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ROSS SHEGOG, PHD
UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH
CENTER FOR PREVENTION RESEARCH
Funded by NIH/NICHD grant R42H...
Research & Teaching in the Service of
Public Health …
“Headbutt”.
(PI. McAlister)
Middle school smoking prevention
“ASPIRE...
“It’s Your Game - Tech”
(PI’s Peskin, Shegog)
Middle school sexual health on-line
Disease Prevention / Health Promotion
“N...
Develop and evaluate a home-based serious
intergenerational computer game to:
❑ Provide developmentally-appropriate sexual...
ACKNOWLEDGEMENTS
Production:
Jeffrey McLaughlin (Principal Investigator)
Adrian Kecki: Senior User Experience Designer
Dav...
BACKGROUND
ADOLESCENT SEXUAL HEALTH
• Many youth in U.S. engage in sexual
risk behaviors resulting in
unintended negative health
outc...
ADOLESCENT SEXUAL HEALTH
• 11%, 15%, 18% and 33% of 6th, 7th, 8th, and 9th
graders respectively report lifetime sexual
act...
INTERVENTION APPROACHES
• School vs. clinic-based programs
• Parental influence is key and
provides support for home-
base...
PARENTAL INFLUENCE
Key factors related to parental influence:
• Parent-child connectedness (closeness)
protective for dela...
WHAT WORKS?
1. Target parent-child relations early.
2. Focus on family for greatest effect.
3. Increase connectedness and ...
[1]: Hutchinson, M. K., & Cooney, T. M. (1998). Patterns of parent-teen sexual risk communication: Implications for interv...
 97% of American teens play computer,
web, console, or mobile games
 31% of teen gamers play games every day
 Another 2...
SERIOUS GAMES
• Serious games, computer-based programs, are promising as an
alternative to didactic approaches.10
• Seriou...
STUDY AIMS
• Develop and test a home-based
serious game to:
• Provide sexual health life skills
education for middle-schoo...
STUDY DESIGN
 Year 1 (Summer / Fall 2013)
 Literature review and needs
assessment
 Focus groups
 Evaluate existing activities
 Bui...
Intervention Mapping approach guided the design and
application of the game from a theoretical perspective
 Needs assessm...
LITERATURE REVIEW: CONCEPTUAL
FRAMEWORK
QUALITATIVE NEEDS ASSESSMENT
Focus groups & semi-structured interviews with parents (n=20)
and youth (n=19).
Themes:
Paren...
RESULTS: Focus Groups
Qualitative Needs Assessment Data
Table: Game Features Inventory
“…I think (the proposed game)
opens...
Source: D’Cruz et al., 2015
CONCEPTUAL GAME FRAMEWORK
Intervention Mapping:
DYADIC PARENT-CHILD COMMUNICATION MATRIX
Intervention Mapping:
DYADIC PARENT-CHILD COMMUNICATION MATRIX
Matrix for Environmental Condition 3-DYADIC ASKABLE PARENT ...
PROGRAM DEVELOPMENT
• Reviewed existing assets from other successful, evidence-
based programs.
ADAPTED FROM…
 Theory-based, multimedia program for 7th & 8th
graders
 Evaluated in two randomized controlled trials
 R...
Strategies:
Information transfer Refusal Skills Training
Peer modeling Condom Skills Training
PROGRAM DEVELOPMENT
Level Content Domain Virtue
1 Communication Communication Respect
2 Character & Goals Possible Me Visi...
GAME DESIGN
THE STORY
A secret war between powerful forces is being waged across time in the town
of Seven Stones. The Hero must uncov...
THE STORY: CHRONOTITANS
Zeroun
Respect
Iksha
Vision
Humiel
Persistence
Jampa
Caring
Netis
Responsibility
Rith
Courage
Kara...
HOW THE GAME WORKS
• 18 levels, 150 embedded dojo skill training activities, and
54 ‘battle’ scenarios for youth
• Hold 7 ...
