Using Games in Public Health (Part 2 of "Let the Games Begin")

This week we are continuing the second part of our two-part series on video games and public health. Last week we spoke with Tina Hoff, Vice President and Director of Entertainment Media Partnerships at the Kaiser Family Foundation, Marguerita Lightfoot of the University of California, San Francisco (UCSF), and David Galiel, an expert on new media with experience in game development.

How can we use video games in public health?

Traditionally, most commercial resources have been devoted to games whose primary purpose is entertainment. There has been little attention to a game's educational value, and "educational games" have been relegated to a niche with little funding and few professional game developers. This has begun to change, however, with the advent of the "Games for Good" movement, which has drawn game developers interested in using the immersive, participatory nature of video games in the public interest.

Marguerita Lightfoot believes there is tremendous potential in using games for public health. As a behavioral scientist, she is interested in using games to change behaviors, as opposed to simply supplying information. She said, "It takes more than information. We have to ask ourselves, how can we use technologies to really change behavior?"

Photo courtesy of Kaiser Family Foundation

Pos or Not online game

In the health arena, games have been used to educate patients about medication and their particular disease or condition. Games have also been used as a form of public education to inform about health risks, to provide basic public health education, and to increase understanding of (and empathy for) individuals suffering from various maladies.

How can we use video games in the fight against HIV/AIDS?

Video games can raise awareness about HIV/AIDS, help change public attitudes, and spark discussion. They can teach about, and encourage, safe behavior through in-game rewards and goals. Most important, they can reach an audience that is increasingly tuning out traditional media (e.g., television and radio). Online games can be a cost-effective way of reaching very large populations without the significant distribution costs associated with offline education.

Photo courtesy of Kaiser Family Foundation

Pos or Not online game

Tina Hoff told us, "Pos or Not is an analogue to the popular online viral game, Hot or Not , and was designed to engage young people in more personal ways about HIV and more specifically about who it affects."

The Kaiser Family Foundation and MTVU , MTV's college network, worked with young people across the U.S. as part of a competition to generate ideas that ultimately led to the development of Pos or Not. Now that the game is live, players are invited to share comments and new ideas for extending its reach. When we asked her about the response to the game so far, Tina said, "In the first 24 hours, we had nearly to 200,000 unique visitors play, and more people keep coming every day to play and offer comments and new ideas."

Challenges and Lessons Learned

Photo courtesy of Marguerita Lightfoot

Project Light video game

Video games have the potential to raise awareness and change behaviors, but with that potential comes challenges. As we mentioned in a recent post, Marguerita's games have been quite successful, but because she is working with schools and community-based organizations, there are challenges in scaling up her video games to reach larger audiences. She told us, "At this point video games are an emerging field, particularly in HIV. We have some indication that they work. For example, youth who completed my program reported reduced number of sexual encounters, as well as a reduced number of sexual partners. We even saw more condom use. But we're still building the evidence that this stuff works. There's a lot of research being done now on the outcomes, and we'll see more results in the next few years."

Resources

• A Fight for Life: Interactive HIV/AIDS Awareness and Prevention Game
• Food Force
• Freedom HIV/AIDS: A Social Initiative Providing HIV/AIDS Education Through Mobile Games
• Games for Change (G4C)
• Games for Change Annual Festival - June 2 -4, 2008 in NYC
• Games for Health
• Games for HIV/AIDS Training--India and Nepal
• HIV/AIDS Maze from the National Institute on Drug Abuse
• Robert Wood Johnson Foundation's Program to Research Interactive Gaming as Health Intervention Tool
• Voices for Youth: HIV/AIDS Games from Unicef

Let the Games Begin

We've been noticing a lot of press about video games lately. Grand Theft Auto IV is flying off the shelves. It sold 60 million copies in the first week. Other games, like Guitar Hero and games for Nintendo's Wii gaming system, continue to increase in popularity. At AIDS.gov, we're interested in video games as one more way to reach people with important HIV/AIDS messages and possibly influence their behaviors. So, this week we begin a two-part series on the subject.

Photo courtesy of Kaiser Family Foundation

Pos or Not online game

To learn more, we spoke with Tina Hoff, Vice President and Director of Entertainment Media Partnerships at the Kaiser Family Foundation, Marguerita Lightfoot of the University of California, San Francisco (UCSF), and David Galiel, a new media expert with experience in game development.

