Juega conmigo: Developing a mobile phone game app to reduce high-risk sexual behavior in Spanish-speaking teens
Awarded 2017
Complex Family Planning Fellowship Research
Meredith Pensak, MD
Yale University

Adolescents are prone to high-risk sexual behavior which exposes individuals to sexually transmitted infections (STIs) and unintended pregnancy. Health disparities account for marked variations in STI and unintended pregnancy rates amongst different adolescent subgroups. Latinx adolescents have pregnancy rates that are two times higher and STI rates that are five to eight times higher than for non-Hispanic, white adolescents. Novel approaches are needed to reach Spanish-speaking Latinx adolescents, who represent the fastest growing group of US immigrants.
This project aimed to meet the needs of Spanish-speaking Latinx adolescents through expanding and tailoring an existing English-language videogame intervention to decrease high-risk sexual behavior to include culturally relevant and responsive content in partnership with Spanish-speaking Latinx adolescents.
We performed a mixed methods pilot study. In the formative phase, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback which was incorporated into an expanded and tailored Spanish-language videogame. In the testing phase, we pilot tested this new videogame among Spanish-speaking Latinx adolescents ages 15 to 17 in a pre/post design. Data on feasibility and preliminary efficacy was collected at enrollment, 6 weeks, and 3 months after videogame exposure.
Fifteen Spanish-speaking Latinx adolescents completed focus groups, and suggested adding more animation and condensing text. In pilot testing we recruited and enrolled 24 Spanish-speaking adolescents, 15 to 17 years of age, 50% female, to test the Spanish-language videogame. All participants were born outside the US and most (58%) lived in the US for 5 to 10 years. Participants played the videogame for an average of 4.2 hours over a 6-week period during monitored sessions. Pilot testing demonstrated feasibility, including producing a usable Spanish-language videogame, and participants’ acceptability of the videogame: 65% enjoyed playing, would play it again, and would recommend it to friends. Mean summary scores for intentions, self-efficacy, risk perceptions, and knowledge did not significantly differ between baseline and follow-up. Condom-specific knowledge scores did significantly increase between baseline and follow-up (p-value 0.007).
We used iterative intervention design in partnership with our target audience to develop and pilot-test an innovative and usable Spanish-language videogame to decrease high risk sexual behavior in adolescents. We demonstrated feasibility, the videogame was well received, there was overall improvement in knowledge scores with a significant increase in condom-specific knowledge. Most importantly, we gained essential information and feedback for further intervention development. Next steps include incorporating participants’ suggestions to improve the videogame and testing among a larger cohort.