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Boomer TP, Larkin K, Duncan LR, Fernandes CSF, Fiellin LE. A Serious Video Game Targeting HIV Testing and Counseling: A Randomized Controlled Trial. J Adolesc Health 2024; 74:252-259. [PMID: 37815773 PMCID: PMC10841098 DOI: 10.1016/j.jadohealth.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/12/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Adolescents are the age group that is least likely to know their HIV status and may unknowingly transmit the virus to others. A randomized controlled trial was conducted to evaluate the impact of the original video game intervention, PlayTest!, on behavioral antecedents for HIV testing and counseling (HTC). METHODS Participants (N = 287 adolescents) were recruited between 2018 and 2020 and were 48% female, aged 14-18 years (mean age = 15.4 years), and 76% racial minorities. Participants were randomized 1:1 and assigned to either play PlayTest! or a set of control games, ∼one session per week for an hour per session over 4-6 weeks (gameplay) after school. The primary outcome measure was participants' attitudes around HTC at 6 months, with intentions, knowledge, self-efficacy, and behaviors assessed as secondary outcomes. RESULTS Two hundred and ninety-six participants were enrolled/randomized; nine were withdrawn due to incomplete parental consent forms, leaving 287 participants: 145 were randomized to PlayTest! and 142 to the control condition. Mixed between-within subjects ANOVAs assessed the impact of the study conditions on outcomes. Improvements were seen in the PlayTest! group in HTC attitudes (p < .001), intentions (p < .001), knowledge (p < .001), and self-efficacy (p = .002) at all time-points. At 6 months, for those who had access to HTC (N = 134; prior to COVID-19) and for those who did not have access to HTC (N = 261; during COVID-19), there were no differences in self-reported HTC between the two groups (p = .289 and p = .074, respectively). DISCUSSION PlayTest! impacted important behavioral antecedents related to HTC and has the potential to broadly increase HTC rates in adolescents.
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Affiliation(s)
- Tyra Pendergrass Boomer
- Department of Internal Medicine, Play2PREVENT Lab at the Yale Center for Health & Learning Games, Yale School of Medicine, New Haven, Connecticut.
| | - Kaitlyn Larkin
- Department of Internal Medicine, Play2PREVENT Lab at the Yale Center for Health & Learning Games, Yale School of Medicine, New Haven, Connecticut
| | - Lindsay R Duncan
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Claudia-Santi F Fernandes
- Department of Internal Medicine, Play2PREVENT Lab at the Yale Center for Health & Learning Games, Yale School of Medicine, New Haven, Connecticut
| | - Lynn E Fiellin
- Department of Internal Medicine, Play2PREVENT Lab at the Yale Center for Health & Learning Games, Yale School of Medicine, New Haven, Connecticut; Yale Child Study Center, New Haven, Connecticut; Yale School of Public Health, New Haven, Connecticut
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Aung ET, Fairley CK, Chow EPF, Lee D, Maddaford K, Wigan R, Read D, Taj U, Vlaev I, Ong JJ. Exploring the Use of "Nudges" to Improve HIV and Other Sexually Transmitted Infection Testing Among Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2641-2650. [PMID: 35708818 PMCID: PMC9202328 DOI: 10.1007/s10508-022-02321-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/21/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
Behavioral economics and its applied branch "nudging" can improve individual choices in various health care settings. However, there is a paucity of research using nudges to improve regular testing for HIV and other sexually transmitted infections (STIs). The study examined which reminder system and message type men who have sex with men (MSM) preferred to remind them to undergo regular 3-monthly HIV and STI testing. A cross-sectional survey study was conducted among MSM attending a sexual health clinic in Melbourne, Australia between 13 January and 5 March 2020, exploring the preferred method of reminder and framing of the message. Descriptive statistics and logistic regression were used to analyze the data. A total of 309 responses were received. The majority of the participants (90%) preferred short messaging service (SMS) as the reminder method for HIV/STI testing compared to other types (e.g., email or instant messaging). More than a third of the participants (45%) showed a preference for a neutrally framed reminder message (Your next check-up is now due. Please phone for an appointment), while one-third (35%) preferred a personalized message (Hi [first name], you are due for your next check-up. Please phone for an appointment). Younger men were more likely to favor positive framed messages than older men who favored neutrally framed messages (p < .01). SMS was the preferred reminder method for regular HIV/STI testing. Reminder messages that were neutrally framed, personalized or positive framed messages were preferred over negative or social norm messages.
