PlayForward: Elm City Stories: An Interactive Videogame for HIV Prevention in Early Adolescents

National Institute of Child Health and Human Development (NICHD), R01HD062080

8/10/09- 7/31/16

Lynn E. Fiellin, MD

Kimberly Hieftje, PhD (Project Director); Lindsay Duncan, PhD; Tyra Pendergrass, MEM

Videogames are ubiquitous, can improve health behavior, but have not been evaluated as a tool to promote protection from HIV transmission in minority early adolescents. A major challenge in HIV prevention for minority adolescents is capturing individuals in their environment – meeting individuals “where they live”. The current proposal combines proven HIV prevention strategies and an interactive videogame platform that incorporates virtual environments and intelligent conversant virtual characters to address this challenge.  Research demonstrates that adolescents who acquire new knowledge, skills and attitudes in a videogame, and practice these skills in the game, are more likely to behave similarly in real life. Therefore, the goal of this proposal is to develop and refine an interactive videogame designed to decrease HIV risk by teaching minority adolescents sex, drug and alcohol negotiation and refusal skills. The game, entitled PlayForward: Elm City Stories, will be adapted with input from minority adolescents, and collaborators with expertise in positive youth development, social cognitive theory and self-efficacy, prospect theory and message framing, software and artificial intelligence development, and commercial game design. We will evaluate the efficacy of the game by conducting a randomized clinical trial in 330 minority youths, ages 11-14 years, attending an after-school and/or weekend youth program, who will be randomly assigned to play the interactive HIV prevention videogame or to play a commercial “off-the-shelf” videogame. Subjects will play two sessions/week of their assigned game for six to eight weeks. The primary outcome is delay of initiation of sexual activity, defined as the initiation of either vaginal or anal intercourse.  Secondary outcomes include HIV risk behavior knowledge, social competency, self-efficacy, drug/alcohol use behaviors and overall risk-taking behaviors. We hypothesize that the experimental group will have lower rates of initiation of sexual activity and have higher knowledge scores at 3 weeks, 6 weeks, 3, 6, 12, and 24 months compared with the control group. We will also explore if selected baseline characteristics are associated with an improved response to the negotiation skills training intervention embedded in the interactive videogame. Unique features of this intervention will include the use of virtual characters or avatars, the use of sex, drug/alcohol “risk challenges” in the form of stories that the subjects can practice repeatedly, skill-based highly interactive minigames, the use of message framing according to prospect theory, a fun and engaging intervention that encourages repeated involvement, and the ability to track the players’ choices and behaviors in the game. The successful implementation of this proposal will represent a paradigm shift, providing evidence for the role of interactive games as HIV/AIDS prevention in minority adolescents. Videogame technology has the potential to expand the available vehicles for HIV prevention to the increasing number of electronic gaming platforms including the internet, personal digital assistants, and cell phones, thereby creating a new avenue for public health interventions.

This project is designed to develop and test a videogame for young teen girls and boys to play with the goal being to reduce their risk for HIV. This study has far-reaching implications as it builds on the engagement and compelling nature of videogames for behavior change as well as the advantages of technology-based interventions in terms of increasing access and optimizing implementation and dissemination of the intervention.