Background The stigma faced by people living with HIV causes difficulties in the treatment of HIV/AIDS. Decreasing this stigma is thus no less urgent than implementing behavioral interventions. Serious games are being increasingly adopted as an intervention mechanism to control HIV/AIDS around the world. However, the development and evaluation of these games in China are far from adequate. Objective This research aimed to help decrease HIV-related stigma in China via the development and evaluation of a serious game, as well as promote a participatory gamification culture for health interventions. Methods Initially, a serious game was developed using free resources from a user-generated content website. Then, quantitative and qualitative methods were employed for game evaluation. A randomized controlled trial was conducted to explore the game’s effect on HIV-related stigma. The trial included 167 university students, who were randomly allocated to game and control groups. After the experimental evaluation, focus group discussions were held with 64 participants, who were invited to form 16 groups. Results The game was called The Second Kind of Life with HIV (SKLWH), which is a free online game that can be played on computers and smartphones. This game hopes to publicize that people living with HIV can live a normal life, that is, a second life different from that imagined by the public. Based on the gamification practice of SKLWH, the participatory serious game development model (PSGDM) was proposed, which guided the development of 3 other HIV-themed games. The trial showed that intimacy stigma was much more severe than morality stigma and personal interaction stigma. Females were more tolerant of morality stigma than males (mean score: 1.29 vs 1.50; P=.01). The game intervention showed an advantage in decreasing intimacy stigma (mean score [game vs control]: 2.43 vs 2.73; P=.04). The group discussions validated the quantitative results and provided further in-depth information. The game intervention was largely preferred by participants, and the belief in intimacy impossibility was commonly expressed by participants when considering their relationship with people living with HIV. Conclusions HIV/AIDS education should adopt appropriate media interventions to mitigate different dimensions of HIV-related stigma. Serious games should be used to decrease intimacy stigma, which is the hardest form to diminish. It is expected that the PSGDM can promote the development of more health games. Furthermore, HIV/AIDS intervention requires interdisciplinary efforts and cooperation that will allow more people to participate and share the responsibility of promoting health.
BACKGROUND The prevalence of HIV/AIDS in China hasn’t declined over the past few years, and people living with HIV (PLWH) are, to a large extent, ostracized by the public. The stigma coming with it adds difficulties to the treatment of HIV/AIDS. Decreasing this stigma is no less urgent than behavioral interventions. Serious games are increasingly adopted as an intervention method to control HIV/AIDS in the global community. Yet, the development and evaluation of such games in China are far from adequate. OBJECTIVE This research aims to help decrease HIV-related stigma in China via the development and evaluation of a serious game, and propose the Participatory Serious Game Development Model (PSGDM) to promote gamification for health. METHODS This research developed a serious game named The Second Kind of Life with HIV, and conducted a randomized controlled trial to evaluate the game’s effect on HIV-related stigma. 167 university students with an average age of 20 joined the trial, and were randomly assigned to four groups: female-game group, male-game group, female-control group, and male-control group. Each subject filled in the HIV-related stigma measurement questionnaire, after playing the game or accessing the material of control groups. RESULTS The Second Kind of Life with HIV was launched in 2019. As a free-of-charge webpage game available both on computer and smartphone, its main target subjects are Chinese youngsters. In this research, HIV-related stigma is measured in three dimensions: morality, everyday contact and intimacy, with the intimacy dimension being the most severe type of stigma. The game group shows an advantage in decreasing moral stigma (mean game=1.35, mean control=1.52, P=.03) and intimacy stigma (mean game=2.41, mean control=2.74, P=.04) compared with the control group, yet no significant difference in deceasing everyday contact stigma (P=.49). Females are more tolerant in moral stigma (mean female=1.34, mean male=1.52, P=.02) and everyday contact stigma (mean female=1.29, mean male =1.49, P=.04) than males, while both genders are conservative in intimacy stigma (P=.52). The interactions are not significant in all three dimensions of HIV-related stigma, indicating that the effect of media interventions will not vary with gender. CONCLUSIONS HIV/AIDS education should adopt the appropriate media interventions to break different dimensions of HIV-related stigma, especially using games in decreasing intimacy stigma which is the hardest to break. It is anticipated that the PSGDM, as proposed in this research, can promote the development of more HIV/AIDS educational games. Moreover, interdisciplinary effort and collaboration is needed for HIV/AIDS intervention, and more people can be engaged and share the responsibility of promoting health.
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