SKILLSTRAINING
• Train up in the Dojo to learn and build skills
• Take a Challenge to test knowledge, skills, and wisdom
6...
THE STORY
Battle Scenario:
Suma want's Frolie to commit to a secret oath. "I will
never tell my parents about our secret t...
THE STORY
Battle Scenario:
Trixie pressured Herc into playing
Truth or Dare. Herc is uncomfortable;
Trixie is asking him t...
• Get Wisdom, Skills, and Support battle cards
• Battle to liberate the townspeople and demonstrate skills
8. User fights
...
… you have to start here …
PEP TALKS
• At 7 milestones, youth are locked
out and instructed to meet with
parent for a “PEP Talk” following
a Partner ...
PEP TALKS
• Youth are provided
with personal rules
and prompted to enter
a strategy for
maintaining the rule.
PARENT WEBSITE
• Monitor youth’s progress and
review game content
• Prepare for PEP Talks
• Get tips and resources
STATUS
USABILITY TESTING
• Study design:
• In-home testing of 2-level prototype of the SSS game and
the SSS parent website with 1...
USABILITY TESTING
• Pilot testing of the SSS prototype indicated that parents and
youth rated SSS as understandable (≥90%)...
USABILITY TESTING
Youth Ratings for Prototype Levels 1 & 2
USABILITY TESTING
Parent Ratings for Parent Website and Prototype Levels 1 & 2
EFFICACY TRIAL
• Study design:
• Randomized controlled trial (RCT) with 80-dyads over a
6-month period with measures at ba...
STUDY PARTICIPANTS:
❑ Parents and their 11-14 year old
❑ English speaking
❑ Internet connectivity from home computer
❑ Par...
STUDY PARTICIPANTS
Youth Parents
Demographics n % n %
Youth Age (11-14) 83 12.4 (+/-1.0) -- --
11-12 years 44 53 -- --
13-...
IMPLEMENTATION
• Intervention families
provided with
recommended
‘prescribed’ dose of 2
hours game play per
week over 12 w...
EVALUATION
• Baseline (T1) in completion; 3-month follow-up (T2) data collection in progress.
Constructs Variables
Parent-...
YOUTH FEEDBACK
“I understand [puberty] better and
know what to expect… it taught me
how to say no [to sex] if I don’t
want...
PARENT FEEDBACK
“I’ve always [said] you need to wait
[to date] and I don’t think she really
understood why. It helped her ...
ADJUNCT IMPACT: DYAD A37 … THE 40
YEAR OLDVIRGIN
“It hasn’t opened the door [for conversations] any wider, for me
anyways....
ADJUNCT IMPACT: DYAD A5… SPARKED
CONVERSE,THE GRAY OF ‘TOXIC’ FRIENDS,
“It’s his personality. There’s not a lot of gray in...
ADJUNCT IMPACT: DYAD A24 … RELIEF
OF SELF-BLAME
• SSS helped a daughter
(12yo) come to terms with
parents divorce and her
...
CONCLUSIONS
The Secret of Seven Stones (SSS) is designed to be an intergenerational (dyadic) adventure
game to encourage p...
IMPLICATIONS
This work will inform developers and researchers on the
development, implementation, and evaluation of an
inn...
QUESTIONS?
Ross.Shegog@uth.tmc.edu
Ross Shegog - The Secret of Seven Stones: A Game to Impact Youth Skills and Parent-Youth Communication for Teen Pregnancy ...
Ross Shegog - The Secret of Seven Stones: A Game to Impact Youth Skills and Parent-Youth Communication for Teen Pregnancy ...
Ross Shegog - The Secret of Seven Stones: A Game to Impact Youth Skills and Parent-Youth Communication for Teen Pregnancy ...