David told us that video games can be divided into games played on game consoles (such as Wii , XBox , and Playstation ) and games played on personal computers.

Photo courtesy of Marguerita Lightfoot

Project Light video game

Another distinction is single player games (one person versus the computer), social (or multiplayer) games (where several players play with and against one another, over a local network or the Internet), and massively-multiplayer online games (MMO), where large numbers of participants play together over the Internet.

Who is using video games?

Video games are no longer the exclusive realm of children. According to the Entertainment Software Association :

• The average video game player today is 33 years old and has been playing games for 12 years.
• Sixty-seven percent of heads of households play video games.
• Forty percent of players are women; in fact, adult women represent a larger proportion of the total game playing public (33 percent) than boys 17 or younger (18 percent).
• Twenty-six percent of players are over 50.
• More than a third of parents play video and computer games.
• The average adult plays more than seven hours a week.

Tina Hoff, Kaiser Family Foundation

That said, there are still many young people who are playing video games. Tina explained, "New media platforms, especially those that engage the audience and leverage the viral marketing opportunities of the Web, such as Pos or Not (an online game that challenges stereotypes about HIV/AIDS), are very popular with our target audience of young people. We have always believed the best communication strategy is to go where our audience goes."

When Marguerita was a high-school counselor in a low-income area of Los Angeles, she observed that nearly all of her students had video games. "These were young people who dealt with violence and poverty on a daily basis," she explained. "Yet video games [and technology] were part of who they are. If we ignore these tools, we are missing opportunities to reach young people and promote behavior change."

Ultimately, a growing percentage of the population spends more and more time playing video games of all kinds.

Why video games?

What all video games have in common is a participatory quality. Unlike traditional forms of entertainment (literature, theater, film, television), players become part of the action, not just passive observers. Their actions determine outcomes, and every step requires decision-making that affects the rest of the player's experience.

According to David, "When people play a game, they tend to be more receptive to new information, particularly if the game is structured in a way that makes the information important to success. Well-constructed video games immerse players in a state of 'flow' that is conducive to constructivist/constructionist learning, and that is where the educational, public-service potential of video games comes into play. Players learn by doing, and in multiplayer and MMO games, by teaching others."

At AIDS.gov, we're curious how video games can and are being used in the fight against HIV/AIDS. Tune in next week as Marguerita, Tina, and David help us answer that question.

Old and New Media Unite--Promoting National HIV/AIDS Awareness Days

This month, the organizations planning and implementing HIV Vaccine Awareness Day and National Asian and Pacific Islander HIV/AIDS Awareness Day are promoting these observances and expanding their reach by using traditional and new media tools.

National Asian and Pacific Islander HIV Awareness Day - May 19

According to the CDC, the number of Asian and Pacific Islanders (API) living with AIDS has climbed by more than 10 percent in each of the last five years. Sixty-seven percent of API men living with HIV/AIDS in 2005 were men who had sex with other men. Eighty percent of API women living with HIV/AIDS in 2005 were infected through heterosexual contact.

As the number of API living with, or at risk for, HIV grows, promoting this annual observance effectively becomes even more important. We spoke with Joseph Cavan, Media and Communications Coordinator for the Banyan Tree Project (BTP) , to hear about how the BTP is using traditional and new media to promote materials and events for this day. BTP is using press statements, a website, and public service announcements (PSAs) with leading Asian and Pacific Islander celebrities, Joan Chen , James Kyson Lee , and Amy Hanaiali`i . The organization is also using new media tools (e.g., video-sharing directories and social networking sites) to expand the reach of their materials.

HIV Vaccine Awareness Day - May 18

Leaders promoting this day are using traditional and online media to encourage people to get involved in vaccine research. In addition to their TV and radio PSAs, the Be the Generation website offers many interactive tools that engage users--for example, "Community Voices" videos, which will soon be added to the site, will offer stories about people who are working in HIV vaccine research. The website also has an HIV Vaccine Quiz .

