CDC’s Program to Incubate Games for Public Health Awareness

1. CDC/HHS Health Game Jam 2014 Winning Entry: I’m Positive – Population Study Among Adolescents Peter Jenkins, Tracking and Triage Specialist, Office of the Associate Director for Communication Leigh Willis, Behavioral Scientist, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Health Communication Science Office Dan Baden, Country Director, Ghana, Center for Global Health Serious Play Conference July 18, 2017 Office of the Associate Director for Communication

2. Disclaimer • The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC)

3. Why Use Games?  63% of American households have video games  Average game player is 35 years old  41% of all game players are women  Women over 18 outnumber boys age 17 or younger (31% vs. 17%) http://essentialfacts.theesa.com/Essential-Facts-2016.pdf

4. But Really, Games?  Re-mission1  Fold-it2  Games for Health Journal  Robert Wood Johnson Foundation • Center for Digital Games Research (UCSB)  White House’s Office for Science and Technology Policy’s Interagency Games for Impact (formerly Federal Games Guild) 1. Pediatrics, Vol. 122, No. 2. August 1, 2008, pp. e305–e317. 2. The Huffington Post, September 19, 2011.

5. Why Not Have a Game Jam?

6. So what is a Game Jam?  “A game jam is a gathering of game developers for the purpose of planning, designing, and creating one or more games within a short span of time”  The time span normally ranges anywhere from 24 to 48 hours.  Development teams are generally made up of programmers, game designers, artists, and others in game development-related fields  Normally a game jam is centered around a theme that all games must adhere to and is announced shortly before the event begins to prevent teams from coming in with pre-made games and to encourage creativity: Similar to the IRON CHEF

7. 2014 HHS Health Game Jam

8. Reflections From Subject Matter Experts

9. 2014 HHS Health Game Jam  September 26th-28th, 2014  Began @ 6pm on the Friday the 26th  Concluded @ 5pm on Sunday the 28th  Southern Polytechnic State University  Focus on Primary and Secondary Prevention of HIV  Produced by HHS agencies, Centers for Disease Control and Prevention, Health Resources and Services administration (HRSA) and National Institutes of Health (NIH)

10. Reflections From Subject Matter Experts

11. Subject Matter Experts  25 Experts provided critical information to game designers including:  Behavioral change  Biological basis of disease  Digital strategies and new media  Epidemiology  Experience with designing interventions for youth  Health Promotion/Education  Health Communication

12. Reflections From Subject Matter Experts

13. Reflections From Subject Matter Experts

14. Judging Game Aesthetics (25%)  Video/Audio quality Game play (25%)  Engagement (how fun is it?)  Accessibility (how easy is it for someone to start playing?) Educational design principles (25%)  How well are the HIV concepts incorporated into the game?  How likely will this improve knowledge or induce behavioral change? Completeness (25%)  How likely is it that the team can finish this project?  How close to “done” is the game?

15. Number of Health Game Demos Produced Goal = 50 Actual = 41

16. What happened after the Jam???

17. After the Jam!!!  The 41 games produced during the jam were judged by a panel of scientists and senior game developers  Field narrowed to 16 games

18. After the Jam!!!  Those 16 games were given five days to further polish their game for judging at the Southern Interactive Entertainment and Game Expo (SIEGE) October 3rd, 2014  Five finalists selected at SIEGE

19. After the Jam!!!  The five finalist teams were each paired with a senior game developer to assist them in creating a finalized version of the game that was due December 4th, 2014  The five games were evaluated by HHS SME’s to determine which game would be tested for its impact on behavior change

20. Project Goal and Research Questions • Project Goal: – To test whether the created game can improve the HIV/AIDS- related knowledge, attitudes, behavioral intent, and beliefs (KABIB) among players consistent with reducing HIV-related mortality and morbidity • Project Research Questions – Are video games a feasible and acceptable means of delivering HIV/AIDS prevention messages to young people (ages 11–24)? – Can the created game have an impact on HIV/AIDS-related KABIB among the target population?

