Utilizing Theories and Evaluation in Digital Gaming Interventions to Increase Human Papillomavirus Vaccination Among Young Males: Qualitative Study

"In all, these data suggest that understanding the purpose of theory and evaluation may have a profound impact on the quality of the game design and on what individuals learn about HPV, sexual health, and STI prevention."

Health professionals are increasingly using interactive games ("serious games") as an educational tool and behaviour intervention strategy to address health disparities. Although human papillomavirus (HPV) is a sexually transmitted infection (STI) affecting both men and women, communication campaigns in the United States (US), where HPV infection is common, have traditionally focused on females. As a result, young men lack knowledge about reasons for vaccination, the benefits of being vaccinated, and their HPV risk, overall. This study examines theoretical models that could be useful in game design to increase HPV vaccination rates in young males aged 18 to 26 years and explores evaluation study designs for digital-based gaming.

Gamification works by providing immediate feedback when the player takes an action or selects an option within the game, which has been found to allow for increased cognitive processing and experiential learning.

Interviews were conducted with 22 experts in the fields of cancer prevention, sexual and reproductive health, public health, game design, technology, and health communication on how a game should be developed to increase HPV vaccination rates among males.

Although individual interviewees either worked in research, government, or academia, collectively, they all encouraged the use of behavioural theories in such games. In particular, theories that focused on increasing a male's perception of benefits and addressing those key barriers that could prohibit HPV vaccine uptake were highly regarded. This resulted in the health belief model (HBM) being highlighted frequently. Constructs most mentioned being instrumental to the intervention design included perceived susceptibility, risk perception, and self-efficacy.

In addition to theory, interviewees mentioned the role and impact of using programme planning tools, approaches, and models to develop a gaming intervention for males. Items that emerged during the one-on-one interviews included intervention mapping and logic models. For example, the former approach can help developers think of the determinants within the intended population that should be considered, so as to help the game be more effective. Social marketing was also mentioned as a possible dissemination tool to encourage game play and promote health among young men.

In terms of evaluation, key predictors of success, highlighted by experts, for a male gaming intervention included changes in knowledge and awareness, changes in behaviour, and gaming-to-vaccine correlation. Ultimately, all interviewees highlighted the need to conduct process, impact, and outcome evaluations. "In analyzing the effectiveness of a digital game, the focus should be on change in uptake measures that include not only vaccination initiation but 3-dose completion."

Future research on this topic could use focus groups with young men to aid in identifying salient content for a serious game intervention. "Creating a safe space to educate young men around safe sex practices and vaccination can help to promote discussions around use, health benefits, and concerns about the virus and vaccine." Another suggestion: Tailor the design to role models and or opinion leaders within the community.

In conclusion: "By providing information and focusing on the rewards to vaccination, gaming can create a constructive learning model and make learning personalized, interactive, and fun."