To learn more about about using new media as part of the campaign, we spoke to A. Cornelius Baker, Project Director for the HIV Vaccine Research Education Initiative at the Academy for Educational Development's Center on AIDS and Community Health. He said, "We know new media is important, and it is very important to us that when we do engage new media, we do so in an appropriate way." He told us that his office is sensitive to the amount of mistrust that exists in the African American community when it comes to vaccine research. "We want to engage this community in an appropriate dialogue...but before we go that route, we must make sure that we have the resources to use new media tools effectively and appropriately."

Lessons Learned

Many of us are still exploring the intersection of traditional and new media. Our colleagues shared with us some of the lessons they have learned:

• Joseph told us that, for last year's National Asian and Pacific Islander HIV Awareness Day, the BTP had developed a MySpace page for users to read about their program. Afterwards, they realized the potential of social networking sites—and also realized that taking advantage of that potential would mean a serious time commitment (i.e., having a dedicated team member to regularly maintain the BTP's MySpace page).
• While not all of us have access to a professional studio like BTP does (or can get the country's leading high-profile talent!), there are inexpensive ways to create and promote videos online. YouTube has information about making and optimizing video for the Web and icyou , a video-sharing website that focuses exclusively on health content, also provides tools to upload videos for free.
• The team managing the Be the Generation website realized the site needed to be 508 compliant for people with disabilities. Cornelius told us, "Be the Generation is fully accessible under Section 508, and audio and video have been enhanced to make sure that all users can learn as much as possible from the site."

Are you using new media to promote HIV/AIDS Awareness Days? Please share your stories with us!

Stay tuned for next week's discussion on gaming and health...

Be Relevant, Be Real, Be Informed, Be There

In last week's post on PodCamp, we noted that our blog would begin to carry a list of new media conferences. We encourage you to visit the new Conferences Page.

We want to highlight conferences because these events can contribute to the dialogue on the effective use of new media. Many of these conferences are free or offer scholarships and volunteer opportunities in exchange for conference fees.

We found the messages coming out of three recent conferences, University of California San Francisco's Center for AIDS Prevention Studios (CAPS) Conference , PodCamp NYC , and the Web 2.0 Expo , useful as we plan our work. Here are some highlights:

Be Relevant

At the CAPS Conference: New Directions in HIV Prevention, there was a presentation on an HIV prevention video game by Marguerita Lightfoot .

Photo courtesy of CAPS

Marguerita Lightfoot

She noted that the video game was adapted from an intervention called Project LIGHT. The video includes health information, triggers impacting unsafe sexual behavior, and opportunities to practice communication skills. Lightfoot involved students ages 14 to 18 years of age in developing the video game. She said, "They helped make it relevant using their own words."

Dr. Lightfoot explained that youth were engaged in the video game and felt the computer was not judging them, unlike their peers often do. Other outcomes from the video game group, as compared with the small group and control group, included a reported decrease in sexual behavior and number of sex partners.

In two weeks we will expand on the topic of gaming.

Be Real

At PodCamp NYC , many talked about the importance of trust and authenticity in using new media successfully. At the session on "Finding Your New Media Voice," Laura "Pistachio" Fitton said, "Don't do social media for the numbers. Do it to connect to the people who are important to you." Fitton and Chris Brogan reinforced the importance of being useful, human, and authentic. By doing so, people will be engaged, and trust you and your message.

L. Johnson Martin Pratt's session, "Reaching African Americans Online," reinforced the message that we need to be authentic. He gave examples of many online websites and communities that identify with their target audience by not trying to be anything else than who they really are.

Be Informed

The Web 2.0 Expo is a large industry expo and conference. While it may not have a direct linkage to our work in HIV/AIDS, walking the expo floor and attending the keynotes is a good way to hear from many new media key players and hear the buzz about the latest new media tools. Many of the Web 2.0 Expo speakers' presentations are available online .

Be There

We encourage you to consider attending the CDC's 2nd Conference on Health Communication, Marketing, and Media, which will be held August 12-14, 2008 in Atlanta, Georgia. Jennie Anderson, AIDS.gov Director of Communications noted that last year's conference, "was a great opportunity for both novices and experts working on HIV/AIDS prevention and other public health topics to learn about the many facets of health communication, marketing, and media."

Don't forget to check out our new list of conferences and help us keep up to date!