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Affiliation(s)
- Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
| | - Daniel Read
- Warwick Business School, University of Warwick, Coventry, UK
| | - Umar Taj
- Warwick Business School, University of Warwick, Coventry, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Xiao S, Wang L, Edelman EJ, Khoshnood K. Interpersonal factors contributing to tension in the Chinese doctor-patient-family relationship: a qualitative study in Hunan Province. BMJ Open 2020; 10:e040743. [PMID: 33303452 PMCID: PMC7733169 DOI: 10.1136/bmjopen-2020-040743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify actionable barriers to communication that contribute to tension in the Chinese doctor-patient-family relationship (DPFR) among surgeons, surgical patients and their family members. DESIGN We employed qualitative research methods using in-depth, semistructured interviews in Mandarin and English and conducted preoperatively and postoperatively. Interviews were audio recorded, transcribed and translated into English. Data were analysed using thematic analysis. SETTING An urban, tertiary-level teaching hospital in Hunan Province, China. PARTICIPANTS We recruited a purposive sample of 11 inpatients undergoing the same minor surgery, 9 of their family members and 9 surgeons between June and August 2015. RESULTS We identified three emergent themes. First, trust degradation occurred before and during the healthcare experience. Second, the healthcare-seeking experience for patients and family members was marked by unmet expectations for achieving a basic understanding of the illness as well as powerlessness over their situation. Third, societal pressures on doctors contributed to a state of learned helplessness. CONCLUSIONS Our findings suggest that tension in the DPFR is associated with interpersonal and structural challenges, with communication playing an important role. Reforms at all levels are needed to promote a more patient-centred experience while ensuring the well-being and security of providers.
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Affiliation(s)
- Siyu Xiao
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lixuan Wang
- Division of Disease Control, New York City Department of Health and Hygiene, Queens, New York, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kaveh Khoshnood
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
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Morrongiello BA, Weinberger E, Seasons M. Sustained Reductions in Children's Risk Taking from Peer-Communicated Behavioral Safety Norms. J Pediatr Psychol 2020; 45:622-632. [PMID: 32403122 DOI: 10.1093/jpepsy/jsaa026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/02/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This research examined whether the positive effects of a peer-communicated social norm that reduces risk-taking behaviors persist over time and if a reminder of this peer-communicated safety message has any impact on this outcome. METHODS Positive mood in 7- to 9-year olds was induced experimentally and risk taking intentions and behaviors were measured when the child was in a positive and neutral mood state and after they had been exposed to either a safety or neutral peer-communicated social norm message. A few weeks later, half of the participants who experienced the safety social norm message were exposed to a reminder of this message via a slogan and risk-taking measures were taken again when in a heightened positive mood state. RESULTS Exposure to a safety norm successfully counteracted the increase in risk taking associated with a positive mood state. These effects persisted for several weeks regardless of whether the children were exposed to a reminder. CONCLUSION Manipulating peer social norms holds promise as an approach to produce reductions in children's risk taking and these effects persist at least over several weeks.
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Pensak MJ, Lundsberg LS, Stanwood NL, Cutler AS, Gariepy AM. Development and Feasibility Testing of a Video Game to Reduce High-Risk Heterosexual Behavior in Spanish-Speaking Latinx Adolescents: Mixed Methods Study. JMIR Serious Games 2020; 8:e17295. [PMID: 32364507 PMCID: PMC7235807 DOI: 10.2196/17295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/28/2022] Open
Abstract
Background Similar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants. Objective This study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior. Methods This is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data. Results In phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65% (3/20) of participants stated that they would play it again, and 65% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up. Conclusions An iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development.
