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The first 2 years of this research were dedicated to the development of the PlayForward intervention through a collaborative and iterative process working with researchers, videogame development teams, adolescents and community programs staff. Our goal is to provide insights and guidance to researchers interested in evaluating videogames and digital media as behavioral interventions. We describe how in-game data may correlate with traditional assessment data and the role videogames may play in providing information about intervention fidelity. It outlines novel approaches for managing large amounts of data produced through videogame software. 8 This article describes the unique methods employed to conduct an RCT using a serious videogame as a behavioral intervention. By incorporating the core efficacious elements of established prevention interventions into an interactive tablet game, this delivery method may have significant impact on retention in the intervention, its reach through mobile devices, and its ability to promote beneficial and sustainable changes.
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We produced an iPad game, PlayForward: Elm City Stories and conducted a randomized controlled trial (RCT) to evaluate its impact on targeted outcomes. Electronic interventions allow for the provision of standardized content, and gameplay or in-game data document every action the player takes in the game, time spent on each discrete action, and their overall performance providing a method of assessing exposure to different intervention components. In addition, delivering behavioral interventions with fidelity, or according to protocol, 7 can be challenging.
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5 Videogame software produces data on activities within the game that may be a proxy for real world actions, 6 mitigating some of these issues. For example, there are concerns about the validity of self-reported data. Evaluating the impact of behavioral interventions has inherent challenges that videogame technology may address.
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4 We strove to harness the potential of mobile videogames to deliver a risk reduction and HIV prevention intervention to adolescents. 2 “Serious videogames” (games for a primary purpose other than entertainment) 3 can serve as interventions to affect behavior change and increase knowledge in youth. The prevalence of videogame playing is increasing with most youth playing videogames daily. A major challenge in HIV prevention for adolescents is capturing them in their environment – meeting them “where they live.” 1 Since younger minorities are at increased risk, it is critical to tailor interventions to help them avoid behaviors that put them at risk for HIV infection. Minority youth are disproportionately affected by human immunodeficiency virus (HIV) infection. We also describe the use of the in-game data as a measure of fidelity to the intervention. We outline the methods used to analyze the in-game data alone and in conjunction with standardized assessment data to establish correlations between behaviors during gameplay and those reported in real life. We highlight the logistical issues of conducting a large-scale trial using mobile technology such as the iPad®, and collecting, transferring, and storing large amounts of in-game data.
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The innovative methods of this randomized controlled trial are described. Assessment data were collected during face-to-face study visits and entered into a web-based platform and unique real-time “in-game” PlayForward data were collected as players engaged in the game. Participants were randomly assigned to play PlayForward or a set of attention/time control games on a tablet at their community-based program. A randomized controlled trial was designed to evaluate the efficacy of PlayForward. Players experience how their choices affect their future and then are able to go back in time and change their choices, creating different outcomes. The videogame PlayForward provides an interactive world where players, using an avatar, “travel” through time, facing challenges such as peer pressure to drink alcohol or engage in risky sexual behaviors. We developed PlayForward: Elm City Stories over a 2-year period, working with researchers, commercial game designers, and staff and teens from community programs.