Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans

Abstract

The increasing availability of smartphones, including in low-income countries, offers an unprecedented opportunity to reach individuals with innovative health promotion interventions. Electronic games delivered via smartphone offer promising avenues for sexual health promotion and HIV prevention, especially for young people. By giving players real agency in a virtual and safe environment, well-designed games can provide a level of experiential learning unparalleled by many other behavioral interventions. The design of effective games for health relies on multidisciplinary insight and expertise. However, relatively few studies discuss the theoretical understanding underlying their intervention. Making explicit the theoretical grounding of a game-based intervention allows articulation of assumptions and strategies, anticipation of outcomes, and evaluation of impacts (including intermediate effects), thereby increasing understanding of pathways to change, with a view to contributing to the development of more effective games. It also helps strengthen the credibility and improve the accountability of games for health. We present the multidisciplinary theoretical framework—integrating intervention design, mediators, and behavioral outcomes—and the structure of an HIV prevention game for young African adolescents that has shown promise in a randomized pilot study in Western Kenya. The central component of Tumaini ( hope for the future in Kiswahili) is an interactive role-playing narrative in which the player makes choices for characters that determine how their paths unfold. In addition, a series of mini-games reinforce skills, and the “My Story” component links the game world to the player’s own life and goals, and a reward system motivates continued play. With its “choose-your-own-adventure” format, Tumaini is intended to be replayed so that players can experience the consequences resulting from different choices made in the role-playing narrative. Grounded in theories of narrative and applied communication and in social behavioral theories, especially Social Cognitive Theory, Tumaini is designed to help young adolescents acquire the information, skills, and motivation they need to avoid and reduce sexual risks. We close by situating Tumaini within discussion of the theory and practice of using interactive narrative in health promotion, with a view to furthering theoretical elaboration.

Serious games para educação sexual de adolescentes e jovens: revisão integrativa de literatura

“…21 e InFection Four 16 ) e um de tabuleiro ("A aventura do adolescente com TEA: descobrindo a sexualidade" 19 ). A maioria dos autores optou por restringir a faixa etária do público-alvo da tecnologia, com jogos indicados aos anos iniciais 7,8,15,17 ou finais da juventude 3,11,12,22 .…”

“…A maioria dos serious games foi desenvolvida de modo participativo, por grupos multidisci-plinares 3,7,13,14,[16][17][18] , alguns passaram por processo sistemático de validação 11,18,20 ou foram avaliados por estudos de intervenção para a mensuração do efeito da ferramenta na população-alvo 3,6,8,[15][16][17]22 . O Quadro 2 apresenta os percursos metodológicos seguidos e os principais resultados dos estudos incluídos nesta revisão.…”

“…Evidências apontam que jogos sobre sexualidade auxiliam no ganho de conhecimento acerca da temática, incitam mudança de atitude e promovem práticas sexuais seguras 6,7 . Além disso, esses jogos propiciam o pensamento crítico, orientam a tomada de decisão e a solução de problemas, criando senso de responsabilidade 8 .…”

The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19

“…Tumaini is a theoretically grounded, narrative-based game for inexpensive Android smartphones designed in collaboration with US-based and Kenyan specialists in adolescent sexual health, with input from Kenyan preadolescents and their parents. It aims to increase age and condom use at first sex by boosting knowledge about sexual health and HIV; building risk avoidance, risk-reduction skills, and related self-efficacy; challenging HIV stigma and harmful gender norms and attitudes; fostering future orientation, goal setting, and planning; and promoting dialogue with adult mentors [ 24 , 25 ]. Tumaini is grounded in (1) theory on narrative and narrative-based applied communication, (2) social behavioral theory and existing evidence-based HIV prevention interventions, and (3) principles of instructional design.…”

The Role of Agency and Threat Immediacy in Interactive Digital Narrative Fear Appeals for the Prevention of Excessive Alcohol Use: Randomized Controlled Trial

“…Many investigations have provided interactive elements in their message design (see the studies by Winskell et al [ 22 ] and Carvalho et al [ 23 ]) but do not contrast interactive to passive appeals directly, making generalizations about the impact of perceived agency difficult. Only a few studies have compared interactive with noninteractive fear appeals, and these studies found contradictory results.…”