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Affiliation(s)
- Meredith J Pensak
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Nancy L Stanwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Abigail S Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
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Huang S, Cui C. Preventing Child Sexual Abuse Using Picture Books: The Effect of Book Character and Message Framing. JOURNAL OF CHILD SEXUAL ABUSE 2020; 29:448-467. [PMID: 32109197 DOI: 10.1080/10538712.2020.1719449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
The aim of this study was to investigate whether and how a picture book preventing child sexual abuse can improve children's self-protection skills. The study was conducted in China with Chinese children. In a 2 × 2 between-subjects design, character in the book (human versus animal) and message framing (gain versus loss) were manipulated. Compared to a baseline group who were not exposed to the prevention book, children in the experimental groups significantly enhanced their ability to recognize a potential abuse situation and refuse an inappropriate touch request. Results suggest that the prevention picture books are more effective when using a human character and a gain-framed message. The explanation for this was that human characters simulated children's perceived norm and gain-framed messages increased children's message recall, perceived self-efficacy and positive attitude toward the message, all of which in turn positively affected children's self-protection skills.
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Affiliation(s)
- Sangruo Huang
- Department of Strategic Communication, College of Media and International Culture, Zhejiang University, Hangzhou, China
| | - Chen Cui
- Department of Strategic Communication, College of Media and International Culture, Zhejiang University, Hangzhou, China
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Pendergrass T, Hieftje K, Duncan L, Fiellin L. Videogame intervention to encourage HIV testing and counseling among adolescents. Mhealth 2020; 6:26. [PMID: 32632364 PMCID: PMC7327291 DOI: 10.21037/mhealth.2020.01.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/10/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adolescents in the United States account for one-fifth of new HIV cases, and have the highest rate of undiagnosed HIV, with more than half (51%) not knowing their status. It is a crucial public health concern to help equip youth with the information and autonomy to minimize their risk and know their status. Serious videogames are emerging as valuable tools for health and behavior change in adolescents, and have potential to engage this population and increase their use of HIV testing and counseling (HTC). The purpose of this study was to: (I) modify an original serious game targeting risk reduction and HIV prevention developed by the play2PREVENT Lab and create a new serious game that focuses on HTC; (II) evaluate its feasibility and acceptability; (III) pilot-test the assessment measures that are subsequently being used in a large randomized controlled trial. METHODS Three focus groups with adolescents, aged 14-17 (n=13, mean age =15), informed artwork and storylines for PlayTest! After the game was completed, a pilot test was conducted using a one-group pretest-posttest design to collect data on: (I) participants' gameplay satisfaction and experience; (II) the validity of the project's assessments. Twenty-six participants, aged 15-16 were enrolled from a local after-school program. Participants played PlayTest! twice weekly for three weeks. Data were collected on behavior, intentions, knowledge, perceived susceptibility, and attitudes related to HTC at baseline, post-gameplay (three weeks), and follow-up (six weeks). RESULTS For the focus groups used in the game development, four major themes emerged: (I) adolescents have strong misperceptions about HTC, including who should get tested and what the test entails; (II) adolescents have incorrect knowledge about how HIV is contracted, spread, and treated; (III) adolescents are supportive of their peers getting tested for HIV, but are not likely to get tested themselves; (IV) while the majority of adolescents know where to get tested for HIV, social stigma, misperceptions around HTC, and fear of having a positive diagnosis keep them from seeking it. For the pilot study, overall, participant experience with the game was highly favorable. The assessments were sensitive enough to capture changes in our target variables: intentions (P=0.037) and knowledge (P=0.025) related to HTC at follow-up. CONCLUSIONS The PlayTest! game provides promising results regarding using an engaging and evidence-informed videogame intervention to promote HTC in adolescents.
