A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study

Abstract

Background Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health. Objective This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions. Methods We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS. Results SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings. Conclusions The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health.

The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review

“…SSS [ 25 ] is a web-based adventure game for teenagers aged 11 to 14 years in the United States aimed at education to prevent unwanted pregnancy and sexually transmitted infections. SSS emphasizes educational training to acquire knowledge about sex-related topics and is based on an intervention mapping approach.…”

“…The results provided preliminary support for the hypotheses that playing an avatar-based virtual reality technology game would strengthen peer resistance skills and that early adolescent Hispanic girls would have a positive response to this game. SSS [25] is a web-based adventure game for teenagers aged 11 to 14 years in the United States aimed at education to prevent unwanted pregnancy and sexually transmitted infections. SSS emphasizes educational training to acquire knowledge about sex-related topics and is based on an intervention mapping approach.…”

An Evidence Map on Serious Games in Preventing Sexually Transmitted Infections Among Adolescents: Systematic Review About Outcome Categories Investigated in Primary Studies

“…A total of 18 studies identified within the systematic review were included in the synthesis on effectiveness and user experiences investigated in primary studies related to serious games in STI prevention ( Table 2 ). Three of the studies are usability tests that focus on usability, user experience, and cultural adaptation or adaptation, among other factors [ 30 - 32 ]. One of these studies only reported perceived efficacy [ 31 ].…”

“…Four of these 7 studies additionally integrated the question whether the participants were willing to repeat the serious game [ 30 , 33 , 38 , 47 ], where 3 of them found that a majority of participants were willing to do so [ 30 , 38 , 47 ]. Three out of the 10 studies addressed the aspect of motivation in general [ 32 , 39 , 41 ]. One study assessed motivation using questions in the domains of attention, relevance, confidence, and satisfaction related to the serious game, showing increased motivation among intervention participants [ 39 ].…”

An Evidence Map on Serious Games in Preventing Sexually Transmitted Infections Among Adolescents: Systematic Review About Outcome Categories Investigated in Primary Studies (Preprint)

“…A total of 18 studies identified within the systematic review were included in the synthesis on effectiveness and user experiences investigated in primary studies related to serious games in STI prevention (Table 2). Three of the studies are usability tests that focus on usability, user experience, and cultural adaptation or adaptation, among other factors [30][31][32]. One of these studies only reported perceived efficacy [31].…”