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Ross Shegog - The Secret of Seven Stones: A Game to Impact Youth Skills and Parent-Youth Communication for Teen Pregnancy Prevention

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Presenter: Ross Shegog, Associate Professor, University of Texas

Few game-based interventions target sexual health and even fewer target parent-youth communication. The presentation describes the development and testing of an online adventure game, ‘The Secret of Seven Stones’ (SSS), to engage parents and youth (11-14 yrs.) to go beyond ‘the sex talk’ to impact youth decisions related to friendships, dating, and sex. SSS, informed by parent-youth dyads and previous empirical data, provides behavioral skills training in 15 domains (drawn from over 1300 learning objectives) encompassing responsible decision making about friendships, dating relationships, and sex. SSS features 18 game levels that include 50 interactive skills training clusters, 54 card ‘battle’ sequences, and 7 game-mediated parent-youth ‘PEP’ talks. As youth play SSS, parents receive progress updates and cues to receive resources to guide communication with their youth. SSS offers insight into an intergenerational gaming approach for health prevention, found feasible for a RCT efficacy trial.

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Ross Shegog - The Secret of Seven Stones: A Game to Impact Youth Skills and Parent-Youth Communication for Teen Pregnancy Prevention

  1. 1. ROSS SHEGOG, PHD UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH CENTER FOR PREVENTION RESEARCH Funded by NIH/NICHD grant R42HD074324
  2. 2. Research & Teaching in the Service of Public Health … “Headbutt”. (PI. McAlister) Middle school smoking prevention “ASPIRE” (PI. Prokhorov, Kelder) High school smoking prevention. “Stop Asthma.” (PI. Abramson, Bartholomew) Pediatrician decision support. “Watch-Discover-Think then Act.” (PI. Gold, Bartholomew) Asthma management simulation “Peacetest.org” (PI. McAlister) Violence prevention on-line. “En Vivo” (PI. Kelder) Web-based motivational enhancement for reduced screen-time in Hispanic youth. “HeadsUp Virtual Molecular Biology Lab” (PI. Murray) AP science virtual transgenics Disease Management Science Training Disease Prevention / Health Promotion “Booster Break” (PI. Taylor) Work-based toning. Epilepsy self-management Network (PI. Begley, Shegog) MINDSET Epilepsy self-management DSS (PI. Begley, Shegog) Clinical decision support MINDSET
  3. 3. “It’s Your Game - Tech” (PI’s Peskin, Shegog) Middle school sexual health on-line Disease Prevention / Health Promotion “NATIVE It’s Your Game” (PI’s Markham, Shegog) IYG for Am. Indians / Alaska Natives Community-based Decision Support (PI Peskin) Adoption of evidence-based sexual health programs “It’s Your Game” (PI. Tortolero) “All About Youth” (PI. Markham) Middle school HIV/pregnancy prevention “It’s Your Game” website (PI. Peskin) Middle school HIV/pregnancy prevention “It’s Your Game – Family” (PI’s McLaughlan, Shegog) IYG for parents and faimlies. “+ CLICK” (PI. Markham) HIV+ youth web management training Disease Management Research & Teaching in the Service of Public Health …Sexual Health
  4. 4. Develop and evaluate a home-based serious intergenerational computer game to: ❑ Provide developmentally-appropriate sexual health life skills education for youth (11-14 years) ❑ Improve parent-youth communication about sex and healthy relationships ❑ Increase youths’ intentions, knowledge, and skills for safe and healthy sexual behaviors ❑ Improve parent monitoring and parent-youth connectedness Study Goals
  5. 5. ACKNOWLEDGEMENTS Production: Jeffrey McLaughlin (Principal Investigator) Adrian Kecki: Senior User Experience Designer David Williams: Lead Developer Renjith Jose: Developer Gabby Alexander & Olga Prokhorov: Production Artists Brian White: Illustration UT Research & Development: Ross Shegog, PhD (Principal Investigator) Christine Markham, PhD (Co-PI) Susan Tortolero, PhD (Co-I) Melissa Peskin, PhD (Co-I) Diane Santa Maria, PhD (Consultant) Mike Wilkerson, PhD (Consultant) Sara Dube, MPH (Project Director) Laura Ceglio, MPH (Research Assistant) Hsing-Yi Song, MD, MPH (Research Assistant) Angela Spencer, BS (Graduate Assistant) Pooja Chaudhary, MD (Graduate Assistant) Community Collaboration: Houston Area Schools and School Districts Parent-Youth Advisory Group
  6. 6. BACKGROUND
  7. 7. ADOLESCENT SEXUAL HEALTH • Many youth in U.S. engage in sexual risk behaviors resulting in unintended negative health outcomes.1 • Despite decline in teen pregnancy and STI incidence, U.S. rates higher than other industrialized countries.2 1. Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: Final data for 2013. Natl Vital Stat Rep. 2015;64(1):1-68. 2. United Nations Statistics Division. Demographic yearbook 2009–2010. http://unstats.un.org/unsd/demographic/products/dyb/dyb2009- 2010.htm. Published 2011. Updated 2011. Accessed February 25, 2015.