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Affiliation(s)
- Tyra Pendergrass
- Yale Center for Health and Learning Games, Yale School of Medicine, New Haven, CT, USA
| | - Kimberly Hieftje
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Lindsay Duncan
- Yale Center for Health and Learning Games, Yale School of Medicine, New Haven, CT, USA
| | - Lynn Fiellin
- Yale Center for Health and Learning Games, Yale School of Medicine, New Haven, CT, USA
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Coppola V, McGLONE M, Girandola F, Camus O. Persuasive Effects of Linguistic Agency Assignment and Linguistic Markers of Argumentation in Health Messages about an Emerging Sexually Transmitted Disease. JOURNAL OF HEALTH COMMUNICATION 2019; 25:33-42. [PMID: 31868126 DOI: 10.1080/10810730.2019.1697398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Answering the call by some health communication researchers to give greater attention to message strategies at the level of word choices and sentence structures, this study examined how the linguistic marking of argumentative orientation and linguistic agency assignment affects young adults' reactions to an informational message about a sexually transmitted infection presented as a new emerging health threat. Participants were randomly assigned to read one of the four versions of a fact sheet defined by a 2 × 2 (agency assignment x marking of argumentation orientation) factorial design and thereafter completed a questionnaire. Results indicated that the assignment of agency to the virus (vs. human) increased the perceived severity of the health threat, perceived susceptibility to it, persuasiveness of the message, and safer sex intentions. The same outcomes occurred when the message was phrased with a high marking of the argumentative orientation rather than a low marking. These findings suggest that a better understanding of language variable effects can boost the efficacy of promotional health messages.
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Affiliation(s)
- Vincent Coppola
- Department of Public Administration Management Studies, University Paul Sabatier, Toulouse, France
| | - Matthew McGLONE
- Department of Communication Studies, University of Texas at Austin, Austin, Texas, USA
| | - Fabien Girandola
- Department of Psychology, University of Aix-Marseille, Aix-en-Provence, France
| | - Odile Camus
- Department of Psychology, University of Rouen, Mont Saint Aignan, France
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Hieftje KD, Fernandes CSF, Lin IH, Fiellin LE. Effectiveness of a web-based tobacco product use prevention videogame intervention on young adolescents' beliefs and knowledge. Subst Abus 2019; 42:47-53. [PMID: 31825759 DOI: 10.1080/08897077.2019.1691128] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Preventing tobacco product initiation in youth is a critical need. While cigarette smoking among youth has been on the decline, tobacco use in other forms, such as e-cigarettes and vaping, continue to be a major concern. The purpose of this study was to conduct a real-world, quasi-experimental test of the effectiveness of a web-based videogame, smokeSCREEN, aimed at developing healthy beliefs and knowledge associated with tobacco product use prevention, including electronic cigarettes. Methods: Adolescents (N = 560) aged 10-16 years were enrolled from schools and afterschool programs in a single-group pre-post study. Measures included a pre- and post-survey of beliefs and knowledge about tobacco product use. At post-survey, participants were asked questions regarding their gameplay experience. Paired responses for the tobacco product use in the beliefs and knowledge survey before and after the smokeSCREEN videogame intervention were compared using McNemar's test. Descriptive statistics were generated to assess overall participant gameplay experience. Results: McNemar's test showed significant differences in the proportions of correct answers before (pre-survey) and after (post-survey) the intervention in seven out of eight belief questions (p < . 0001). It also suggested significant differences in the proportions of correct answers before (pre-survey) and after (post-survey) the intervention in all six knowledge questions (p < . 0001). Several gender and age differences were noted for belief and knowledge questions related to e-cigarettes and vaping. There was no association between gameplay duration at post-survey or to the answers of the beliefs or knowledge questions. Overall, participants reported that they enjoyed playing the game. Conclusions: Findings suggest that the videogame intervention, smokeSCREEN, has a promising effect on participants' beliefs and knowledge about tobacco product use, including electronic cigarettes and vaping, and is well accepted by adolescents.
