Video game helps empower Black teens to prioritize their health

Damien is knowledgeable about sexually transmitted infections (STIs), open to serious conversations about sex, has questionable taste in music, and won’t stop talking about his ex.

Is this someone you might want to date?

This is the type of question aimed at the players of InvestiDate, a video game designed through peer-reviewed studies and the recommendations of Black female adolescents who have provided guidance to the researchers. It is just one question within the video game designed to help navigate the challenges of dating and, if sexually active, while remaining protected against STIs, including HIV/AIDS.

All adolescents face these kinds of challenges and have similar behaviors across demographic groups. Yet, Black female American adolescents are at increased risk for infection due to greater rates of limited access to health care, reduced awareness of infection status, and reluctance to seek help due to a higher sense of stigma and fear of discrimination, according to the U.S. Centers for Disease Control and Infection.

Research has demonstrated that games can deliver valuable health information and influence health behaviors.

“Our game is about helping teens ages 14–18 become empowered to overcome the unique obstacles they face as young, female people of color in the highly technological world of modern dating,” said Dr. Kimberly Hieftje, leader of the project, assistant professor of pediatrics, and director of the play4REAL XR Lab at Yale. “When adolescents are starting to think about becoming sexually active or they want to get tested for STIs with a partner, we can help them navigate that.”

Begun as a role-playing card game through a Women’s Health Research at Yale grant awarded to Dr. Hieftje and Dr. Lynn Fiellin, director of the Yale Center for Health & Learning Games, InvestiDate earned additional funding from the National Institutes of Health (NIH) to evolve into a prototype web-based collaborative multiplayer game developed by PreviewLabs. Now, Dr. Hieftje and her colleagues are conducting a randomized controlled trial to evaluate the game’s capacity for helping make good choices about health when dating.

“In designing this game, it was vital to involve voices with lived experience,” Hieftje said, emphasizing the contributions of Dr. Ijeoma Opara, assistant professor at the Yale School of Public Health and founder and director of the school’s Substance Abuse and Sexual Health Lab, and the game’s graphic artist, Leslie Glanville.

The game’s design follows the original WHRY-funded template, introducing an assortment of male adolescent characters represented with an illustrated headshot and a brief social media profile. As the game progresses and storylines form, the players can learn positive personality traits and bits of information that could represent “green flags” for the players—evidence that the possible “date” might be someone worth getting to know better. Negative details represent “red flags” that might characterize an individual as someone not worth pursuing. The players discuss the details—either in the same room or in an online chat—and vote on how safe or risky, cool or uncool, they consider each trait.

Players select goals worth various points, such as starting to date someone (50 points), “unfollowing” a character with two or more risky traits (80 points), getting tested by a doctor for HIV (120 points), or changing a partner’s mind about condom use (150 points). The first player to 300 points wins the game.

As the players gather information about each character, they can decide if they want to date them or pass on them to pursue other opportunities. The game includes a pair of older peers and a doctor to provide helpful information on topics such as STIs and how to engage in safer sex practices. Players can also challenge each other to trivia contests on health topics and even compete to see who has the “best” boyfriend.

“It’s a social game,” Hieftje said. “We provide important information on STIs but present it within the larger context of healthy dating and what relationships are like today.”

The researchers, including Dr. Opara, Dr. Veronica Weser, Brandon Sands, and Dr. Claudia-Santi Fernandes, conducted focus groups with heterosexual Black female adolescents to better understand how they and their peers evaluate and choose potential romantic partners online. Future iterations of the game might involve different sexual orientations and genders, but this one focuses on heterosexuality because of the high risk of STI transmission for females. The sessions helped the researchers design gameplay that matched the lived reality of the participants, including how teenagers use different social media platforms for different purposes and how they can experience racism and bias over social media.

Hieftje also stressed the importance of WHRY’s early investment, particularly for junior faculty just beginning to build a research program.

“That initial pilot project generated the data I needed to receive my first NIH grant,” Hieftje said. “That type of funding is essential for newer investigators, who don’t necessarily have a lot of opportunities to launch our own projects. This has been a really wonderful experience.”

Hieftje is partnering with schools to test the game, making sure participants have the support they need. The researchers are playing the game with 40 participants, while another group of 40 will serve as a control group playing a different game that does not provide the same educational content. When completed, the researchers will follow up to compare the groups and see if InvestiDate players retain knowledge and change behaviors about saying no and practicing safer sex, among other outcomes. The game provides specific resources to access free health services in players’ communities, including STI testing.

After demonstrating the game’s effectiveness in promoting safer behavior through more informed, empowered decision making, Hieftje hopes to offer the game to schools and community programs.

“We need to talk to young people early,” Hieftje said. “So when the time comes, they can be prepared with the knowledge and strength to choose what’s best for themselves.”