Researchers at Yale University are testing whether a humorous card game can help young, black women reduce their chances of contracting HIV and AIDS—part of a new but growing trend examining whether games can spur health behavior changes.
Played among three to five people, “One Night Stan” has players draw cards to establish sexual scenarios and then prompts players to discuss how they would react in those settings.
The game, developed by play2PREVENT, a gaming lab within the Yale School of Medicine, is still a prototype, but designers are hoping to launch a video game version eventually and bring it to a broader audience.
“It’s really about evaluating sexual situations and encounters,” said Kimberly Hieftje, a developer of the game who is an associate research scientist at Yale School of Medicine and deputy director of the play2PREVENT Lab.
A growing number of developers, in Connecticut and nationally, are testing whether card, video, online and mobile games are effective tools for getting people to make healthier choices.
“Using games for social reasons is still relatively new,” said Elena Bertozzi, associate professor of game design and development at Quinnipiac University. She also is founder of the Engender Games Group Lab, which gives Quinnipiac students and alumni opportunities to develop and program games.
In her research, Bertozzi developed a game intended to persuade children to get flu shots, and most recently has been assisting the National Institute of Public Health of Mexico by developing a smartphone-based game aimed at reducing sexually transmitted diseases among homosexual men in Mexico City.
There is not much data on games’ effectiveness as behavior-changing tools, she said, though early indications suggest games “can be very effective” in addressing specific problems among a targeted demographic.
Increasingly, game developers are making a concerted effort to collect data about games’ outcomes, for example, tracking whether game play makes players more likely to have safe sex, Bertozzi said.
Games, particularly ones that integrate some type of personal narrative, have been shown to spur health behavior changes among players, according to the National Institutes of Health (NIH), but further research into their effectiveness is needed.
A 2009 NIH study examined the impact 25 health-related video games had on those who played them and found most people “demonstrated positive health-related changes from playing.” The most successful games were interactive, had a specifically tailored message, had a “moral” and told a story, according to NIH.
“One good thing about play is it’s a way of getting around embarrassment and shame,” Bertozzi said, noting people seem more open to discussing personal topics as part of a game. “Knowledge is power, and a lot of people don’t have good information about sexual practices and that’s one of the reasons they make poor decisions.”
People who have played Yale’s “One Night Stan” have been very receptive to its health-related messaging, more so than they would if it were presented differently, said Dr. Lynn Fiellin, associate professor of medicine at the Yale Child Study Center and director of the play2PREVENT Lab.
“Games are particularly engaging and interactive,” she said. “You hope that not only are they more engaged but the content really sticks.”
In “One Night Stan,” each player picks a card with a man’s name on it and another card telling her where she met the man. Subsequent cards give the player additional characteristics of the man and, at some point, she must decide whether or not to sleep with him. Should she opt to have unprotected sex, there are consequences.
The game is geared for black women between the ages of 18 to 25. Women from Greater Bridgeport, through a partnership with the University of Bridgeport, and women from Greater New Haven tested the game in pilot groups.
The game sparked real, serious conversations about sexual safety among players in the pilot groups, Hieftje said.
“The goal is to empower women to insist their partners wear condoms and get tested for HIV,” Hieftje said. “We wanted to make this a humorous game. We wanted it to be fun and engaging.”
Of the estimated 47,500 new HIV infections in the United States in 2010, women made up 20 percent, or 9,500 of the new infections, according to the most recent data available from the U.S. Centers For Disease Control and Prevention (CDC). When comparing groups by race, and other factors, new cases among black women totaled 5,300 (64 percent) compared with 1,800 (18 percent) among whites and 1,400 (15 percent) among Hispanics/Latinos, the CDC reports.
Other sexually transmitted diseases also are more prevalent among black women than other races. In 2013, the rate of chlamydia among black women was roughly six times higher than that among white women, according to the CDC, while gonorrhea rates were 12 times higher in black women than in whites.
Hieftje said she is encouraged by the early results of card game, adding that players reported the game prompted them to get tested for HIV/AIDS and to ask their sexual partners to get tested.
“The game actually was changing attitudes, knowledge and even behavior,” Hieftje said.
So far, development of the game has been funded by a grant from Women’s Health Research at Yale, an independent center within Yale School of Medicine. Focus groups ended last December and developers have spent the months since exploring funding options to finalize the prototype version of the card game and develop a video game.
This is not the first game the Yale lab has developed to address risky sexual behavior. In 2009, play2PREVENT created a game aimed at helping teens reduce their HIV risk. That game, called PlayForward: Elm City Stories, was piloted among more than 300 youths in Greater New Haven and participants are being tracked—against a control group that played typical puzzle games—to see whether playing the game has impacted their sexual behavior, Fiellin said.