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Affiliation(s)
- Kimberly D Hieftje
- play2PREVENT Lab at the Yale Center for Health & Learning Games, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Claudia-Santi F Fernandes
- play2PREVENT Lab at the Yale Center for Health & Learning Games, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - I-Hsin Lin
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Lynn E Fiellin
- play2PREVENT Lab at the Yale Center for Health & Learning Games, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Child Study Center, New Haven, Connecticut, USA
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Maisonneuve AR, Witteman HO, Brehaut J, Dubé È, Wilson K. Educating children and adolescents about vaccines: a review of current literature. Expert Rev Vaccines 2018; 17:311-321. [PMID: 29569498 DOI: 10.1080/14760584.2018.1456921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Until recently, research on vaccine hesitancy has focused primarily on parent populations. Although adolescent knowledge and views are gaining momentum within the literature, particularly with regards to the human papillomavirus and influenza, children remain a virtually unstudied population with regards to vaccine hesitancy. AREAS COVERED This review focuses on the lack of literature in this area and argues for more vaccine hesitancy research involving child and adolescent populations. It also outlines special issues to consider when framing health promotion messages for children and adolescents. Finally, we explore the use of new and existing technologies as delivery mechanisms for education on vaccines and immunizations in populations of children and adolescents. EXPERT COMMENTARY Children undergo cognitive development and experiences with vaccines (e.g. pain or education) have the potential to create future attitudes toward vaccines. This can influence future vaccine behaviour, including their participation in decision-making around adolescent vaccines, their decisions to vaccinate themselves when they are adults, and their decisions to vaccinate their own children. Interventions aimed at children, such as education, can create positive attitudes toward vaccines. These can also potentially influence parental attitudes toward vaccines as children convey this knowledge to them. Both of these impacts require further study.
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Affiliation(s)
| | - Holly O Witteman
- b Department of Family and Emergency Medicine , Université Laval , Québec , QC , Canada
| | - Jamie Brehaut
- c Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Ève Dubé
- d Institut national de santé publique du Québec , Québec , QC , Canada
| | - Kumanan Wilson
- c Ottawa Hospital Research Institute , Ottawa , ON , Canada
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Fiellin LE, Hieftje KD, Pendergrass TM, Kyriakides TC, Duncan LR, Dziura JD, Sawyer BG, Mayes L, Crusto CA, Forsyth BW, Fiellin DA. Video Game Intervention for Sexual Risk Reduction in Minority Adolescents: Randomized Controlled Trial. J Med Internet Res 2017; 19:e314. [PMID: 28923788 PMCID: PMC5625130 DOI: 10.2196/jmir.8148] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed. Objective We hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents. Methods Participants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age. Results A total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56). Conclusions An interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months. Trial Registration Clinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).
