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.