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Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health.
This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the
We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS.
SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings.
The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health.
Early sexual debut in adolescents is a pervasive public health challenge in the United States. Nearly half (46.8%) of high school students reported having engaged in sexual intercourse, whereas 5.6% reported having engaged in sex before the age of 13 years [
School- and clinic-based prevention programs often achieve broad support and success in reducing sexual risk behaviors in young adolescents [
The purpose of this study is to describe the development of a novel in-home web-based intergenerational game for parent and young adolescent (11-14 years) dyads, the
We developed SSS through a National Institutes of Health (NIH) Small Business Technology Transfer Research (STTR) project collaborative between UTHealth (The University of Texas Health Science Center Houston) and Radiant Creative Group, LLC. Our development team comprised specialists in adolescent sexual health, computer-based interventions, parent-child communication, and digital media development. The Parent-Youth Advisory Group (P-YAG) provided conceptual guidance and formative evaluation. Parents (n=20) and young adolescents (n=19, aged 11-14 years) were recruited through flyers, targeted Facebook advertisements, and word of mouth. Young adolescents were mainly female (13/19, 68%), mean 12 (SD 0.28) years old, African American (9/19, 47%), and White (8/19, 42%). Parents were mainly mothers (17/20, 85%), African American (8/20, 40%), White (9/20, 45%), and Hispanic (3/20, 15%). IM, a 6-step framework for developing evidence- and theory-based intervention programs, guided our development process (
Intervention mapping steps with associated tasks and intermediate development products.
IMa steps | IM tasks | Intermediate development productsb |
Step 1: Assess need & develop a logic model of the problem |
Establish and work with a planning group. Describe the context for the intervention, including the population, setting, and community. Conduct a needs assessment to create a logic model of the problem. |
P-YAGc Literature review–evidence table PRECEDEd model |
Step 2: Develop matrices of change objectives |
State expected outcomes for behavior and environment. Specify performance objectives for behavioral and environmental outcomes. Select determinants for behavioral and environmental outcomes. Construct matrices of change objectives. |
Matrices for parent (n=6), youth (n=8), and dyadic (n=1) outcome behaviors comprising performance objectives for parent (n=65), youth (n=70), and dyad (n=8) and learning objectives for parent (n=869), youth (n=781), and dyad (n=72). Conceptual model for SSSe game flow (model of change). |
Step 3: Identify theory-based methods and practical applications for program design |
Choose theory- and evidence-based methods to create change. Select or design practical applications to deliver change methods. Generate program themes, channels, components, scope, and sequence. |
Table of content domains (n=9). SSS design document comprising specifications including functional inventory, game flow, screen map design, game mechanics, scripts, character descriptions, and interactive activities. |
Step 4: Produce program components and materials |
Refine program structure and organization. Prepare plans for program materials. Draft messages, materials, and protocols. Pretest, refine, and produce materials. |
SSS game consisting of 18 levels of content. SSS parent website including parent training videos (n=7) and tip sheets (n=10). Pilot test protocols and results: Manual of procedures. Usability rating results table (parent & youth) with ratings on ease of use, acceptability, credibility, motivational appeal, and applicability for 2 prototype levels. Qualitative data (parent and youth) on acceptability for in-home use. |
Step 5: Plan for program adoption, implementation, and sustainability |
Identify potential program implementers. State outcomes and performance objectives for implementation. Construct matrices of change objectives for implementation. Design implementation interventions. |
Marketing and commercialization plan for future implementers. Written University of Texas Tech Transfer agreement. SSS game and website revisions for future implementation. |
Step 6: Plan for evaluation |
Write effect and process evaluation questions. Develop indicators and measures for assessment. Specify evaluation design. |
Efficacy study design Manual of Procedures comprising: Study hypotheses and protocols. Baseline and first and second follow-up Questionnaire Development System (QDS) software and paper-based surveys. Qualitative exit interview prompts. |
aIM: intervention mapping.
bYouth indicates young adolescents (11-14 years).
cP-YAG: Parent-Youth Advisory Group.
dPRECEDE: predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation.
eSSS: Secret of Seven Stones.
