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The Game of Science and the Science of a Game The Development of an HIV Prevention Video Game

The Game of Science and the Science of a Game The Development of an HIV Prevention Video Game. Lynn E. Fiellin, M.D. Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant: R01HD062080. The Problem.

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The Game of Science and the Science of a Game The Development of an HIV Prevention Video Game

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  1. The Game of Scienceandthe Science of a GameThe Development of an HIV Prevention Video Game Lynn E. Fiellin, M.D. Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Developmentgrant: R01HD062080

  2. The Problem No change in HIV incidence = 48,100 new cases in 2009 Those most affected: Younger age groups = 39% between ages 13-29 years Ethnic minorities = 115 cases/100,000 blacks/Hispanics vs. 15 cases/100,000 whites Sexual risk = 85% due to sex

  3. An Opportunity Early teen years are a window of opportunity to intervene on sexual risk: 48% of high school students reported sex ONLY 7% before age 13(Youth Risk Behavior Survey 2007)

  4. An Interactive Video Game For HIV Prevention in At-Risk Adolescents

  5. Why a Video Game? 15 million play interactive video games 63% of 11-14 year-olds play on a given day Extends across racial and economic lines 60% of Blacks, 55% of Hispanics, 61% of Whites 58% with household incomes < $35,000 Video game play has been found to affect change in health behaviors Asthma Diabetes Eating habits/obesity Physical activity Smoking prevention

  6. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  7. The Team • Collaborators: • Scientists: • HIV risk behaviors (sex and drug-related) • Lynn Sullivan, M.D. • David Fiellin, M.D. • Jen Edelman, M.D. • Child development • Linda Mayes, M.D. • Marjorie Rosenthal, M.D. • Deepa Camenga, M.D. • Brian Forsyth, M.D. • Gail Slap, M.D. • Health behavior change • Kimberly Hieftje, Ph.D. • M. Zachary Rosenthal, Ph.D. • Carl Lejuez, Ph.D. • Lindsay Duncan, Ph.D. • Prospect theory/message framing • Peter Salovey, Ph.D. • Game Developers: • Ben Sawyer—Digitalmill • Noah Falstein—The Inspiracy • Robin Hunicke--Thatgamecompany • Alex Seropian—Disney Interactive Studios • Schell Games • Community Programs: • Elizabeth Gambardella—Farnam Neighborhood House

  8. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  9. Theoretical Constructs • Proven factors in behavior change/risk reduction: • Social learning theory/self-efficacy • Social competency • Prospect theory • Delay discounting • Message framing

  10. My Future is My Life Components and Minigames IntraPersonal (Individual) Social Context/ Situations Socio-Cultural Environment Aspirational Avatar Genetics Biology Personality Family School Neighborhood Peers Mass Media Regulations Religion Economy Priority Sense Social Bonding/ Attachment Others’ Behavior & Approval General Values Information Environment Sense of Self Social Competence Know Power People Sense Trouble Sense Self- Determination Social Skills Others’ Expectations Desire to Please Evaluation of Outcomes Expected Consequences Future Sense Refuse Power Social Normative Beliefs Attitudes Toward the Behavior Self-Efficacy Epilogue Collages INTENTIONS/DECISIONS BEHAVIOR Experiences from Behavior 13

  11. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  12. Creating a Design Document: The “Game” • “Aspirational Avatar” • Goals and values • Mini-games tied together • Pre-visualization • Sexual health education • HIV education • Refusal, persuasion (negotiation) skills • Handling negative situations • “Reading” individuals, reading groups • Delay discounting • Risk literacy • Prospect theory/ message framing

  13. Aspirational Avatar • Move beyond physical representation of players in a virtual environment • Expand to include aspirations, goals, dreams • Future orientation & decisions

  14. Initial Visualization

  15. The Game • A 2D "RPG" (role-playing game)-style game: • How the choices one makes in life impact both short-term and long-term life goals • Target audience = inner-city youth ages 11 to 14 years • The goal = to improve youth’s understanding of risk and risky behaviors associated with the acquisition of HIV  • Player’s engagement in game play will provide opportunities to practice skills: • Navigating situations and negotiating decision-making to avoid risk

  16. How to Play the Game • The player plays as their Aspirational Avatar • Multiple “trips” through their life with different “choices” • Iteratively experiencing impact of choices on their life plan • 8-12 45 minute sessions • Data captured through game play and by standardized instruments during trial and at 12 and 24 months

  17. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  18. Content Development • Working with community program with at-risk youth: • Interviews and focus groups: • Purposeful sample of African-American and Latino young adolescents • Participating in an after-school or summer enrichment program • 21 boys and 20 girls, ages 10-15 years