21. Recruitment  Participants were recruited from community based organizations, civic organizations and churches in Metropolitan Atlanta:  Churches  Boys and Girls Clubs  Big Brothers/ Big Sisters  Offered Token of appreciation for participation of up to $25 in gift cards from  Target, Wal-Mart, or Visa

22. Research Design  In order to test the game we used the classical experimental design: participants were randomly assigned to the following groups: 1. Experimental Group  Completed pre-test survey, play the game for 20 minutes and then completed immediate post-test survey.* Thirty days later they completed 30-day follow up survey 2. Control Group  Completed pre-test survey and then post-test survey 30 days afterward *included identical attitudinal items to the pretest, but contained items about satisfaction with the game

23. Research Design Experimental Group Control Group Pre-Game Survey Pre-Game Survey Play Game Immediate Post-game Survey 30-day Post-Game Survey 30-day Post Survey

24. Research Design  Survey measures  HIV/AIDS knowledge  HIV/AIDS stigma  HIV/AIDS beliefs  HIV/AIDS related intentions to engage in protective behaviors  HIV/AIDS risk/protective behaviors  We created summary variables of Likert scaled items for each domain

25. Research Design  Immediate post-game measures 1. Do they like the game? 2. How many times did they play they game? 3. How likely would you be to play it again? 4. Would they share it with their friend? 5. Do you feel you learned something new from playing the game? 6. How much do you play games? 7. Do you think games can be used to educate people about health?

26. The Tested Game

27. I’M POSITIVE www.impositivegame.com Stephen Borden – programming and game design Ilya Polyakov – art, writing, and game design Ali Yildirim – sound design Stephanie Chergi - producer

28. Problem •Lack of awareness •Misconceptions •Stigma www.impositivegame.com

29. What •Interactive narrative •Quirky mini games •Easy to play www.impositivegame.com

30. Goals •Secondary and primary intervention •Reduce fear and stigma •Raise awareness www.impositivegame.com

31. How •“Put yourself in someone else's shoes” •Choice •Reflect real life •Wide accessibility •Short game www.impositivegame.com

32. Game Demo

34. Results  Participants (62 Experimental, 68 Control)  Average Age – 14.7 years of age;  Average Grade in school – 9thgrade;  Gender: 52% Female, 48% Male  Race: • 76.0% African American • 3.5% White • 20.5% Latino

35. Participant Satisfaction with Game No Yes 9.4% Would you share the game with your friends? 90.6% Would you recommend your friends if they could download it in an app store? 11.5% 88.5%

36. Participant Satisfaction with Game Highly unlikely/ unlikely Likely/highly likely Neutral How likely are you to play the game again? 20.8% 34.0% 45.3% Learned nothing/almost nothing Learned a good bit/ learned a lot Learned some Do you think you learned anything from playing the game? 3.8% 7.5% 88.7%

37. Results Conducted repeated measure t-tests at 30 days post • Compared to Control Group: • Experimental group had higher knowledge; 3.0 point difference in HIV/STI knowledge; (t = 8.70, p = <.001) • Experimental group was lower for HIV stigma; 4.81 point difference in HIV stigma; (t = 4.53, p = <.001) • Experimental group had greater intentions to engage in HIV/STI protective behaviors; 4.31 point difference (t =-3.45, p <.01) 37

38. Conclusion  Results of this study were encouraging:  Exposure to the game led to positive changes in HIV/AIDS stigma, knowledge, and intentions to engage in HIV protective behaviors  Were exposed to game only for 10-15 minutes on average  This is an easily implemented educational activity for parents, schools, and youth-serving organizations  Download for free and install on computer  Available now at http://impositivegame.com/

39. Conclusion  Results of game jam event were encouraging:  Increased event attendance over previous year  The event demonstrated that game jams can effectively and efficiently be used to build inexpensive demos of HIV- related games • Spent total of $50k to get 41 prototypes vs 1 prototype for the amount  Number of games produced exceeded expectations  Improved awareness of and interest in public health careers • Robust growth in interest in public health among participants

40. Thank You  Participants  Game Developers  Subject Matter Experts Across HHS  CDC  HRSA  NIMH  Senior Game Developers  HHS Idea Lab  Partners  Southern Polytechnic State University  Berklee College of Music  Georgia Game Developers Association  National Network of Public Health Institutes

41. Questions? Peter Jenkins PMJ0@cdc.gov 404-639-0198 Leigh Willis LNW8@cdc.gov 404-639-8447 Dan Baden dbaden1@cdc.gov