IM is a stepped framework to guide the development of behavioral interventions, providing a process by which program developers can apply social and behavioral science theories within the practice of health behavior change [
In step 1, we conducted a needs assessment to understand the health problem and priority population and to describe a theoretically- and empirically-based model for sexual health behavior (
Predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation “logic model of the problem” of young adolescent sexual behavior for the Secret of Seven Stones. STI: sexually transmitted infections.
Our needs assessment determined a priority population of young adolescents (aged 11-14 years) and their parents and program goals to increase young adolescent intentions to delay initiation sex until they are older and increase parent-child sexual health communication to delay sexual initiation. P-YAG recommendations for sexual health topics included puberty, sexual behavior, and STIs and skill building on parent-young adolescent communication, negotiation, and decision making [
In step 2, we described the behavioral outcomes, delineated these behaviors into their component parts (performance objectives), specified behavioral determinants, and developed change (learning) objectives (
Drawing from our needs assessment findings and our previous studies, we identified 15 outcome behaviors that were important for the current program (
Outcome behaviors for young adolescents, parent, and dyad with performance objectives for the dyadic (parent-young adolescent) communication outcome behavior.
Learner–domain | Outcome behavior | |
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Healthy peer and dating relationships | Youth will have healthy peer and dating relationships | |
Abstinence | Youth will not have sex | |
Condom use | Youth who are sexually active or considering having sex will use condoms correctly and consistently when having sex | |
Contraceptive use | Youth who are sexually active will use effective method of birth control along with condoms | |
HIV and STDb Testing | Youth who are sexually active will get tested and counseled for HIV and STD and unintended pregnancy | |
HPVc vaccination | Youth will complete the 3-dose HPV vaccination series | |
Parental monitoring | Youth will establish common rules with parents about supervision and monitoring | |
Youth to parent communication | Youth will communicate with their parents about dating, intimate or healthy relationships, and sexual behaviors | |
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Parental monitoring | Parents will monitor their youth’s adherence to personal rules | |
Parent to youth communication | Parents will communicate with their youth about dating, healthy intimate relationships, and sexual behaviors | |
Condom use | Parents will talk to their youth about condom use when having sex | |
Contraceptive use | Parents will talk to their youth about contraceptive methods | |
HIV and STD testing | Parents will talk to their youth about getting tested and counseled for HIV and STD and unintended pregnancy | |
HPV vaccination | Parents will talk to their youth about completing the 3-dose HPV vaccination series | |
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Dyadic communication | Parents and youth will interact in a mutually engaging and responsive communication process to achieve shared goals | |
Performance objectives for dyadic communication |
POd.1: Parent and youth will pick the right time and place (T&P) to talk. PO.2: Parent and youth will converse with respect. PO.3: Parent and youth will assess the youth’s motivation to engage in the behavior under discussion. PO.4: Parent and youth will assess alternative actions to the behavior under discussion and their benefits and consequences. PO.5: Parent will share their values and expectations regarding possible behaviors (the behavior under discussion and alternate actions). PO.6: Parent and youth will develop the best plan of action together. PO.7: Parent and youth will encourage each other to keep communicating openly. PO.8: Parent and youth will reflect on what to do the same or differently next time. |
aYouth refers to young adolescent (11-14 years).
bSTD: sexually transmitted disease.
cHPV: human papillomavirus.
dPO: performance objective.
We identified 143 performance objectives (sub-behaviors) that are necessary to complete the outcome behaviors.
Once the target behaviors were defined, we used theory and empirical applications of theory, including our literature review and previous studies to guide the identification of determinants that likely influence successful performance. Determinants that have been described as impacting sexual behavior in young adolescents include constructs derived from the Social Cognitive Theory, social influence models, and the theory of triadic influence [
We also attended to determinants of game play using motivational theory to optimize learner attention [
We defined the program learning objectives by creating separate matrices of performance objectives (row headings) and determinants (column headings) for each outcome behavior.
Parent matrix for the dyadic parent-youth communication outcome objective that parents and children will interact in a mutually engaging and responsive communication process to achieve shared goals.
