By Matt Wood
It’s a perennial question for doctors, teachers and parents trying to teach young people about sexual health: How do you get through to them? No parent relishes the thought of talking to a teenager about using condoms or avoiding sexually transmitted diseases, and traditional school settings offer less time for health education with the increased emphasis on standardized testing in math and reading.
To overcome the stumbling blocks of awkward conversations and diminishing resources in schools, researchers are experimenting with digital media such as social networking sites, text messaging and online games to reach kids where they hang out now — virtually at least. Melissa Gilliam, MD, professor of obstetrics, gynecology and pediatrics at the University of Chicago Medicine, is developing a number of projects using digital media to teach kids about reproductive health, including a new twist on gaming that may have them learning something before they realize it.
Gilliam said she sees digital media filling in the gaps left by less formal sexual education. “What’s nice about digital media is that it’s something that can be inserted into the classroom, into the clinical setting, into the personal space,” she said. “It overlays so many parts of our lives already, so you could imagine for a young person it could wrap around their in-school activities and out-of-school activities too.”
She and her colleagues wrote a review paper recently in the Journal of Adolescent Health about various intervention studies that used digital media to engage young people about sexual health. They looked at 10 studies that used a variety of tools to engage young people from 13-24 years old, from web-based video modules and interactive exercises, to analysis of social media profiles and using text messages to send medication reminders to HIV-positive youth.
They found this kind of intervention was somewhat successful. Seven of the studies significantly influenced attitudes about using condoms and abstinence, and six increased knowledge about HIV, sexually transmitted diseases and pregnancy. Two studies significantly delayed the beginning of sexual activity in adolescents, and one successfully convinced young people to remove sexual references from their MySpace profiles. While this would seem encouraging news for the prospect of engaging with kids using digital media, Gilliam said the results are still difficult to quantify.
“We still have some questions about what works best and what’s effective,” she said. Part of the problem is that it can be difficult to measure outcomes of sexual behavior. The goals of these interventions — preventing STDs, delaying sexual activity, avoiding unwanted pregnancies — are difficult to attribute to any one cause. How much does watching a video about condom use in an academic study influence a teenager’s decision-making? If a young person contracts an STD, does that mean the intervention failed completely, or is it part of a longer process to change behaviors?
“One of the issues is that people are still thinking through is how we change behaviors,” Gilliam said. “For a lot of behaviors, you adopt a new behavior and then you relapse and you have to re-adopt it. Think of people who diet. They do great, but then what happens? Most people regain the weight.”
“It’s the same for using condoms. It’s very hard to do anything perfectly, and that might be one of the beauties of digital media. You can re-dose the intervention in a way that’s appealing for them and might be more accessible,” she said.
After the review, Gilliam and her colleague Patrick Jagoda, PhD, assistant professor in the Department of English at the University of Chicago, formed a working group that became a multi-project initiative called Game Changer Chicago. The various Game Changer projects combine aspects of digital media and storytelling with the learning components of a traditional clinical intervention.
Game Changer Chicago is particularly interested in transmedia games that tell a story across multiple platforms, both online and in the real world. Game players might find a cryptic note on a flyer that leads them to search for a clue on the Internet. That search might lead them to a YouTube video or a chatroom with more hints, and on and on as the mystery unfolds. Along the way they just happen to learn about sexual and reproductive health from the game’s puzzles and clues.
Gilliam and Jagoda held a workshop with teenagers to write the script and develop a game called “Stork,” learning critical research skills and technical aspects of game development like video production and programming in the process. Dianna Douglas wrote about Game Changer for Science Life before it launched in March. It has since completed, and Gilliam said that at its peak they saw 500-600 unique hits in the discussion forum that served as the hub of the game’s community. The game also received more than 4,500 views on Unfiction, a popular alternate reality gaming forum.
The game is part of a series of workshops on digital storytelling and game design that Gilliam hopes will help change sexual behaviors by involving kids in the creative process and sharing their own stories. “If you give them the tools to tell their own story, we get great stories. They had really wonderful information to share, and we realized that personal narrative would be a really important piece of this.”
The benefit of such a project is twofold, both for the designers and those who play it. “The people who design it are doing research. They’re reading newspapers, taking photographs and learning programming. They get an amazing experience,” Gilliam said. “What was really interesting for us was watching the players work through the game. We watched them piece through our story and stumble across these artifacts that we had as part of the game. So clearly people were seeing these patterns and discovering websites, discovering statistics and phenomena that they hadn’t seen before.”
The results of the game were promising enough that Gilliam and her colleagues hope to implement a similar model in Africa through a partnership with the University of Ibadan in Nigeria. They wrote another paper for the African Journal of Reproductive Health exploring ways that games could capitalize on the strong storytelling culture of Nigeria and its population’s near-universal use of mobile phones. Such tools could allow young people there to overcome taboos about sexual activity and practice advocacy skills for youth rights.
But is using interactive games, social networks and mobile phones really the way to get through to teens, or is it just the newest way of sugar-coating educational material? Gilliam said projects like Game Changer avoid leaving a bad taste in the mouth because they include kids in the process. “I think when things are overtly educational, they get much more painful for kids,” she said. “We’re trying to overcome that by designing things with them.”
Kylene Guse, M.A., Deb Levine, M.A., Summer Martins, M.P.H., Andrea Lira, M.H.S., Jenna Gaarde, Whitney Westmorland, & Melissa Gilliam, M.D., M.P.H. (2012). Interventions Using New Digital Media to Improve Adolescent Sexual Health: A Systematic Review Journal of Adolescent Health DOI: 10.1016/j.jadohealth.2012.03.014