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Affiliation(s)
- Lynn E Fiellin
- play2PREVENT Lab, Yale School of Medicine, Yale University, New Haven, CT, United States.,Yale Child Study Center, New Haven, CT, United States.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Kimberly D Hieftje
- play2PREVENT Lab, Yale School of Medicine, Yale University, New Haven, CT, United States.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Tyra M Pendergrass
- play2PREVENT Lab, Yale School of Medicine, Yale University, New Haven, CT, United States.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States
| | | | - Lindsay R Duncan
- play2PREVENT Lab, Yale School of Medicine, Yale University, New Haven, CT, United States.,McGill University, Montreal, QC, Canada
| | - James D Dziura
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Benjamin G Sawyer
- play2PREVENT Lab, Yale School of Medicine, Yale University, New Haven, CT, United States.,Digitalmill, Freeport, ME, United States
| | - Linda Mayes
- Yale Child Study Center, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Cindy A Crusto
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States.,University of Pretoria, Department of Psychology, Pretoria, South Africa
| | - Brian Wc Forsyth
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States
| | - David A Fiellin
- play2PREVENT Lab, Yale School of Medicine, Yale University, New Haven, CT, United States.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States.,Yale School of Medicine, Yale University, New Haven, CT, United States.,Yale School of Public Health, Yale University, New Haven, CT, United States
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Macapagal K, Janssen E, Matson M, Finn PR, Heiman JR. The Impact of Gain- and Loss-Framed Messages on Young Adults' Sexual Decision Making: An Experimental Study. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:385-394. [PMID: 26696408 PMCID: PMC4917478 DOI: 10.1007/s10508-015-0679-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 11/20/2015] [Accepted: 12/07/2015] [Indexed: 05/31/2023]
Abstract
Messages that frame a target behavior in terms of its benefits (gain frame) or costs (loss frame) have been widely and successfully used for health promotion and risk reduction. However, the impact of framed messages on decisions to have sex and sexual risk, as well as moderators of these effects, has remained largely unexplored. We used a computerized laboratory task to test the effects of framed messages about condom use on young adults' sexual decision making. Participants (N = 127) listened to both gain- and loss-framed messages and rated their intentions to have sex with partners who posed a high and low risk for sexually transmitted infections (STIs). The effects of message frame, partner risk, participant gender, ability to adopt the messages, and message presentation order on intentions to have sex were examined. Intentions to have sex with high-risk partners significantly decreased after the loss-framed message, but not after the gain-framed message, and intentions to have sex increased for participants who received the gain-framed message first. Yet, participants found it easier to adopt the gain-framed message. Results suggest that loss-framed messages may be particularly effective in reducing intentions to have sex with partners who might pose a higher risk for STIs, and that message presentation order may alter the relative effectiveness of gain- and loss-framed messages on sexual decision making. Future studies should examine the precise conditions under which gain- and loss-framed messages can promote healthy sexual behaviors and reduce sexual risk behaviors.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA.
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA.
| | - Erick Janssen
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
- Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Leuven, Belgium
| | - Margaret Matson
- Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Peter R Finn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Julia R Heiman
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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13
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Pendergrass TM, Hieftje K, Crusto CA, Montanaro E, Fiellin LE. If We Build It, Will They Come? A Qualitative Study of Key Stakeholder Opinions on the Implementation of a Videogame Intervention for Risk Reduction in Adolescents. Games Health J 2016; 5:279-85. [PMID: 27336205 PMCID: PMC4991582 DOI: 10.1089/g4h.2015.0092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Serious games are emerging as important tools that offer an innovative approach to teach adolescents behavioral skills to avoid risky situations. PlayForward: Elm City Stories, an interactive videogame targeting risk reduction, is currently undergoing evaluation. Collecting stakeholder data on its acceptability and real-life implementation strategies is critical for successful dissemination. MATERIALS AND METHODS We collected interview data from four stakeholder groups regarding incorporating PlayForward into settings with adolescents. Transcripts were coded, creating a comprehensive code structure for each stakeholder group. RESULTS We conducted 40 semi-structured interviews that included 14 adolescents (aged 12-15 years; 10 boys), eight parents/guardians (all women), 12 after-school/school coordinators (nine women), and 14 community partners (13 women). We identified four themes that reflected stakeholders' perceptions about how the videogame might be implemented in real-world settings. (1) Stakeholder groups expressed that the topics of sex, alcohol, and drugs were not being taught in an educational setting. (2) Stakeholder groups saw a videogame as a viable option to teach about sex, alcohol, and drugs. (3) Stakeholder groups thought that the videogame would fit well into other settings, such as after-school programs or community organizations. (4) Some stakeholder groups highlighted additional tools that could help with implementation, such as manuals, homework assignments, and group discussion questions. CONCLUSION Stakeholder groups supported the game as a delivery vehicle for targeted content, indicating high acceptability but highlighting additional tools that would aid in implementation.