POa | Determinants of behavior | ||||||
Knowledge | Skills | Self-efficacy | Outcome expectations | Perceived norm | Perceived barriers | Social support | |
PO.1 Parents and child will pick the right T&Pb to talk |
K1.1. State that the right T&P is one where both parent and child are focused and calm. K1.2. Describe the influence of emotions, preconceived thoughts, and distractions on communication. K1.3. State the importance of being aware of these influences and setting them aside before initiating communication. |
S1.1. Demonstrate the ability to pick the right time and place to converse. S1.2. Demonstrate the ability to set aside emotional or cognitive predispositions before conversing. |
SE1.1. Demonstrate the confidence to pick the right time and place to converse. SE1.2. Demonstrate the confidence in ability to set aside emotional or cognitive predispositions before conversing. |
OE1.1. State that picking the right T&P will lead to a more focused and calm discussion. OE1.2. State that reflecting on one’s emotions, preconceived thoughts, and distractions before communication will facilitate open and respectful communication. |
PN1.1 State that other parents and children have greatest communication success when they pick the right T&P. |
PB1.1. State ways to overcome barriers to selecting a right T&P to communicate (schedule or environment). PB1.2. Recognize barriers to being aware of and setting aside one’s emotions or cognitions before conversing. |
SS1.1. Identify others who can help in arranging a right T&P to converse. |
aPO: performance objective.
bT&P: time and place.
In step 3, we identified theoretical methods and practical applications to inform program design (
A theoretical method is a general technique that influences the determinants of behaviors. If a young adolescent theoretically requires the knowledge, skills, self-efficacy, positive outcome expectations, positive perceived norms, and engagement of social support to perform sexual risk reduction and communication behaviors, then an effective sexual health education program needs to elicit positive change in these determinants. We drew from empirical literature and our previous research on sexual health and web-based curricula [
Partial (example) matrix of methods and applicationsa.
Method (and theory) | Practical application | |
For youth | For parents | |
Information and consciousness raising | Communication activity describing PEPb steps and importance of respectful communication; SDPc activity teaching how to use this tool to protect personal rules; RRRd to manage emotions; and “What kind of friend are you” quiz and activity. | PEP Talks 101 and SDP tip sheets with communication tips and “Ask the Expert” advice on communicating about specific topics and information on planning ahead to protect rules; and parent/youth video testimonials illustrating benefits of talking. |
Goal setting (theories of self-regulation and Social Cognitive Theory) | Prompt to set personal rules before each PEP Talk and develop strategies with parent. | Personal rule to orient communication and expectation. |
Chunking (information processing) | PEP to teach steps of PEP Talk; RRR to manage emotions; and SDP tool to help youth maintain personal rules. | PEP to teach steps of healthy communication and SDP tool to help youth maintain personal rules. |
Verbal persuasion (Social Cognitive Theory) | SDP activity training and practice by presenting youth with pressure lines in various situations and asking youth to select appropriate response and RRR activity to manage emotions. | PEP Talk videos; parent and youth video testimonials illustrating how other parents talk to their children and describing how to talk about family values to set rules; Virtues tip sheet reviewing virtues and how to talk about them; and PEP Talk question prompts. |
Modeling (Social Cognitive Theory) | Parent and youth video testimonials on communication and discussing values. | Parent and youth video testimonials on communication and discussing values. |
Enactive mastery (Social Cognitive Theory) | Communication activity reviewing PEP steps and how to choose right time and place to talk; SDP activity training and practice by presenting youth with pressure lines in various situations and asking youth to select appropriate response; RRR activity to manage emotions; and prompt for youth to enter personal rules and strategies. Content progresses in terms of |
PEP Talk videos; Virtues tip sheet reviewing virtues and how to talk about them; and PEP Talk question prompts. |
Public commitment (transtheoretical model) | Discussing rules and strategies with parent during PEP Talk and then entering rules into game where they can be viewed by youth and parent throughout the game. | Rules and strategies inform social support |
aOutcome behavior: Parents and children will interact in a mutually engaging and responsive communication process to achieve shared goals. Performance objective #1: Parents and children will pick the right time and place to talk. Determinant and change objective: Skills (S1.1) and self-efficacy (SE1.1) to pick the right time and place to converse. Youth refers to young adolescent (ages 11-14 years).
bPEP: partner-engage-plan.
cSDP: select, detect, protect.
dRRR: relax, rewind, replay.
