An iterative process for developing digital gamified sexual health education for adolescent students in low-tech settings

Date11 November 2019
Published date11 November 2019
AuthorHussein Haruna,Zamzami Zainuddin,Robin R. Mellecker,Samuel K.W. Chu,Xiao Hu
An iterative process for
developing digital gamied sexual
health education for adolescent
students in low-tech settings
Hussein Haruna and Zamzami Zainuddin
Faculty of Education, University of Hong Kong, Hong Kong, Hong Kong
Robin R. Mellecker
Institute of Human Performance, University of Hong Kong,
Hong Kong, Hong Kong, and
Samuel K.W. Chu and Xiao Hu
Faculty of Education, University of Hong Kong, Hong Kong, Hong Kong
Purpose Digital technology has great potential for educating todays digitally oriented adolescents
on health. In particular, digital health gamied learning can make the promotion of the sexual well-
being of adolescents more effective. Although venereal diseases such as HIV/AIDS have become a
greater problem in Sub-Saharan African (SSA) countries than in any country outside of Africa, little is
publicly known about the development of gamied learning for use in counter-measures. This paper
aims to address that decit by presenting the process of developing one such game. The paper
highlights how the My Future Begins Todaygame for sexual health education was developed,
evaluated and rened in the real-world of low-tech settings and made improvements based on the
response of users.
Design/methodology/approach Design-based research (DBR) was used to guide the design,
develop, test and rene the digital game in iterative cycles. The evaluation of the effectiveness of
iterations of the game was done using adolescent sexual health literacy tests and the validated
Motivation, Attitude, Knowledge and Engagement framework, the authors developed based on existing
approaches. That framework combines the elements of motivation, attitude, knowledge and
engagement, effectiveness was evaluated based on the games ability to motivate students, improve
their attitudes, increase their acquisition of knowledge and engage them in learning self-rating surveys
and interviews. The whole process of game design, testing, evaluation and renement were
underpinned by the activity theory, DBR and participatory design (PD) research.
Findings Participants in the gamied learning platforms demonstrated higher average scores on
their post-tests than their counterparts subjected to the traditional teaching classroom. Also, gamied
learning groups commented positively on the effectiveness of their instructional approach than their
counterparts in the traditional learning group. The stakeholdersinvolvement in developing gamied
learning provided a good understanding of the importance of the game to the adolescent students and
how it was going to be used to address the problem identied. The application of PD contributed to the
effectiveness of the game. It involved various actors from various elds who were relevant to the game.
Also, engaging targeted users from the beginning resultedinthecreationofabetter correspondence
with the preferences of end-users.
Practical implications This study has contributed to a better understanding of sex education and
knowledge in the area of adolescentreproductive health issues, using developed innovativegame mechanics
featuresand its applicability in low-tech settings.
sexual health
Received9 July 2019
Revised20 September 2019
1 October2019
Accepted2 October 2019
Informationand Learning
Vol.120 No. 11/12, 2019
pp. 723-742
© Emerald Publishing Limited
DOI 10.1108/ILS-07-2019-0066
The current issue and full text archive of this journal is available on Emerald Insight at:
Originality/value The study will be a recommendationfor future researchers in applying this gamied
learning concept and its suitabilityin their teaching practice, particularly regarding sexual healtheducation
and adolescentreproductive health issues in low-tech settingsof SSA.
Keywords Sub-Saharan Africa, Participatory design, Digital health game,
Digital-savvy adolescents, Gamied learning, Iterative cycle, Sexual health education,
Low-tech settings, Design-based research
Paper type Research paper
Digital technology refersto the use and application of information technology resources and
devices to support the solving of problems. Digital technology devices, including the
internet, smartphones and tablets, are increasingly inuencing the lives of adolescents
(Kachur et al., 2013). It has also been used to educate them on health promotion and
behaviour change (Temple-Smith et al.,2016). Digital games are among the digital
technology products, which refer to an interactive program for one or more players, meant
to provide entertainment at the least and quite possibly more. In an educational context,
digital games sometimes refer to serious games, which are designed for a meaningful
intention of delivery learning rather than entertainment only (Ronimus et al.,2019;
Zainuddin, 2018).
Generally, there has been a rapid increase in the use of digital health gamied learning
platforms to support and promoteadolescent sexual well-being (Chu et al., 2015;Fiellin et al.,
2017;Zhang et al.,2017). Digital games for sexual health education increase engagement and
make the learning environment more interactive. They also offer practical skills through
hands-on learning activitiesthat are translatable to the real world (Hieftje et al., 2016). Their
repetitive nature is ideal for improving learning.Digital gamied learning for sexual health
education provides immediate feedback, which is benecial to the learner (Hieftje et al.,
The use of digital health gamied learning platformshas been found to affect the sexual
health behaviour of adolescents.Some digital games focus on a general promotion of sexual
health education (Chib, 2011;Chu et al., 2015); some focus on HIV/AIDS prevention (Hieftje
et al., 2016); some focus on preventing the spread of Chlamydia and other sexually
transmitted infections (STIs) (Jiang et al.,2017); some focus on encouraging human
papillomavirus vaccination (Cates et al., 2018); and others aim to eliminate coercion and
pressure in adolescentrelationships (Arnab et al.,2013).
Digital health gamied learning platforms have been designed to be used on various
learning platforms. Though the game neighbourhood (Jiang et al.,2017) has its video games
available on YouTube, it is unclear, which learningplatform technologies were used on the
Land of Secret Gardens (Cates et al., 2018) and the PR:EPARe (Arnab et al.,2013) video
games. PlayForward uses an iPad learning platform to play video games during learning
(Fiellin et al., 2017). The MakingSmart Choices game was developed to educate adolescents
using a number of popular digital learningplatforms, including iPad, Facebook and the web
(Chu et al.,2015). Furthermore, the computer multimedia game platform was used in Chib
(2011). Of these studies, only one was conducted in a low-income country (Chib, 2011).
Overall, most of these studies indicate the usefulness of digital game interventions in
reducing risky sexual behaviours and promoting healthy sexual behaviours among
Researchers have used different approaches to evaluating the effectiveness of the
designed digital health gamied learning platforms for the delivery of sexual health

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