A Smartphone Game to Prevent HIV among Young Kenyans: Household Dynamics of Gameplay in a Feasibility Study.

Abstract

mHealth interventions often favour individual-level effects. This is particularly problematic in contexts where social support and shifts in social norms are critical to sustained behaviour change. Mobile digital games represent a promising health education strategy for youth, including in low-resource settings. We sought to better understand the interpersonal and social interactions that can be elicited by digital games for health. We piloted Tumaini, a smartphone game rooted in interactive narrative designed to prevent HIV among young Africans (aged 11-14), in a randomised controlled feasibility study and analysed reports of the household dynamics surrounding gameplay. Following a 16-day intervention period, phone gameplay log files were downloaded and intervention arm participants (n=30) completed a gameplay experience survey; eight focus group discussions were held, four with intervention arm participants (n=27), four with their parents (n=22). This study took place in Kisumu, Kenya, in Spring 2017. Descriptive statistics were computed from survey responses and log files. Focus group transcripts were labelled, analysed thematically, and compared demographically using MaxQDA software. Data from log files, survey and focus groups indicate that the game generated considerable interaction and dialogue with parents, siblings, and friends, and served as a catalyst for children to act as advocates for healthful decisions about sex, both within the family and beyond. The game showed a high level of acceptability with parents. Serious digital games using a smartphone platform can generate considerable household interaction. Games can model and facilitate these exchanges, maximising multi-level effects. An additional app for parents could reinforce these effects.