  8. 8. ADOLESCENT SEXUAL HEALTH • 11%, 15%, 18% and 33% of 6th, 7th, 8th, and 9th graders respectively report lifetime sexual activity. 3,4 • Teenagers (10-19 years) make up 7% of all births and 89% of unmarried mothers.1 • Nationally, teen pregnancy cost more than $9 billion.5 1. Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: Final data for 2013. Natl Vital Stat Rep. 2015;64(1):1-68. 3. Centers for Disease Control and Prevention. Youth risk behavior surveillance: United states, 2007. MMWR Morbidity and mortality weekly report. 2008;SS-4(57). 4. Shanklin SL, Brener N, McManus T, Kinchen S, Kann L. 2005 middle school youth risk behavior survey 2007. 5. The National Campaign to Prevent Teen and Unplanned Pregnancy. Counting it up: The public costs of teen childbearing. 2014.
  9. 9. INTERVENTION APPROACHES • School vs. clinic-based programs • Parental influence is key and provides support for home- based programs.6 6. Simpson AR. Raising teens: A synthesis of research and a foundation for action. 2001.
  10. 10. PARENTAL INFLUENCE Key factors related to parental influence: • Parent-child connectedness (closeness) protective for delayed sexual debut.7 • Parental monitoring (knowledge of wherabouts) associated with lower levels of risk taking.8 • Parent child communication about sex that is open, positive, and frequent leads to delayed debut, fewer partners and using protection effectively.9 7. Neumark-Sztainer D, Story M, French SA, Resnick MD. Psychosocial correlates of health compromising behaviors among adolescents. Health Educ Res. 1997;12(1):37-52. 8. DiIorio C, Resnicow K, McCarty F, et al. Keepin' it R.E.A.L.!: Results of a mother-adolescent HIV prevention program. Nurs Res. 2006;55(1):43-51. 9. Hutchinson MK, Jemmott JB,3rd, Jemmott LS, Braverman P, Fong GT. The role of mother-daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: A prospective study. J Adolesc Health. 2003;33(2):98-107.
  11. 11. WHAT WORKS? 1. Target parent-child relations early. 2. Focus on family for greatest effect. 3. Increase connectedness and monitoring. 4. Include skills-based activities to enhance behavioral capability and self-efficacy. 5. Longer and more intensive programs. Empirically-based principles of parental interventions:11 11. Spoth RL, Kavanagh KA, Dishion TJ. Family-centered preventive intervention science: Toward benefits to larger populations of children, youth, and families. Prev Sci. 2002;3(3):145-152.
