Development of an HIV Prevention Videogame: Lessons Learned


  • Kimberly Hieftje Yale School of Medicine
  • Lynn E. Fiellin Yale School of Medicine and Yale Child Study Center
  • Tyra Pendergrass Yale School of Medicine
  • Lindsay R Duncan McGill University



videogame, intervention, HIV prevention


The use of videogames interventions is becoming an increasingly popular and effective strategy in disease prevention and health promotion; however, few health videogame interventions have been scientifically rigorously evaluated for their efficacy. Moreover, few examples of the formative process used to develop and evaluate evidence-based health videogame interventions exist in the scientific literature. The following paper provides valuable insight into the lessons learned during the process of developing the risk reduction and HIV prevention videogame intervention for young adolescents, PlayForward: Elm City Stories. 

Author Biographies

Kimberly Hieftje, Yale School of Medicine

Kimberly Hieftje, PhD, is an Associate Research Scientist at the Yale School of Medicine. She is also the Deputy Director of the play2PREVENT Lab and Deputy Director of the Yale Center for Health & Learning Games.

Lynn E. Fiellin, Yale School of Medicine and Yale Child Study Center

Lynn Fiellin, MD, is an Associate Professor at the Yale School of Medicine and the Yale Child Study Center.  She is the founder and Director of the play2PREVENT Lab and the Director of the Yale Center for Health & Learning Games.

Tyra Pendergrass, Yale School of Medicine

Tyra Pendergrass, MEM, is an Associate Director of the play2PREVENT Lab and a member of the Yale Center for Health & Learning Games.


[1] Hieftje KD, Edelman EJ, Camenga DR, Fiellin LE. Electronic Media-Based Health Interventions for Behavior Change in Youth: A Systematic Review. JAMA pediatrics. 2013;167:574-580.
[2] Bainbridge WS. The scientific research potential of virtual worlds. Science (New York, N.Y.). 2007;317:472-476.
[3] Fiellin LE, Hieftje KD, Duncan LR. Videogames, here for good. Pediatrics. 2014;134:849-851.
[4] Brown SJ, Lieberman DA, Germeny BA, Fan YC, Wilson DM, Pasta DJ. Educational video game for juvenile diabetes: results of a controlled trial. Medical informatics = Medecine et informatique. 1997; 22:77-89.
[5] Horan PP, Yarborough MC, Besigel G, Carlson DR. Computer-assisted self-control of diabetes by adolescents. The Diabetes educator. 1990;16:205-211.
[6] Krishna S, Francisco B, Balas E, Konig P, Graff G, Madsen R. Internet-enabled interactive multimedia asthma education program: a randomized trial. Pediatrics. 2003;111:501-510.
[7] Lieberman DA. Management of chronic pediatric diseases with interactive health games: theory and research findings. The Journal of ambulatory care management. 2001;24:26-38.
[8] Davis MA, Quittner AL, Stack CM, Yang MC. Controlled evaluation of the STARBRIGHT CD-ROM program for children and adolescents with Cystic Fibrosis. Journal of pediatric psychology. 2004;29:259-267.
[9] Merry S, Stasiak K, Shepherd M, Frampton C, Fleming T, Lucassen M. The effectiveness of SPARX: a computerised self-help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. British Medical Journal. 2012;344.
[10] Kato PM, Cole SW, Bradlyn AS, Pollock BH. A video game improves behavioral outcomes in adolescents and young adults with cancer: a randomized trial. Pediatrics. 2008;122:e305-317.
[11] Peng W. Design and evaluation of a computer game to promote a healthy diet for young adults. Health communication. 2009;24:115-127.
[12] Primack BA, Carroll MV, McNamara M, et al. Role of video games in improving health-related outcomes: a systematic review. American journal of preventive medicine. 2012;42:630-638.
[13] Duncan LR, Hieftje KD, Culyba S, Fiellin LE. Game playbooks: tools to guide multidisciplinary teams in developing videogame-based behavior change interventions. Translational behavioral medicine. 2014;4:108-116.
[14] Fiellin LE, Kyriakides TC, Hieftje KD, et al. The design and implementation of a randomized controlled trial of a risk reduction and human immunodeficiency virus prevention videogame intervention in minority adolescents: PlayForward: Elm City Stories. Clinical trials (London, England). 2016.
[15] Montanaro E, Fiellin LE, Fakhouri T, Kyriakides TC, Duncan LR. Using Videogame Apps to Assess Gains in Adolescents' Substance Use Knowledge: New Opportunities for Evaluating Intervention Exposure and Content Mastery. Journal of medical Internet research. 2015;17:e245.
[16] Camenga DR, Hieftje KD, Fiellin LE, Edelman EJ, Rosenthal MS, Duncan LR. The use of message framing to promote sexual risk reduction in young adolescents: a pilot exploratory study. Health education research. 2014;29:360-366.
[17] Hieftje K, Duncan LR, Fiellin LE. Novel methods to collect meaningful data from adolescents for the development of health interventions. Health promotion practice. 2014;15:714-722.
[18] Hieftje K, Rosenthal MS, Camenga DR, Edelman EJ, Fiellin LE. A qualitative study to inform the development of a video game for adolescent HIV prevention. Games for health journal. 2012;1:294-298.
[19] Drew SE, Duncan RE, Sawyer SM. Visual storytelling: a beneficial but challenging method for health research with young people. Qualitative health research. 2010;20:1677-1688.
[20] Mulrow C. Rationale for systematic reviews. London: BMJ; 1995.
[21] Tortolero SR, Markham CM, Peskin MF, et al. It's Your Game: Keep It Real: delaying sexual behavior with an effective middle school program. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2010;46:169-179.
[22] Downs JS, Murray PJ, Bruine de Bruin W, Penrose J, Palmgren C, Fischhoff B. Interactive video behavioral intervention to reduce adolescent females' STD risk: a randomized controlled trial. Social science & medicine (1982). 2004;59:1561-1572.
[23] Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annual review of public health. 2010;31:399-418.
[24] Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. AIDS and behavior. 2008;12:335-353.
[25] Jemmott L, Jemmott J, McCaffrey K. Making a Difference!: An Abstinence Approach to HIV/STD and Teen Pregnancy Prevention. New York: Select Media; 2002.
[26] Fiellin LE, Hieftje KD, Fakhouri T, Duncan LR, Kyriakides TC. A videogame increases HIV risk-related knowledge in adolescents. AIDS 2014: 20th International AIDS Conference. Melbourne, Australia2014.
[27] Fiellin LE, Hieftje KD, Fakhouri T, Duncan LR, Sawyer BG, Fiellin DA. PlayForward: A videogame that increases drug, alcohol and sexual risk knowledge in teens. Drug and Alcohol Dependence. 2015:e277-e278.




How to Cite

Hieftje, K., Fiellin, L. E., Pendergrass, T., & Duncan, L. R. (2016). Development of an HIV Prevention Videogame: Lessons Learned. International Journal of Serious Games, 3(2).