Developing a Sexual Health Video Game to Optimize the Likelihood of Desired Health Outcomes

Purpose:  

Gaming interventions are gaining momentum as a viable tool for addressing a number of health promoting behaviors. Gaming interventions are posited to change behavior through three different mechanisms which include providing an immersive state in which players become absorbed in game play while grasping personally relevant experiences from game characters; allowing for a state of high concentration in which the player experiences a balance between skills and challenge; and meeting the players intrinsic motivation needs of diversion or challenge. Recent studies with young adolescents suggest that electronic gaming hold promise of being developmentally appropriate for young adolescent populations. Global organizations working with youth in developing countries are already taking advantage of games for health approaches. However, research on electronic games in sexual health of young adolescents in the United States is quite limited. The purpose of this study was to develop a prototype for an individually tailored electronic sexual health adventure game for young rural adolescents, age 12-16 years.

Methods:

In this study, we used a user-centric approach to intervention development which involves identifying user needs, using a rapid iterative prototyping process in which components are reviewed by samples of potential users and their feedback used to develop the next iteration. Building on prior pilot work, this study was completed in three phases. In the first phase, focus groups were conducted with 84 rural adolescents age 12-16, to better understand the sociocontextual influences on sexually risky behaviors and their sexual risk reduction intervention needs. In phase 2, findings from the first phase were used to draft intervention components in the form of a game storyboard and initial components were then programmed into a gaming prototype with the assistance of programming experts. The game also incorporate evidence based components that have been demonstrated to promote behavior change. These included theory driven content that focused on enhancing competence, autonomy, and relatedness. In addition, the game was designed to include tailored goal setting to enhance relevance, behavior specific knowledge enhancement, self-regulatory skills and modeling of behaviors and skills. In Phase 3, the storyboard and programmed components were assessed by additional 45 members of the target population for acceptability and relevance. Findings from the third phase were used to further refine the game.  

Results:

Major themes from phase 1 were that sexually active adolescents were primary focus on pregnancy prevention not the prevention of sexually transmitted diseases and participants described sex during adolescence as normative. Participants wanted the sexual health game to be player controlled, tailored to player/avatar characteristics to increases buy in and transferability to real life situations and for the game to reflect their daily lives. However, participants did not want the game to be overtly educational. In phase three, participants found the game to be relevant and acceptable to the target population. Focus group findings provided overwhelming support for game plans and mechanics. Focus group participants also provided additional input on components that could make the game more enticing to players.

Conclusion:

Achieving a balance between funs aspects and essential messages in the design of games for health is a formidable task but this balance is necessary to enhancing likelihood of behavior change folowing gaming interventions. Using evidence based components of health games allows for the design of games that optimize the likelihood of achieving desired outcomes. Storyboarding allows interventions developers to assess major game components before programming and partnering with the target population from the beginning of intervention development enhances relevance. In addition, working with potential users ensures that the sexual health game being developed reflects their lives and needs and increase the likelihood of effectiveness.  Games also offer the ability to circumvent traditional barriers to access to health promoting interventions faced by adolescents in rural areas.