  12. 12. [1]: Hutchinson, M. K., & Cooney, T. M. (1998). Patterns of parent-teen sexual risk communication: Implications for intervention. Family Relations, 47(2), 185-194. Retrieved from http://search.proquest.com/docview/213936519?accountid=7126 [2]: Hyde, A., Drennan, J., Butler, M., Howlett, E., Carney, M. and Lohan, M. (2013), Parents' constructions of communication with their children about safer sex. Journal of Clinical Nursing, 22: 3438–3446. doi: 10.1111/jocn.12367 ❑ Communication: Most teens identified one or more sexual topics they wished their mothers (97%) and fathers (87%) would have discussed with them, but did not[1] ❑ Self-efficacy: Most parents reported being open about sexuality with their children, but very few conveyed direct messages about contraception and condom use [2] ❑ Accurate Information: Even when parents provide information, their knowledge about contraception or other sexual health topics may often be inaccurate or incomplete [3] THE missing links
  13. 13.  97% of American teens play computer, web, console, or mobile games  31% of teen gamers play games every day  Another 21% play games three to five days per week  Potential for ‘Edutainment’  Potential for developing developmentally and culturally appropriate interventions WHY games? [1]: Lenhart, A., Kahne, J., Middaugh, E., Macgill, A. R., Evans, C., & Vitak, J. (2008). Teens, Video Games, and Civics: Teens' Gaming Experiences Are Diverse and Include Significant Social Interaction and Civic Engagement. Pew Internet & American ife Project. [2]: Shegog R, Peskin MF, Markham CM, et al. ‘It’s Your Game-Tech’: Toward sexual health in the digital age. Creative Educ 2014; 5(Special Edition):1428–1447
  14. 14. SERIOUS GAMES • Serious games, computer-based programs, are promising as an alternative to didactic approaches.10 • Serious games also present a means for developing intergenerational approaches. 10. Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: Video games and stories for health-related behavior change. Am J Prev Med. 2008;34(1):74-82.
  15. 15. STUDY AIMS • Develop and test a home-based serious game to: • Provide sexual health life skills education for middle-school aged youth (11-14 years). • To enhance parents’ skills and confidence to support their youth.
  16. 16. STUDY DESIGN
  17. 17.  Year 1 (Summer / Fall 2013)  Literature review and needs assessment  Focus groups  Evaluate existing activities  Build prototype of The Secret of Seven Stones  UsabilityTesting of prototype in lab-based setting  Year 2 & 3 (2014 & 2015)  Build complete SSS game  Alpha-Test complete SSS game in homes with 12 dyads  Randomized ControlTrial efficacy testing of SSS in homes with 80 dyads (ongoing) PHASE 1: Create andTest a Prototype PHASE 2: Create andTest Complete Program STUDY OVERVIEW
  18. 18. Intervention Mapping approach guided the design and application of the game from a theoretical perspective  Needs assessment to inform design, development, and implementation  Mapping behavioral/environmental outcomes and related determinants  Develop performance/change objectives  Develop theory-based methods and applications  Matrices covering: risk reduction, risk avoidance, parental monitoring, dyadic parent-child communication Intervention Mapping
  19. 19. LITERATURE REVIEW: CONCEPTUAL FRAMEWORK
  20. 20. QUALITATIVE NEEDS ASSESSMENT Focus groups & semi-structured interviews with parents (n=20) and youth (n=19). Themes: Parents want …  to be a focal part of their child’s sexual health education  to be a credible resource for their youth Parents and youth …  regard sexual health and communication as important.  want to be better at initiating the conversation.  want to keep the conversation going  want a fun, educational, and customizable game experience D’Cruz et al., Games For Health, 2015.
