; Enah, Moneyham, Vance, Gakumo, Chandler, 2014).These games provide a simulated and interactive environment where players can engage in behavioral rehearsal using a platform that is inherently appealing to them (Baranowski et al., 2013;Enah et al.,2015). Gaming interventions show great potential to reduce risky sexual behaviors (DeSmet et al., 2016).
Aims: The aim of this study was to assess the potential efficacy of an immersive adventure game (RAHPe) focused on decreasing sexual risky behavior in rural African American. The game was designed with and for African American adolescents residing in a low resource setting (rural Deep South of the U.S.) in a previous project. We hypothesized that after navigating high-risk contextually relevant situations in the immersive RAHPe game, adolescents will exhibit less risky behaviors than before game play.
Methods: Participants were enrolled after parental consent and participant assent was obtained. A total of 24 adolescents (41% male and 59% female) adolescents completed study. Data were collect over a period of 9 months in 2016 to evaluate the potential efficacy of the RAHPe game in reducing risky sexual behaviors. The game was designed using community based-participatory approaches in which our multidisciplinary research team partnered with the target population to generate data that informed the content and design of a gaming. The game was found to be acceptable and relevant to the target population in a previous study. Electronic questionnaires using REDcap were completed before game play, immediately after playing the game, and three months post-intervention using study provided tablets. After the initial assessment, participants played the RAHPe game at their convenience using study tablets over a period of one month for a total of six hours. Participants could play the game for up to two hours per game play session. All game play and data collection sessions were completed on study provided tablets and took place in a collaborating community center. Community-based sexually transmitted Infections (chlamydia, gonorhea, and trichomoniasis) testing was also completed as part of the assessment. Participants self collected samples were taken to our university infectious disease clinic for analysis. Self-reported behavioral data from study tablets were captured in REDcap and imported into SPSS for data management and analysis. Data was analyzed using descriptive and nonparametric Mcnemar test to determine changes in risk behaviors.
Results: We found promising changes in sexual risk behavior three months post-intervention. There was a 50% decrease in reports of the number of sexual acts (oral, vaginal, anal) and a 19% increase in condom use. The reported number of sexual partners did not change. All participants in this study tested negative for sexually transmitted infections during the study period.
Nursing Implications: Findings have implications for nurses and health professionals who work with adolescents and for further research. Nurses and health professionals who work with adolescents may want to incorporate engaging interactive electronic based approaches to deliver health messages Findings from this study show potential efficacy of the RAHPe and support further larger-scale studies to determine efficacy and effectiveness.
Global Health Implications: Findings from this study have global health implications regarding access to risk reduction interventions in low resource settings. The use of an electronic video gaming intervention provides a means to circumvent traditional access barriers in rural and geographically dispersed populations. The design and content of the videogame with the target population ensured that scenarios within the game reflected the context and enhanced. This content can be adapted to reflect local context in other resource poor settings that need similar risk reduction efforts. In addition to potential dissemination of the intervention in multiple electronic formats (CDs, cell phones) allows for easy scalability of the intervention once effectiveness is established.
Conclusions: The RAHPe game shows promise in reducing risky sexual behaviors in resource limited settings. However, larger and more rigorously designed studies on the efficacy and effectiveness of the videogame are needed.
Aims: The aim of this study was to assess the potential efficacy of an immersive adventure game (RAHPe) focused on decreasing sexual risky behavior in rural African American. The game was designed with and for African American adolescents residing in a low resource setting (rural Deep South of the U.S.) in a previous project. We hypothesized that after navigating high-risk contextually relevant situations in the immersive RAHPe game, adolescents will exhibit less risky behaviors than before game play.
Methods: Participants were enrolled after parental consent and participant assent was obtained. A total of 24 adolescents (41% male and 59% female) adolescents completed study. Data were collect over a period of 9 months in 2016 to evaluate the potential efficacy of the RAHPe game in reducing risky sexual behaviors. The game was designed using community based-participatory approaches in which our multidisciplinary research team partnered with the target population to generate data that informed the content and design of a gaming. The game was found to be acceptable and relevant to the target population in a previous study. Electronic questionnaires using REDcap were completed before game play, immediately after playing the game, and three months post-intervention using study provided tablets. After the initial assessment, participants played the RAHPe game at their convenience using study tablets over a period of one month for a total of six hours. Participants could play the game for up to two hours per game play session. All game play and data collection sessions were completed on study provided tablets and took place in a collaborating community center. Community-based sexually transmitted Infections (chlamydia, gonorhea, and trichomoniasis) testing was also completed as part of the assessment. Participants self collected samples were taken to our university infectious disease clinic for analysis. Self-reported behavioral data from study tablets were captured in REDcap and imported into SPSS for data management and analysis. Data was analyzed using descriptive and nonparametric Mcnemar test to determine changes in risk behaviors.
Results: We found promising changes in sexual risk behavior three months post-intervention. There was a 50% decrease in reports of the number of sexual acts (oral, vaginal, anal) and a 19% increase in condom use. The reported number of sexual partners did not change. All participants in this study tested negative for sexually transmitted infections during the study period.
Nursing Implications: Findings have implications for nurses and health professionals who work with adolescents and for further research. Nurses and health professionals who work with adolescents may want to incorporate engaging interactive electronic based approaches to deliver health messages Findings from this study show potential efficacy of the RAHPe and support further larger-scale studies to determine efficacy and effectiveness.
Global Health Implications: Findings from this study have global health implications regarding access to risk reduction interventions in low resource settings. The use of an electronic video gaming intervention provides a means to circumvent traditional access barriers in rural and geographically dispersed populations. The design and content of the videogame with the target population ensured that scenarios within the game reflected the context and enhanced. This content can be adapted to reflect local context in other resource poor settings that need similar risk reduction efforts. In addition to potential dissemination of the intervention in multiple electronic formats (CDs, cell phones) allows for easy scalability of the intervention once effectiveness is established.
Conclusions: The RAHPe game shows promise in reducing risky sexual behaviors in resource limited settings. However, larger and more rigorously designed studies on the efficacy and effectiveness of the videogame are needed.