Abstract
BackgroundHuman immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed.ObjectiveWe hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents.MethodsParticipants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age.ResultsA total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56).ConclusionsAn interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months.Trial RegistrationClinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).
Highlights
BackgroundHuman immunodeficiency virus (HIV) disease and sexually transmitted infections (STIs) significantly impact young people, with racial/ethnic minority youth disproportionately affected
There is a considerable range in both the quantity and quality of education around sexual health, HIV, and acquired immune deficiency syndrome (AIDS) adolescents receive
The PlayForward group played a median of 10.1 hours (interquartile range (IQR) 3.9) over 10 sessions for a median of 60.4 minutes/session (IQR 11.6)
Summary
BackgroundHuman immunodeficiency virus (HIV) disease and sexually transmitted infections (STIs) significantly impact young people, with racial/ethnic minority youth disproportionately affected. Nineteen states require that if sex education is taught, it must be factually accurate [2]. Barriers to implementation include access to adequately trained providers, resource constraints, fidelity, and challenges of adapting an intervention from one population to another [6,7,8]. To address these issues, digital health interventions have demonstrated efficacy at influencing sexual health [9,10], featuring adaptable content for broader reach, with greater fidelity, at a potentially lower cost [11].
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