  21. 21. RESULTS: Focus Groups Qualitative Needs Assessment Data Table: Game Features Inventory “…I think (the proposed game) opens up to more GENUINE CONVERSATIONS and sharing…to show that it is real. It’s not just something that you see or know on TV -Mother “…you need to create something where parents are going to bring it to their kids and say, Look, I think this is cool, or not even I think this is cool. Hey, I want you to do this with me for a little bit, and it STARTS THE CONVERSATION” -Father “It’s important to talk to your parents throughout the game, because… when all the lessons are over and you already learned about everything then what else you are going to do now? You can’t just go find another computer game or download another one. You have to be able to TALK TO YOUR PARENTS about anything. If you have questions, its really important to ask them while you are doing the game -Female Youth
  22. 22. Source: D’Cruz et al., 2015 CONCEPTUAL GAME FRAMEWORK
  23. 23. Intervention Mapping: DYADIC PARENT-CHILD COMMUNICATION MATRIX
  24. 24. Intervention Mapping: DYADIC PARENT-CHILD COMMUNICATION MATRIX Matrix for Environmental Condition 3-DYADIC ASKABLE PARENT MATRIX: Dyad relationship of parent-youth; Parents and children will interact in mutually engaging and responsive communication process to achieve shared goals Performance Objectives: Knowledge Skills Self-efficacy PO.1. Parent and child will pick the right time and place (T&P) to talk 1. State that the right T&P is one where both parent and child are focused and calm 2. Describe the influence of emotions, preconceived thoughts and distractions on communication. 3. State the importance of being aware of these influences and setting them aside before initiating communication 1. Demonstrate the ability to pick the right time and place to converse 2. Demonstrate the ability to set aside emotional or cognitive predispositions before conversing 1. Demonstrate the confidence to pick the right time and place to converse 2. Demonstrate the confidence in ability to set aside emotional or cognitive predispositions before conversing
  25. 25. PROGRAM DEVELOPMENT • Reviewed existing assets from other successful, evidence- based programs.
  26. 26. ADAPTED FROM…  Theory-based, multimedia program for 7th & 8th graders  Evaluated in two randomized controlled trials  Results showed IYG • Delayed initiation of sex • Increased condom use • Increased positive beliefs about abstinence • Increased confidence to refuse sex • Increased intentions to abstain from sex N a t i o n a l l y R e c o g n i z e d E f f e c t i ve H I V / S T I a n d P r e g n a n c y P r eve n t i o n P ro g r a m f o r M i d d l e S c h o o l Yo u t h Tortolero, S.R., Markham, C.M., Peskin, M.F., Shegog, R., Addy, R.C., Escobar-Chaves, S.L., Baumler, E.R. It’s Your Game…Keep it Real: Delaying Sexual Behavior with an Effective Middle School Program. Journal of Adolescent Health. 2010; 46(2):169-179. Markham, C.M., Tortolero, S.R., Peskin, M.F., Shegog, R., Thiel, M., Baumler, E.R., Addy, R.C., Escobar-Chaves, S.L., Reininger, B., Robin, L. Sexual Risk Avoidance and Sexual Risk Reduction Interventions for Middle School Youth: A Randomized Controlled Trial. Submitted to Journal of Adolescent Health.
  27. 27. Strategies: Information transfer Refusal Skills Training Peer modeling Condom Skills Training
  28. 28. PROGRAM DEVELOPMENT Level Content Domain Virtue 1 Communication Communication Respect 2 Character & Goals Possible Me Vision 3 Friendships Friendship 4 Select, Detect, Protect - Friendships Persistence 5 Developing Body & Reproduction My Body 6 Intentions - Sex Select, Detect, Protect Caring 7 Healthy Dating Dating 8 Healthy Dating 9 Consequences of Sex Consequences 10 Select, Detect, Protect - Sex Select, Detect, Protect Responsibility 11 HIV Consequences 12 Dating Violence Dating 13 Pregnancy Consequences 14 Sex Refusal Select, Detect, Protect 15 Intro. to Condoms Safeguards Courage 16 Condom Negotiation & Contraceptives 17 Getting Tested for HIV/STDs 18 The Future My Future Integrity
  29. 29. GAME DESIGN
  30. 30. THE STORY A secret war between powerful forces is being waged across time in the town of Seven Stones. The Hero must uncover the secret of the town and liberate its citizens from the clutches of the evil villain Frostbyte, before it's too late.
  31. 31. THE STORY: CHRONOTITANS Zeroun Respect Iksha Vision Humiel Persistence Jampa Caring Netis Responsibility Rith Courage Karama Honor
  32. 32. HOW THE GAME WORKS • 18 levels, 150 embedded dojo skill training activities, and 54 ‘battle’ scenarios for youth • Hold 7 ‘PEP Talks’ with parent at game milestones
  33. 33. SKILLSTRAINING • Train up in the Dojo to learn and build skills • Take a Challenge to test knowledge, skills, and wisdom 6. User takes
  34. 34. THE STORY Battle Scenario: Suma want's Frolie to commit to a secret oath. "I will never tell my parents about our secret tree house hideout." Frolie doesn't like swearing to secrecy from her parents. Challenge: Help Frolie use negotiation skills and avoid breaking her rule about secrecy from her parents.