Given that we were designing a serious game, we also adopted methods to influence the determinants of young adolescent persistence in game play. To address learner challenge, we designed the game to include goals to accomplish and milestones to reach and provided game scenarios of moderate difficulty [
Practical applications refer to the mode and context of program delivery that fits with the priority population. These comprise channel, scope and sequence, and theme. We designed the program to operationalize the theory-based methods and to be responsive to needs assessment recommendations from the P-YAG [
We provided 2 underlying themes. The first theme was that young adolescents do not have to “go it alone,” that the parent is a social support, dyadic communication is important, and that the discomfort and lack of confidence to discuss sexual health topics (by both young adolescent and parents) can be overcome with skills to initiate and maintain the sexual health dialogue. The second underlying theme was that young adolescents have control of their life decisions and that smart life decisions (based on self-regulation by selecting, detecting, and protecting their personal rules) have positive consequences. The game motif was a quest to liberate the citizens of the town of Seven Stones from the control of an evil villain, Frostbyte. The young adolescent is victorious if they can defeat Frostbyte in a final
SSS comprised (1) an adventure game for young adolescent skills training delivered via a desktop computer, (2) a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their young adolescent, and (3) a website for parent skills training and progress monitoring (
The Secret of Seven Stones program scope and sequence of play and content domains (inset). PEP: partner-engage-plan; SSS: the Secret of Seven Stones.
We designed the SSS interactive adventure game to provide sexual health skills training primarily for young adolescents because, although dyads supported a gaming strategy, parent time constraints would not accommodate extensive parental gameplay. As such, we designed SSS to accommodate parents in an adjunct, supporting, and gatekeeper role. The game had 18 levels to accommodate the educational content. Each game level approximated 45 to 60 min of game play and contained multiple short duration (2-5 min) activities. The SSS game sequence required young adolescents to (1) visit a location in Seven Stones and encounter citizens who are facing a sexual health challenge (eg, a conflict between being true to yourself vs maintaining a friendship); (2) enter the
The Secret of Seven Stones (SSS) sample game and parent website screens and personified virtues. (a) Animated video introducing “Suma” and “Frollie” and the challenge scenario that requires resolution, (b) the “Dojo” (and Dojo master, Alfred) where the player receives skill training activities to prepare for “battle,” (c) card battle with wisdom, skill, and support cards to liberate Frollie, and (d) SSS parent website featuring parent resources (videos and tip sheets) to enable parent competency in partner-engage-plan talks, and an array (on right) of personification and imagery of virtues referred to in the game.
The program title, SSS, derives from (1) the town of Seven Stones, (2) the 7 supportive parental interactions during the quest, and (3) the 7 character virtues acquired at each of these dialogues (
The parent is updated on the young adolescents’ progress through text messages (
SSS provides increased challenge by sequencing content from topics with less
SSS was designed to respond to game preferences emanating from the focus groups. A general preference for boys was the quest to defeat Frostbyte in a boss battle, with girls to resolve interpersonal relationship conflicts among the citizens of Seven Stones, and both girls and boys to use card games for
We designed an SSS website (
In step 4, we produced and pilot tested an SSS prototype comprising the first 2 game levels (
We designed SSS for installation on desktop computers (both Windows and Mac) using the Adobe Interactive Runtime through a broadband connection. The back end mini Structured Query Language (MSQL) database and parent website were implemented using a web server running Hypertext Preprocessor (PHP) built on the Yii framework and accessible through standard browsers using a broadband connection. The back end database was designed to store game data allowing
We conducted a 2-week pilot test of feasibility in the homes of 10 dyads to determine functional integrity, acceptability by parents and young adolescents, and to explore psychosocial impact. This sample size is sufficient for usability testing and comprises young adolescents (aged 11-14 years; mean 13.1, SD 1.20 years, predominantly males (7/10, 70%), and of White (5/10, 50%) and Hispanic (3/10, 30%) ethnicity [
We collected parent and young adolescent self-report data using computer-assisted self-administered surveys on study laptops at baseline and at the 2-week follow-up. Our pilot study enabled the testing of protocols to be employed in subsequent efficacy testing. Parent consent and young adolescent assent were obtained before data collection. The feasibility process measures comprised system access logs and user reports (written and verbal) of program issues. Dyads rated SSS on likeability, ease of use, duration, understandability, credibility, perceived impact, and motivational appeal using previously described rating scales [
The SSS prototype functioned according to specifications with players completing the 2 levels within the 2-week period. Most young adolescents rated SSS as likable and credible (6/10, 60%-10/10, 100%) and helpful in making healthy choices (9/10, 90%;
Parents rated the website as likable, easy to navigate, credible, and understandable and the game as useful in helping young adolescents make healthy choices (6/10, 60%-10/10, 100%;
Young adolescent ratings for prototype levels 1 and 2.