  19. Established in 1943 • Fair Haven section of New Haven • Serves inner-city at-risk population • Provides after-school and weekend programs • Over 900 youth ages 6 -18 years

  20. In-depth Individual Interviews • Audiotaped • 15 final interviews • Domains: • Extracurricular activities • Video game play • Life plan • Risk-taking • Decision-making • Peer influences • Future orientation • Demographics

  21. In-depth Individual Interviews • Interviews professionally transcribed • Text reviewed by 3 reviewers for themes in an iterative fashion • Results informed focus groups • Coded transcripts to be entered into Atlas Ti: • Qualitative data analysis software • Output is a comprehensive identification of key themes

  22. Focus Groups • Onsite at Farnam Neighborhood House • Used themes elicited from interviews • 6 focus groups: 3 boys-only, 3 girls-only • Audiotaped • Professionally transcribed • 5 reviewers coded transcripts • A grounded theory approach

  23. Focus Group Themes • Video Game Play • Reality • Alternate reality/fantasy • Success • Self • Others • Environment • Party Scene • Risk-taking • Future orientation • Consequences • Message framing • Positive • Negative • Combined

  24. Results • Main themes from individual interviews: • Avatar • Often represents “ideal self” • Protective • Ownership in decisions, choices • Game play • Kids know what they like • Not educational; not too hard, not too easy • Be able to control character’s choices and actions • Develop mastery (self-efficacy) • Able to translate to both real life and alternate life

  25. Results • Main themes from focus groups: • 1) Boys and girls both described pregnancy and its associated impact as the major consequence of sexual risk-taking behavior with very limited discussion of sexually transmitted infections, including HIV • 2) Risk-taking behaviors described by both boys and girls included sexual violence, gun violence and bullying • 3) Factors associated with avoiding high-risk behaviors included internal strength, a connection with a mentor figure, and a supportive, safe environment • 4) Both boys and girls preferred sexual risk reduction and HIV prevention messages that included positive and negative message framing.

  26. Content Development <- -> Game Development

  27. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  28. Hiring a Studio • Request for Information (RFI) from 10 studios • Narrowed to 5 studios to send Request for Proposal (RFP) • Created a 30-page design document to send to studios with RFP • 3 studios responded • 2 proposals—reviewed by commercial game consultants • Awarded project to Schell Games of Pittsburgh

  29. Schell Games Founder Jesse Schell: Assistant Professor at Carnegie Mellon’s Entertainment Technology Center

  30. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  31. Contracts and Negotiations • Interface with the Office of Cooperative Research (OCR) • Secured a patent on concept of the “Aspirational Avatar” • Work with Grants & Contracts to draft additional language addressing intellectual property • Met with Yale’s Office of General Counsel • Met with Schell Games

  32. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  33. People

  34. Places

  35. Stories

  36. Project Phases Forming a team/forging collaborations • Content Development: • Individual interviews • Focus groups • Game Development: • Identification and integration of established theoretical constructs • Creating a design document/How to play the game • Hiring a video game studio • Contracts/Negotiations Pre-Production Randomized Clinical Trial

  37. Study Design Randomized Clinical Trial: HIV Prevention Video Game vs. commercial video game 2 sessions/week of assigned game for 4 weeks 2 booster sessions at 6 months Educational materials Subjects 330 minority adolescents Ages 11-14 years Attend after-school or other youth program Outcomes: Primary: delay initiation of sexual activity Secondary: HIV risk behavior knowledge Prevention of drug/alcohol use Improved self-efficacy and social competency

  38. Conclusions HIV incidence is unacceptably high, especially among young minorities Young teens offer a window of opportunity to intervene on sexual risk Video game play offers a unique vehicle as an intervention

  39. Conclusions • The development process involves: • Multi-faceted approach with multi-disciplinary teams • Incorporating qualitative data into development of an intervention • Parallel and intersecting efforts in game development and content development • Success requires coordination between science, community, technology, and law • Development of a video game for HIV prevention: • If effective, will serve as a model for other technology-based interventions targeting prevention and health promotion • Can translate to mobile technologies such as smart phones for broader dissemination (including international)

  40. Acknowledgements • Game Side: • Ben Sawyer • Noah Falstein • Alex Seropian Science Side: • Kimberly Hieftje, PhD • E. Jennifer Edelman, MD • Deepa Camenga, MD • Marjorie Rosenthal, MD • Linda Mayes, MD • David Fiellin, MD • Peter Salovey, PhD • Brian Forsyth, MD • Lindsay Duncan, PhD • Gail Slap, MD • Maria Mezes • Legal/Contracts Side: • Kimberly Muller • Lauren Pite The Community Side: Elizabeth Gambardella

  41. Thank You!

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