A smartphone game to prevent HIV among young Kenyans: Household dynamics of gameplay in a feasibility study

Abstract

Objective: mHealth interventions often favour individual-level effects. This is particularly problematic in contexts where social support and shifts in social norms are critical to sustained behaviour change. Mobile digital games represent a promising health education strategy for youth, including in low-resource settings. We sought to better understand the interpersonal and social interactions that can be elicited by digital games for health. Design: We piloted Tumaini, a smartphone game rooted in interactive narrative designed to prevent HIV among young Africans (aged 11–14), in a randomised controlled feasibility study and analysed reports of the household dynamics surrounding gameplay. Following a 16-day intervention period, phone gameplay log files were downloaded, and intervention arm participants ( n = 30) completed a gameplay experience survey; eight focus group discussions were held, four with intervention arm participants ( n = 27) and four with their parents ( n = 22). Setting: This study took place in Kisumu, Kenya, in Spring 2017. Method: Descriptive statistics were computed from survey responses and log files. Focus group transcripts were labelled, analysed thematically and compared demographically using MAXQDA software. Results: Data from log files, surveys and focus groups indicate that the game generated considerable interaction and dialogue with parents, siblings and friends and served as a catalyst for children to act as advocates for healthful decisions about sex, both within the family and beyond. The game showed a high level of acceptability with parents. Conclusion: Serious digital games using a smartphone platform can generate considerable household interaction. Games can model and facilitate these exchanges, maximising multi-level effects. An additional app for parents could reinforce these effects.

Does Digital Literacy Empower Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review

“…Sample sizes ranged from 120 to 25,929 subjects in quantitative studies, 12 to 726 participants in qualitative studies, and 68–800 participants in mixed methods studies. Most of the studies have been conducted in the African countries ( n = 20) ( 30 – 33 , 37 , 39 – 43 , 45 , 49 , 53 – 58 , 60 ), 12 studies conducted in Asia ( 26 , 27 , 29 , 35 , 36 , 38 , 39 , 46 , 51 , 52 , 59 ), three studies conducted in South American countries ( 34 , 38 , 54 ), and one study in North America: Mexico ( 34 ). The methodological qualities of included studies are provided in Tables 1 , 2 .…”

“…Most of the studies ( n = 12) identified that the internet is the main source of information for many adolescents and youth in LMICs. Studies reported that SRH information available on the internet increased the SRH knowledge and improved the attitudes toward SRH of participants ( 45 , 46 , 48 , 50 , 53 – 55 , 58 , 60 – 62 , 65 ). Studies also reported that young girls prefer to use the internet to access SRH information because of its ease of access, low cost, anonymity/privacy, and trustworthiness ( 39 , 40 , 42 , 44 , 45 , 47 – 49 , 54 – 56 , 59 ).…”

“…Winskell et al piloted a mobile phone game “ Tumaini” to prevent HIV among young Africans (11–14 years). The study identified that the game generated interaction and engagement with parents, siblings, and friends and served as a catalyst for children to act as advocates for health decisions about sex, both within the family and beyond ( 53 ). Studies also reported that digital literacy improves the utilization of reproductive health services such as family planning, antenatal care, childbirth, postnatal care services, and child care among women of reproductive age ( 38 , 52 ).…”

A Smartphone Game to Prevent HIV Among Young Africans (Tumaini): Assessing Intervention and Study Acceptability Among Adolescents and Their Parents in a Randomized Controlled Trial

“…Despite this misunderstanding, there were many reports of parent-child communication across a broad range of topics, which are detailed in a separate publication [26].…”

“…This resulted in users noticing some bugs and some of the minigame mechanics proving more challenging than intended. These minor usability issues did not appear to affect the overall acceptability of the game or its appeal and, in fact, resulted in additional communication with older family members about the game as they sought help [26]. These issues will be addressed and a full bug test conducted before further game testing as originally planned.…”