|Authors||T. Ruiz-Lopez, S. Sen, E. Jacobsen, A. Tropé, P. E. Castle, B. T. Hansen and M. Nygård|
|Title||FightHPV: Design and Evaluation of a Mobile Game to Raise HPV Awareness and Nudge People to Take Action against Cervical Cancer|
|Project(s)||The Certus Centre (SFI)|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Journal||Journal of Medical Internet Research : Serious Games|
|Keywords||cancer screening, cervical cancer, digital game-based learning, health knowledge, HPV, HPV vaccine, mobile applications, Serious games|
Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, which is the fourth most common female cancer in the world, other anogenital cancers, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening to diagnose and treat precancerous lesions. However, there is a lack of awareness and knowledge of HPV and these preventive strategies, which represents an important barrier to reducing the burden of disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, modern health communication strategies.
Objective: To describe the development of a mobile application called “FightHPV”, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods.
Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of six participants aged 40-50 years, and a second focus group of 23 participants aged 16-18 years. Gameplay data from the beta testing study were collected using Google Analytics, while feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire.
Results: FightHPV communicates main concepts about HPV, associated diseases, and their prevention, by representing relationships between 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants that returned a questionnaire, all stated that FightHPV is an appealing educational tool, eighteen of 26 (69%) reported that they liked the game, and 21 (81%) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=0.001).
Conclusions: FightHPV was easy to access and to use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer.