An iterative process for developing digital gamified sexual health education for adolescent students in low-tech settings
Authors: Haruna Hussein , Zainuddin Zamzami , Mellecker Robin R. , Chu Samuel K.W. , Hu Xiao 
Published: November 2019

Purpose
Digital technology has great potential for educating today’s digitally oriented adolescents on health. In particular, digital health gamified learning can make the promotion of the sexual well-being of adolescents more effective. Although venereal diseases such as HIV/AIDS have become a greater problem in Sub-Saharan African (SSA) countries than in any country outside of Africa, little is publicly known about the development of gamified learning for use in counter-measures. This paper aims to address that deficit by presenting the process of developing one such game. The paper highlights how the “My Future Begins Today” game for sexual health education was developed, evaluated and refined in the real-world of low-tech settings and made improvements based on the response of users.

Design/methodology/approach
Design-based research (DBR) was used to guide the design, develop, test and refine the digital game in iterative cycles. The evaluation of the effectiveness of iterations of the game was done using adolescent sexual health literacy tests and the validated Motivation, Attitude, Knowledge and Engagement framework, the authors developed based on existing approaches. That framework combines the elements of motivation, attitude, knowledge and engagement, effectiveness was evaluated based on the game’s ability to motivate students, improve their attitudes, increase their acquisition of knowledge and engage them in learning self-rating surveys and interviews. The whole process of game design, testing, evaluation and refinement were underpinned by the activity theory, DBR and participatory design (PD) research.

Findings
Participants in the gamified learning platforms demonstrated higher average scores on their post-tests than their counterparts subjected to the traditional teaching classroom. Also, gamified learning groups commented positively on the effectiveness of their instructional approach than their counterparts in the traditional learning group. The stakeholders’ involvement in developing gamified learning provided a good understanding of the importance of the game to the adolescent students and how it was going to be used to address the problem identified. The application of PD contributed to the effectiveness of the game. It involved various actors from various fields who were relevant to the game. Also, engaging targeted users from the beginning resulted in the creation of a better correspondence with the preferences of end-users.

Practical implications
This study has contributed to a better understanding of sex education and knowledge in the area of adolescent reproductive health issues, using developed innovative game mechanics features and its applicability in low-tech settings.

Originality/value
The study will be a recommendation for future researchers in applying this gamified learning concept and its suitability in their teaching practice, particularly regarding sexual health education and adolescent reproductive health issues in low-tech settings of SSA.