iPad game hopes to stop HIV transmission

A new iPad application designed to educate ethnic minority teens about HIV prevention strategies is being pioneered by a team of Yale researchers from the School of Medicine.
A new iPad application designed to educate ethnic minority teens about HIV prevention strategies is being pioneered by a team of Yale researchers from the School of Medicine. Photo by Jacqueline Sahlberg.

Play a sedentary video game and live a healthier life? That’s the hope of Yale researchers who are joining the booming health games industry with an iPad application designed to help ethnic minority teens learn about HIV prevention strategies.

As part of Yale’s Play2Prevent initiative, a group from the School of Medicine conducted focus groups with New Haven teens to gain an understanding common factors and behaviors that affect HIV risk. The findings are guiding the design and content of a new iPad game titled PlayForward: Elm City Stories, which aims to promote better decisions among minority youth. The researchers will conduct a study on the game’s impact HIV transmission rates starting later this year.

“The overall goal is to help kids practice skills in the game that will decrease their engagement in behaviors that put them at risk for HIV,” said brief author Lynn Fiellin MED ’96, associate professor of medicine and director of Play2Prevent. “The idea is to build an evidence-based HIV intervention. The game has to be fun and engaging, but it has to accomplish something.”

According to the clinical brief that was published in the August edition of the journal Games for Health, national HIV infection rates among teens and young adults increased by 21 percent between 2006 and 2009. Ethnic minority youth are at greater risk, according to the Center for Disease Control, with African-American and youth accounting for 69 percent of teen HIV infection diagnoses in 2010, despite making up only 15 percent of the teen population.

The research team conducted individual interviews and focus groups with 36 New Haven youth between the ages of 10 and 15, who reported that peer pressure, mentors and their neighborhood had the most influence over their decisions to engage in risky behaviors or not.

Kimberly Hieftje, an associate research scientist at the School of Medicine and the lead author on the study, said these themes are fundamental in the development of the iPad app. The game is different from others, she said, in that teens also provided feedback on the characters’ speech and clothing. Images of New Haven were used to create more realistic scenes, Hieftje added.

“What makes this game unique is that we are focused on behavior change, not just knowledge acquisition,” Hieftje said. “There are not a lot of clinical trials that have been done about the efficacy of games for behavior change. We want to see if kids can take what they learned and apply it to life.”

The game involves creating an avatar who goes through a virtual life and makes decisions revolving around risk behaviors, including unprotected sex and drug and alcohol abuse. The player will be able to see how their choices and actions influence later situations and rewind to play out how making another decision could produce a different outcome. Researchers will study the impact of the game among New Haven teens in an 18-24 month clinical trial starting later this year.

Debra Lieberman, director of the Health Games Research national program and media researcher at the University of California, Santa Barbara, said health games have been around since the early 1980s. She explained that video games were once pegged as a health nemesis for promoting sedentary lifestyles, but health focused video games have recently gained acceptance as an asset for education and behavioral change.

“In the past several years, the word ‘game’ has become less frightening to the health field,” Liberman said. “The field is absolutely growing. In most cases people know what they need to do to take care of themselves, but games can motivate them to keep their self-care in the front of mind.”

Since the first Games for Health Conference in 2004, more researchers, developers and investors have joined the field, she said. She said that the increased affordability of mobile devices and continued technological innovations should aid further expansion.

Fiellin said that while Play2Prevent has not studied the ownership of iPads among New Haven minority youth, she does not believe iPad avaliability will be a barrier to distributing the game. Tablets will be more affordable by the end of the 24 month trial and the game may be developed for other mobile devices and computers, she said.

Play2Prevent was founded in 2009 to create video games focused on prevention. Playforward: Elm City Stories is being developed in collaboration with Digitalmill and Schell Games.

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