  35. 35. THE STORY Battle Scenario: Trixie pressured Herc into playing Truth or Dare. Herc is uncomfortable; Trixie is asking him to do something against his personal rules. He wants to stay friends, but he's just not ready to do what Trixie asks. Challenge: Help Herc get out of this risky situation gracefully.
  36. 36. • Get Wisdom, Skills, and Support battle cards • Battle to liberate the townspeople and demonstrate skills 8. User fights Battle THE ‘BATTLES’
  37. 37. … you have to start here …
  38. 38. PEP TALKS • At 7 milestones, youth are locked out and instructed to meet with parent for a “PEP Talk” following a Partner - Engage - Plan paradigm.
  39. 39. PEP TALKS • Youth are provided with personal rules and prompted to enter a strategy for maintaining the rule.
  40. 40. PARENT WEBSITE • Monitor youth’s progress and review game content • Prepare for PEP Talks • Get tips and resources
  41. 41. STATUS
  42. 42. USABILITY TESTING • Study design: • In-home testing of 2-level prototype of the SSS game and the SSS parent website with 10-dyads over a 2-week period with measures at baseline (T1) and 2-week follow- up (T2).
  43. 43. USABILITY TESTING • Pilot testing of the SSS prototype indicated that parents and youth rated SSS as understandable (≥90%), credible (≥70%), and helpful in making healthy choices (≥80%). • Ratings indicated need for improvement in areas of ease of use (40-50%) and parental acceptability (29%). • Qualitative data supported these findings and informed design modifications to improve the parent and child experience.
  44. 44. USABILITY TESTING Youth Ratings for Prototype Levels 1 & 2
  45. 45. USABILITY TESTING Parent Ratings for Parent Website and Prototype Levels 1 & 2
  46. 46. EFFICACY TRIAL • Study design: • Randomized controlled trial (RCT) with 80-dyads over a 6-month period with measures at baseline (T1) and 3- month (T2) and 6-month follow-up (T3). • Randomized into: • Intervention group: tests SSS over 3-months (n=40) • Control group: standard care, waitlisted (n=40)
  47. 47. STUDY PARTICIPANTS: ❑ Parents and their 11-14 year old ❑ English speaking ❑ Internet connectivity from home computer ❑ Parents with a cell phone with text messaging ❑ Willing to be randomized to intervention or comparison categories Methods
  48. 48. STUDY PARTICIPANTS Youth Parents Demographics n % n % Youth Age (11-14) 83 12.4 (+/-1.0) -- -- 11-12 years 44 53 -- -- 13-14 years 39 47 -- -- Gender Male 46 55 5 6 Female 37 45 78 94 Race / Ethnicity Caucasian 35 42 41 49 African American 27 33 26 31 Hispanic/Latino 18 22 16 19 Asian/Pacific Islander 3 4 0 0 American Indian / Other 0 0 0 0
  49. 49. IMPLEMENTATION • Intervention families provided with recommended ‘prescribed’ dose of 2 hours game play per week over 12 weeks. • Progress through game monitored weekly. 1 P1 2 3 P2 4 5 P3 6 7 8 9 P4 10 11 12 13 14 P5 15 16 17 P6 18 P7 A24 A33 A5 A27 A7 A28 A21 A81 A22 A20 A2 A37 A34 A35 A16 A82 C08 A31 A29 A40 A19 A17 A1 A32 A88 A84 A38 A9 A12 A23 A14 A86 ID Levels & PEP Talks
  50. 50. EVALUATION • Baseline (T1) in completion; 3-month follow-up (T2) data collection in progress. Constructs Variables Parent-child communication Frequency and content of parent-child communication about sex Self-efficacy and outcome expectancy toward communication about sex Parent-child connectedness,communication, communication ability and openness Parental involvement, oversight, and monitoring Sexual initiation Youth beliefs and intentions toward sex Youth perceived friends’ and parents’ beliefs about sex Youth self-efficacy to refuse sex and/or use condoms Usability SSS likeability, ease of use, credibility, perceived impact, motivational appeal, and suggestions for improvement. Gaming for education.
