“What we’re really striving to do here is behavior change,” said Play2Prevent director and principal investigator Dr. Lynn E. Fiellin in an interview with Gamasutra. “It’s really not about awareness or education per se. Awareness really doesn’t get at the essence of what we’re trying to do.”
The Play2Prevent initiative was created as part of a $4 million NIH grant awarded to Yale University in 2009 with the express goal of creating a game that actually helps kids make better decisions to avoid risky situations that can lead to HIV, Fiellin said.
While there’s lots of existing research into motivating this kind of risk-mitigation in teenagers, very little has been done to translate those results into an interactive tool, she said, and making such a leap is harder than it seems.
“You don’t just take an intervention that’s been proven and established and say, ‘Let’s make a game of it,’” she said. “You actually start on the flipside of it; you actually start with the intricacies of game development, and embed and build in that the proven theoretical construct for behavior change.”
That means doing more than just a quickie, 15-minute Flash game that pushes risk-prevention ideas at players. To really motivate changes in behavior, “it’s really important to engage [players] in a way that’s not really trivial,” said Schell Games founder and CEO Jesse Schell.
“It’s not merely enough to just show kids situations and say ‘Look, here are the situations, here are the outcomes,’” Schell said. “You can do that with a TV show or a video or something. … In order to get behavior change, you have to get people to buy into what you have going on. If they don’t believe this thing is real and credible and connected to their lives, they’re not going to take it seriously.”
Schell said he’s had direct experience with these issues in designing training software for firefighters. In that case, little inconsistencies like the wrong set of gear or outfits on the virtual firefighters could ruin the simulation’s credibility with the audience. So the team at Schell Games and Play2Prevent has already invested heavily in focus groups with the target 11- to 14-year-olds, to make sure they’re capturing a look and feel that resonates with their daily lives.
With that credibility hopefully established, the game as currently planned will take a multi-dimensional approach to changing children’s behavior gradually as they’re drawn into the game world, Schell said. The first step is asking players to visualize their ideal future selves, a process many young teenagers put on hold as they grow out of the ‘what do you want to be when you grow up’ phase of childhood, he said. Schell compared the idea to The Sims, which children already use to try out different lifestyle choices in a safe environment.
“In not thinking about their future, they often don’t realize how the decisions they’re making now can impact their future,“ Schell said. “Part of what happens during the game is you get to see how the decisions you make might influence that. If you want to become a veterinarian, you’ll have to go to school, and there are certain choices you might make economically or lifestyle wise that might screw up that plan.”
With their life goals set, players will encounter a variety of real-world situations, not all of which will deal directly with HIV risk prevention -- Schell gave an example of taking a ride home with a friend who’s been drinking a bit. The point of showing these scenarios is not simply to warn kids to stay away from them, Schell says, but to help them learn to look at a situation, evaluate which parts might be dangerous, and elegantly navigate past them “without feeling like a total dork,” he said.
Part of the point is also to help kids understand how probability plays into risk assessment, Schell said. “Sure, maybe 80 percent of the time your drunk friend can get you home okay, and maybe that sounds like a lot, but if the consequences are serious, that’s really a risky thing to do,” he said. The repetition inherent in the game’s design can help highlight these kinds of probabilities, Schell said, by showing that engaging in the same risky behavior regularly will eventually lead to serious consequences.
To make sure that message can stick with players, Play2Prevent is actually planning to test the finished product with a clinical trial on a group of 300 children selected from New Haven after-school programs. Half the children will be asked to play the game twice a week for 4 to 6 weeks, for approximately 45 minutes each session (the control group will play an unrelated game to mirror the time commitment). The research team will then spend two years monitoring the children’s decision making -- both in the game and in the real world, using written surveys -- to see if the game is actually accomplishing its goals.
“It’s a fairly specified ‘dose’ of the game, so to speak, to control for what the kids have been involved with in the gameplay,” Fiellin said. “My sense of the design is there’s lots of parts of it that kids can engage in over and over again, on the theory that practicing those skills will make them much more facile for these kids, but the game from beginning to end takes the kids through this [learning] process.”
More than the ability to have a positive effect on children’s health outcomes, Schell said he also sees this major project as a sign of the increasing mainstream acceptance of using interactive tools to deliver a lasting message.
“Ten years ago it was hard to get anybody to take the idea of simulations seriously at all,” he said. “We’ve seen a lot of changes in the last ten years, where people are really starting to understand the power that games can have and people really can step up and do more meaningful experiments and make investments. … It’s an exciting time, where people are going into it not in a foolish way, not just throwing their money left and right, but by making strategic investments in the right places to do things that are really going to make a difference.”