Parent ratings for parent website and prototype levels 1 and 2.
Exploratory analysis demonstrated positive change in young adolescent attitudes toward using computer games for learning and parent communication outcome expectations (
Young adolescent change in dyadic communication following exposure to Secret of Seven Stones 2-level prototype
Scales | Young adolescent | Parent | ||||||||
Baseline | 2-week follow-up | P valuea | Baseline | 2-week follow-up | P valuea | |||||
n | Mean (SD) | n | Mean (SD) | n | Mean (SD) | n | Mean (SD) | |||
Attitudes to computer games for learning |
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N/Ac | N/A | N/A | N/A | N/A |
Communication about sex self-efficacy | 7 | 1.35 (1.09) | 9 | 1.67 (1.11) | .45 | 1d | 2.75 (0.00) | 7 | 2.57 (0.36) | .32 |
Communication about sex outcome expectation | 8 | 2.33 (0.61) | 9 | 2.48 (0.65) | .99 |
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Quality of communication about sex | 8 | 1.91 (0.37) | 7 | 2.01 (0.34) | .73 | 10 | 2.18 (0.25) | 9 | 2.28 (0.29) | .07 |
Communication ability | 10 | 3.80 (2.30) | 9 | 5.22 (1.09) | .14 | 10 | 4.90 (0.57) | 10 | 4.20 (1.40) | .15 |
Communication openness | 8 | 1.43 (0.57) | 8 | 1.41 (0.61) | .67 | 10 | 1.31 (0.21) | 8 | 1.28 (0.22) | .72 |
Parent-adolescent connectedness | 10 | 3.52 (0.57) | 9 | 3.64 (0.52) | .85 | 10 | 3.72 (0.33) | 10 | 3.70 (0.45) | .87 |
aWilcoxon signed-rank.
bItalics indicate significance at
cN/A: not applicable.
dRespondent data missed in web-based survey.
Prototype testing informed our completion of the full 18-level prototype. SSS had demonstrated feasibility and compared favorably to other sexual health education programs. However, design modifications were indicated for both the adventure game and parent website. Program
In step 5, we planned for SSS implementation and dissemination (
Parents and young adolescents in the feasibility pilot provided information on purchase interest, cost points, barriers, and facilitators for purchase and expected marketing channels. Most young adolescents (6/10, 60%) expressed interest in purchasing SSS if it was for sale. They cited potential barriers to purchase of cost (56%), uncertainty about SSS efficacy (2/9, 22%), and long play duration (2/9, 22%). Most parents (6/10, 60%) were willing to pay at least US $20 for SSS. They cited barriers to purchase of duration (5/10, 50%) and possible misalignment with their values (4/10, 40%), potential facilitators to purchase as testimony from other parents (5/9, 56%), and evidence of effectiveness (4/9, 44%). Parents (4/10, 40%) and young adolescents (5/9, 56%) expected to hear about SSS mainly through school.