  51. 51. YOUTH FEEDBACK “I understand [puberty] better and know what to expect… it taught me how to say no [to sex] if I don’t want to do it.” - Female, 12yo, Caucasian, 18 levels “I did like some of the animation. The videos were long and sometimes I got bored. It made it hard to finish [the game] in time.” - Female, 13 yo, Hispanic, 18 levels“The battles were fun. It was something to look forward to.” - Male, 13yo, Hispanic, 14 levels
  52. 52. PARENT FEEDBACK “I’ve always [said] you need to wait [to date] and I don’t think she really understood why. It helped her [know] this is what I can expect in my life from my mom and this is what I should do to stay out of this bad situation.” - Mother, 45yo, Caucasian, 18 levels “He complained… the graphics were elementary, but as he kept playing the game… it sparked better conversation. It makes you communicate.” - Mother, 45yo, African American, 3 levels “[SSS] has opened a lot of doors and I’m hoping they will stay open... It’s given us a point to engage.” - Father, 48yo, Caucasian, 18 levels
  53. 53. ADJUNCT IMPACT: DYAD A37 … THE 40 YEAR OLDVIRGIN “It hasn’t opened the door [for conversations] any wider, for me anyways. I’m kind of blunt. I tell it like it is. But for him, it has. So our conversations [about sex] have gotten a little more [open]. He’s more willing to talk. Before he wouldn’t say anything about it. ” - Mother, 42yo, Hispanic, 14 levels • SSS made a son (13yo) more willing and open to talk about sexual health with his Mom.
  54. 54. ADJUNCT IMPACT: DYAD A5… SPARKED CONVERSE,THE GRAY OF ‘TOXIC’ FRIENDS, “It’s his personality. There’s not a lot of gray in the way he views the world. They’re a friend or not. They’re trustworthy or not. But he got a view into what other kids are going through which gave him a point of empathy that he might not have had otherwise. Having the discussion put him in a position to understand some of his friends that are dealing with these difficulties.” - Father, 48yo, Caucasian, 18 levels • The PEP Talks in SSS opened the door for new discussions and allowed father to connect with son (14yo) with Autism Spectrum Disorder.
  55. 55. ADJUNCT IMPACT: DYAD A24 … RELIEF OF SELF-BLAME • SSS helped a daughter (12yo) come to terms with parents divorce and her insecurities about lack of relationship with her father. “Here’s an important point that I think you need to know about the game … [SSS] talked about how to recognize bad characteristics… and she saw that in her Dad. She was very upset when she realized and put those two things together but I think it gave her a sense of what really happened between me and her Dad. She’s always felt bad about their relationship and I think she blamed herself so I think the game gave her that extra lesson that was not anticipated.” - Mother, 45yo, Caucasian, 18 levels
  56. 56. CONCLUSIONS The Secret of Seven Stones (SSS) is designed to be an intergenerational (dyadic) adventure game to encourage parent-child communication that goes beyond “the sex talk” to impact healthy and responsible decisions about friendships, dating, and sex. • SSS is a feasible delivery channel. • Play progress is highly variable. • Initial youth reactions to the game appear mixed. • Initial parent reactions appear positive. • Adjunct impact appears positive though main effects need to be formally determined.
  57. 57. IMPLICATIONS This work will inform developers and researchers on the development, implementation, and evaluation of an innovative intergenerational computer game to impart life skills education and enhance parent-youth communication.
  58. 58. QUESTIONS? Ross.Shegog@uth.tmc.edu

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