When Lynn Fiellin, an associate professor of medicine at Yale University, first started talking about designing a video game for young teens to help them improve their sexual health knowledge, she recalls thinking what a great tool it could be to complement all the other educational programs out there. Then she and fellow researchers on the project realized the sad state of sex ed in the US.
“What really became apparent to us,” she tells Broadly, “was that there was absolutely no standardization—it’s totally hit or miss around this country, in terms of whether kids are even getting sex education.”
That’s where PlayForward: Elm City Stories comes in. A two-dimensional, role-playing video game, PlayForward was created Fiellin and her colleagues to help educate minority teens who are disproportionately at risk for HIV and other sexually transmitted infections. A study published last month in the Journal of Medical Internet Research, focused on the findings of Fiellin’s year-long trial, revealed how effective a video game could be on young people’s knowledge and attitudes about sex and other risk-taking behaviors.
The graphic novel-style game, which targets 11- to 14-year-olds, draws inspiration from the classic boardgame Life and movies like Groundhog Day and It’s a Wonderful Life, Fiellin says. “A big part of this was to help kids build a sense of future-orientation—that the decisions you make now have an impact on you now, but they can also have an impact on you down the road.”
While the project was funded by the National Institute of Health with the intention of creating a proven model for HIV prevention in teens, researchers took it one step further and created scenarios that involve all sorts of risks. Players have to make important, life-changing decisions, including whether or not they should go upstairs to make out with someone, if they should use a condom or not during sex, and whether they should accept pills found in someone’s grandmother’s medicine cabinet. At any point, they can fast-forward to the epilogue to see what their character’s life looks like at 30, based on the decisions they’ve made.
PlayForward is a mix of stories and skill-building, Fiellin explains. The tricky part was figuring out how much information they should share with an 11-year-old. “We really made a goal of being honest and accurate with kids. There are people who could push back and say, ‘You can’t talk to 11-year-olds about oral sex.’ The fact is, they’re going to hear about it soon. They’re much better equipped if they’re educated, but if they’re educated in an honest and accurate way.”
While sex ed advocates have been utilizing technology to deliver important sexual health information to adolescents for a number of years now, Fiellin says gaming has the potential to be more engaging because of the simulation aspect. PlayForward, for example, is a create-your-own-adventure type of game, she says, which really personalizes the experience for the player.
“The hope is that it resonates with kids,” she says, “and it’s experiential enough that when they’re confronted with that type of decision in real life, they’ll go, ‘Oh, I remember in the game when I made that decision to do that, that happened. No, I’m not going to do that here.’ They’ve tried it out in the game and now they don’t have to try it out in real life.”
And, according to their study trial, they may be on to something. Fiellin and her team recruited 333 participants ages 11 to 14, (90 percent of whom were of racial/ethnic minorities) to play either PlayForward or an unrelated game on iPads for six weeks, for up to 75 minutes twice per week. After the gaming period, researchers followed the teens for a year, assessing them for a range of outcomes, including sexual attitudes, sexual health knowledge, and sexual intentions. While ultimately there was no significant difference between the number of students who initiated sexual intercourse in both the control group and the group that played PlayForward, there was a greater improvement in attitudes and knowledge on sexual health among the PlayForward group.
What may be even more telling is that many study participants wanted to keep playing the game. “At the end of the six weeks of playing,” Fiellin says, “many kids came up to us and asked if they could download it from the app store. That’s a huge endorsement.”
Currently, Fiellin and her team are in the process of building out the game and working to disseminate it. That means creating a Web-based version of PlayForward so that students can access it from anywhere. “If a school or youth program has a good curriculum—great, this can augment it. If it doesn’t, this can go in and be easily accessible, as that really is the goal.”