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Background Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69% (18/26) reported that they liked the game, and 81% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game ( P =.001). Conclusions FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate ...

Context: Requirements Engineering (RE) has established itself as a software engineering discipline over the past decades. While researchers have been investigating the RE discipline with a plethora of empirical studies, attempts to systematically derive an empirical theory in context of the RE discipline have just recently been started. However, such a theory is needed if we are to define and motivate guidance in performing high quality RE research and practice. Objective: We aim at providing an empirical and externally valid foundation for a theory of RE practice, which helps software engineers establish effective and efficient RE processes in a problem-driven manner. Method: We designed a survey instrument and an engineer-focused theory that was first piloted in Germany and, after making substantial modifications, has now been replicated in 10 countries worldwide. We have a theory in the form of a set of propositions inferred from our experiences and available studies, as well as the results from our pilot study in Germany. We evaluate the propositions with bootstrapped confidence intervals and derive potential explanations for the propositions. Results: In this article, we report on the design of the family of surveys, its underlying theory, and the full results obtained from the replication studies conducted in 10 countries with participants from 228 organisations. Our results represent a substantial step forward towards developing an empirical theory of RE practice. The results reveal, for example, that there are no strong differences between organisations in different countries and regions, that interviews, facilitated meetings and prototyping are the most used elicitation techniques, that requirements are often documented textually, that traces between requirements and code or design documents are common, that requirements specifications themselves are rarely changed and that requirements engineering (process) improvement endeavours are mostly internally driven. Conclusion: Our study establishes a theory that can be used as starting point for many further studies for more detailed investigations. Practitioners can use the results as theory-supported guidance on selecting suitable RE methods and techniques. CCS Concepts: • General and reference → Empirical studies; • Software and its engineering → Requirements analysis;

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