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Affiliation(s)
| | - Kimberly Hieftje
- play2PREVENT Laboratory, Yale School of Medicine, New Haven, Connecticut
| | - Cindy A. Crusto
- play2PREVENT Laboratory, Yale School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- The Consultation Center, Yale University, New Haven, Connecticut
| | - Erika Montanaro
- play2PREVENT Laboratory, Yale School of Medicine, New Haven, Connecticut
| | - Lynn E. Fiellin
- play2PREVENT Laboratory, Yale School of Medicine, New Haven, Connecticut
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14
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Fiellin LE, Kyriakides TC, Hieftje KD, Pendergrass TM, Duncan LR, Dziura JD, Sawyer BG, Fiellin DA. The design and implementation of a randomized controlled trial of a risk reduction and human immunodeficiency virus prevention videogame intervention in minority adolescents: PlayForward: Elm City Stories. Clin Trials 2016; 13:400-8. [PMID: 27013483 DOI: 10.1177/1740774516637871] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To address the need for risk behavior reduction and human immunodeficiency virus prevention interventions that capture adolescents "where they live," we created a tablet-based videogame to teach skills and knowledge and influence psychosocial antecedents for decreasing risk and preventing human immunodeficiency virus infection in minority youth in schools, after-school programs, and summer camps. METHODS We developed PlayForward: Elm City Stories over a 2-year period, working with researchers, commercial game designers, and staff and teens from community programs. The videogame PlayForward provides an interactive world where players, using an avatar, "travel" through time, facing challenges such as peer pressure to drink alcohol or engage in risky sexual behaviors. Players experience how their choices affect their future and then are able to go back in time and change their choices, creating different outcomes. A randomized controlled trial was designed to evaluate the efficacy of PlayForward. Participants were randomly assigned to play PlayForward or a set of attention/time control games on a tablet at their community-based program. Assessment data were collected during face-to-face study visits and entered into a web-based platform and unique real-time "in-game" PlayForward data were collected as players engaged in the game. The innovative methods of this randomized controlled trial are described. We highlight the logistical issues of conducting a large-scale trial using mobile technology such as the iPad(®), and collecting, transferring, and storing large amounts of in-game data. We outline the methods used to analyze the in-game data alone and in conjunction with standardized assessment data to establish correlations between behaviors during gameplay and those reported in real life. We also describe the use of the in-game data as a measure of fidelity to the intervention. RESULTS In total, 333 boys and girls, aged 11-14 years, were randomized over a 14-month period: 166 were assigned to play PlayForward and 167 to play the control games. To date (as of 1 March 2016), 18 have withdrawn from the study; the following have completed the protocol-defined assessments: 6 weeks: 271 (83%), 3 months: 269 (84%), 6 months: 254 (79%), 12 months: 259 (82%), and 24 months: is ongoing with 152 having completed out of the 199 participants (76%) who were eligible to date (assessment windows were still open). CONCLUSION Videogames can be developed to address complex behaviors and can be subject to empiric testing using community-based randomized controlled trials. Although mobile technologies pose challenges in their use as interventions and in the collection and storage of data they produce, they provide unique opportunities as new sources of potentially valid data and novel methods to measure the fidelity of digitally delivered behavioral interventions.
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Affiliation(s)
- Lynn E Fiellin
- play2PREVENT Lab, Yale University School of Medicine, New Haven, CT, USA
| | | | - Kimberly D Hieftje
- play2PREVENT Lab, Yale University School of Medicine, New Haven, CT, USA
| | - Tyra M Pendergrass
- play2PREVENT Lab, Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Benjamin G Sawyer
- play2PREVENT Lab, Yale University School of Medicine, New Haven, CT, USA Digitalmill, Inc., Freeport, ME, USA
| | - David A Fiellin
- play2PREVENT Lab, Yale University School of Medicine, New Haven, CT, USA Yale School of Public Health, New Haven, CT, USA
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15
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Petróczi A, Dodge T, Backhouse SH, Adesanwo C. Review of the literature on negative health risks based interventions to guide anabolic steroid misuse prevention. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.peh.2014.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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