Discussions with representatives from third-party distribution channels that promote family wellness (eg, WebMD, Aetna, Humana, and ActiveHealth) resulted in awareness of the SSS proof-of-concept and interest in ongoing discussion as the product matures out of prototype through efficacy testing. Additional market analysis will use the Strategyzer strategic management framework to further develop the business model [
In step 6, we planned to evaluate the SSS (
The SSS represents a novel application of an intergenerational serious game for sexual health education, adding to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking [
SSS is an intergenerational game to the degree that it provides both parents and young adolescents’ roles in the gaming experience and encourages dialogue to accelerate game play. Parents and young adolescents could sit together to play SSS, but currently the game does not allow parents and young adolescents to synchronously play or compete in the game space. Parental time constraints necessitated a gatekeeper role for parents rather than a dual-player mode. This is consistent with what Voida et al [
Success in serious game design is predicated on achieving a balance between strategies for behavior change and playability. This introduces a tension between ensuring sufficient educational content and optimal exposure for behavioral impact while providing an engaging and immersive experience. As a health education program, parents positively rated SSS, reporting it to be valuable and credible. The positive impact on attitudes toward the use of computer games for learning supports the utility of this strategy. The interest of young male adolescents (7/10, 70% of our feasibility sample) to play SSS, which is a population group that has traditionally been more difficult to recruit and retain in sexual health education programs, was also encouraging [
Young adolescents rated SSS as fun as other computer games (56% agreement) but, perhaps predictably, none rated SSS as much fun as their favorite computer game. SSS exhibited common gaming features such as the quest motif, characters and bosses, virtues, power-ups, battles, and points. However, there were dissimilarities relating to the educational content, including power-up dojo activities, quizzes, parent updates, PEP talks, and skills training around life skills issues. Furthermore, SSS could not compete with the production value of high-end commercial games that feature richly textured graphics, epic musical scores, massive scope, greater user control, and sophisticated three-dimensional game mechanics. SSS, similar to other serious games for health, may best be marketed as a palatable way to consume health information and training rather than as a direct competitor to commercially available entertainment games. Health-oriented games occupy a commercial niche that offers social value and has the potential to operate in community settings with an aligned mission (eg, schools, work places, clinics). In the context of the home, where there is an array of competing demands, the use of serious games may be more tenuous and contingent on parent and child commitment.
IM is one of a number of useful development frameworks [
The findings need to be interpreted in light of study limitations. The pilot study was formative in nature. A small sample size (n=10 dyads), abbreviated intervention dose (2 levels over 2 weeks), and the use of self-selected sampling, although appropriate in this setting for feasibility assessment, were insufficient to assess the efficacy of the game and impact on psychosocial and dyadic communication outcomes. The sample was inherently biased, attracting parents predisposed to improving communication with their children, and predominantly of mothers, which may have affected the parental content and resources (and hence appeal and relatability) of SSS. Our development was not powered to provide a meaningful comparison of mother and father perceptions of SSS. Mothers and fathers provided similar responses regarding the usability and feasibility of SSS (eg, that SSS was useful in helping young adolescents make healthy choices and that most parents would tell their friends about SSS). Further investigation of varied parental perspectives would be useful. It is possible that the male (father) perspective was underrepresented in the SSS development process. Postponing commencement of the field testing in favor of more extensive alpha testing may have mitigated some program
Important empirical questions remain regarding SSS. SSS allows families to choose the
SSS provides a feasible strategy to overcome parent and young adolescents discomfort about discussing sexual health topics and enhancing the skills required to initiate and maintain this dialogue. IM is a useful framework for developing a theoretically and empirically based intergenerational, sexual health computer game (SSS) for in-home use. Further testing to assess the efficacy of the complete SSS program on parent-young adolescent communication is indicated.
human papillomavirus
intervention mapping
lesbian, gay, bisexual, transgender, queer, and intersex
National Institutes of Health
partner-engage-plan
predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation
Parent-Youth Advisory Group
Secret of Seven Stones
sexually transmitted infection
Small Business Technology Transfer Research
This work was conducted through a collaborative between UTHealth and Radiant Creative LLC and was supported by grant 1R42HD074324-01 from the National Institute of Child Health and Human Development, NIH.
None declared.