Tackling Sensitive Issues using a game-based environment: Serious Game for relationships and sex education (RSE) Katherine Browna, Sylvester Arnabb, Julie Bayleya, Katie Newbya, Puja Joshia, Becky Judda, Alison Baxtera, & Samatha Clarkeb a Applied Research Centre for Health & Lifestyle Intervention, Coventry University b Serious Games Institute, Coventry University Abstract. Experience of sexual coercion during adolescence can lead to a range of adverse psychological and physical health outcomes. Working to eliminate coercive sexual experiences for young people is therefore important for enhancing wellbeing in this population. Delivering good quality relationships and sex education (RSE) can help to achieve this aim. Engaging young people on sensitive subjects such as this can be challenging and using Serious Gaming technology may help educators and young people to overcome this. This paper describes the use of Intervention mapping (IM) in the development of a serious game on the topic of sexual coercion for RSE. IM is an iterative process that draws on stakeholder engagement and the theory and evidence base for what works, to support health improvement intervention planning. Serious game developers took the game concept plan and transformed it into an interactive game show, led by a teacher or facilitator to engage students in game play and discussion around the issue of sexual coercion. The final product known as PR:EPARe (Positive Relationships: Eliminating Coercion and Pressure in Adolescent Relationships) is currently the subject of a cluster Randomised Controlled Trial (RCT) in local schools which will assess whether change objectives relating to psychological preparedness to deal with sexual coercion has improved compared with controls. This works represents the first attempt to use IM in the development of a Serious Game and the use of Serious Gaming for RSE delivery. Stakeholders are supporting plans for sustainability of the product once RCT results are established. Keywords. Serious game; Relationships & Sex Education; Sexual coercion; Intervention Mapping; adolescents. 1. Introduction Experience of sexual coercion during adolescence can lead to a range of adverse psychological and physical health outcomes. There is a strong link between incidence of sexual coercion in young people and increased sexual risk-taking, rates of sexually transmitted infections (STIs) and unwanted or unintended pregnancy. Working to reduce and eliminate coercive sexual experiences amongst adolescents and young people is therefore an important component of approaches needed to enhance sexual health and wellbeing in this population. Delivering good quality relationships and sex education (RSE) in schools and other educational settings, can help to achieve this aim. Within the UK there is growing determination that RSE ought to not only provide young people with knowledge about reproduction, contraception and prevention of STI transmission, but also tackle issues related to the nature of sexuality and relationships. It should encourage the acquisition of skills and attitudes which allow pupils to manage their relationships in a responsible and healthy manner. In addition, one of the challenges of delivering RSE is to do so in a way that both engages the young people involved and draws on the evidence-base about what will work to ensure positive outcomes. With this perspective, we aimed to capitalise on the ability of games technologies to engage target audiences who may already use interactive technology recreationally; conveying instructional outcomes to audiences who may sometimes be more resistant to formal teaching methods. We aimed to assess whether an interactive Serious Game could have a positive influence on outcomes for RSE and to draw on the theory and evidence-base for supporting learning and behavioral change in the development process. 2. Methods An Intervention Mapping approach (Bartholomew et al., 2011) was applied to the development and design of the Serious Game. Needs assessment was conducted with a range of stakeholders which included input from young people (n=25), sexual health service (n=4) and local authority commissioners (n=5), and those involved in sexual health education (n=6). Over the course of several meetings, stakeholders identified experience of pressure/coercion in sexual relationships as a priority topic for RSE. They identified Year 9 students (aged 13-14 years) as the priority target group for RSE on this topic. An ongoing and iterative process of further stakeholder engagement, and systematic literature review led to the development of a series of change objectives (e.g. Young people will be able to recognize different types and levels of coercion; young people will develop an expectation that there will be negative consequences of allowing coercion to continue) for the serious game and evidencebased techniques that would directly address the change objectives were scoped out and applied in the concept design. Throughout the process stakeholders were updated on progress and asked to feedback and provide input and ideas. Once the concept was fully conceived it was passed to the Serious Game developers for translation into an interactive game. A script to apply to the game was developed and young people from the local stakeholder groups auditioned to provide game audio for characters’ voices. User engagement and usability within a classroom context were major priorities for the development build. A combination of highly stylized 3D and 2D graphics and characters with audio based interaction have been used to create a dynamic game to build and maintain motivation to play. Conceptually, the user is placed within a high fidelity game show environment, providing an entertaining platform in which the subject matter is addressed. Adopting this mechanic, PRE:PARe avoids type heavy interfaces which can gradually decrease attention in users. Allowances for group discussions as are also integrated within the game mechanics through use of a pause button. A timer supports pace-setting and a menu function puts control in the hands of the educational facilitator in selecting the most appropriate content for their students. A scoring system mechanic supports the provision of feedback to game players and helps to build a sense of purpose and achievement. By applying these specific games mechanics, PRE:PARe provides a virtual educational platform that attempts to maximise usability and engagement for both user and educationalist. 3. Results The final product is known as PR:EPARe (Positive Relationships: Eliminating Pressure and coercion in Adolescent Relationships). PR:EPARe is currently the subject of a cluster randomised controlled trial (RCT) in RSE lessons across 3 secondary schools in Warwickshire. It is predicted that young people in the intervention condition will demonstrate greater psychological preparedness, in-line with our identified change objectives, for recognising and responding to sexual coercion, compared with controls. Data collection will be completed during March 2012 and results will be available from April 2012 and included in subsequent dissemination. 4. Conclusions This work represents the first application of an Intervention Mapping approach to the development of a Serious Game. The process brings together the expertise of a range of stakeholders and partners to produce a unique and innovative tool for improving wellbeing in young people. Provided RCT results demonstrate a positive effect, the PR:EPARe serious game will become part of RSE provision in extended learning centres and schools in Coventry and Warwickshire from September 2012. The PR:EPARe project team are working to ensure the game has a sustainable impact on local RSE delivery. We are working on early commercialization plans that may help to further improve and develop the game and develop further resources to address wider RSE relevant issues. 5. References Bartholomew, L.K., Parcel, G.S., Kok, G. et al (2011). Planning Health Promotion Programs: An Intervention Mapping approach. 3 rd edition. Jossey-Bass: San Francisco.