Construction and validation of a serious game about human papillomavirus infection

Maciel, Maylla Pereira Rodrigues; Costa, Lílian Maria Almeida; Sousa, Kayo Henrique Jardel Feitosa; Oliveira, Adélia Dalva da Silva; Amorim, Fernanda Cláudia Miranda; Moura, Luana Kelle Batista; Zeitoune, Regina Célia Gollner; Almeida, Camila Aparecida Pinheiro Landim

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Acta Paulista de Enfermagem

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Artigo Original • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AO03012 copy

Construction and validation of a serious game about human papillomavirus infection

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To describe the process of construction and validation of a serious game for the prevention of infection caused by human papillomavirus.

Methods

This is a methodological study that followed the steps: conceptualization, pre-production, prototyping, production and expert assessment. For conceptualization and pre-production, an integrative review was developed, which generated demands for knowledge, categorized and used in the prototype production. In an expert assessment, 13 participated for content analysis and seven for design, who answered different instruments. Data were analyzed for the score of Suitability Assessment of Materials and Content Validity Index.

Results

A serious game was developed based on gaps in population’s knowledge identified in the literature, called electronic roulette. Content experts considered that the technology developed has potential for health education and prevention of forms of illness caused by the human papillomavirus. For assessing appearance, design experts found the understandability and quality of the interface satisfactory.

Conclusion

Electronic roulette presented satisfactory evidence of content validity. The recommendations of the experts improved the content and appearance, enabling the mediation of educational activities.

Play and playthings; Papillomaviridae; Disease prevention; Sexually transmitted diseases; Health education; Validation study

Code	Category	Main results
A1, A2, A4, A5, A6, A7, A8, A10, A12, A14	Meaning of HPV	In six studies, it was observed that more than 50% of the interviewees reported not having heard about HPV. And more than 70% of the individuals who reported knowing the infection had poor knowledge about it. Still in this reasoning, two studies showed that just under 30% of individuals had never heard of HPV. Only one article reported good knowledge about the meaning of the virus, where 91.7% said they had heard of it and know what the virus means.
A1, A2, A5, A7	Transmission	In studies that presented the transmission category, it was evidenced that people reported knowing HPV, but more than 60% did not know how to identify the ways in which the virus is transmitted. Women knew more than men about the sexual transmission of the pathogen.
A2, A3, A4, A6, A7, A8, A9, A12, A13.	Prevention	A study revealed that 57% of medical students knew more than two preventive methods and 43% knew only one or no preventive methods. The general population pointed out that they had insufficient knowledge of prevention methods. Still, between female s and males, the population did not know who should receive the HPV vaccine. 90% of women who have sex with women do not use condoms in their sexual experiences. 10% of the interviewees reported that they would not allow their daughters to take the vaccine, because they believed that this would induce the anticipation of the beginning of sexual life. 80% reported having heard about the Pap smear, 40% reported never having done it, 10% reported that they never did it for fear of hurting and not knowing its importance.
A1, A5, A6, A12	Signs and symptoms	In one study, more than 60% of participants could not identify symptoms of HPV infection. Less than 15.5% indicated HPV as a cause of genital warts. Less than 10% indicated that HPV can cause cervical cancer.
A3, A8, A10, A11, A12	Where to find the vaccine	Almost 14% cited the lack of knowledge of the national vaccination campaign. More than 30% had never heard of the vaccine and did not know where to find it and almost 20% were already vaccinated against HPV. A study reported a rate of 20% of respondents who reported that the vaccine is in the testing phase and that it only exists in the private network and that, therefore, its cost is high.
A8, A9, A12	Who can receive the vaccine	Most female and male students did not know who should receive the HPV vaccine and when to be vaccinated. Many felt that these vaccines should be received by people who have already had sex.
A1, A12, A6	Relationship with cancer	The women demonstrated that they had more knowledge about HPV as a cause of genital warts and its relationship with uterine cancer. Women were more concerned than men about HPV-associated penile cancer in the future. 10% of the interviewees pointed to HPV as the cause of cervical cancer.

Criterion	E1	E2	E3	E4	E5	E6	E7	E8	E9	E10	E11	E12	E13
Content
Objective is evident facilitating a prompt understanding of the material	2	2	2	2	2	0	2	2	2	2	2	2	0
The content addresses pertinent information related to the prevention of human papillomavirus infection	2	2	2	2	2	2	2	2	2	2	2	1	1
Electronic roulette’s proposal is limited to the objectives so that the public can understand	2	1	2	2	2	1	2	2	2	2	2	2	0
Language
Reading level is adequate for readers’ understanding	2	2	1	2	2	2	2	2	2	2	2	2	2
Conversation style makes it easy to understand sentences	1	2	1	2	2	2	2	2	2	2	0	2	1
Information is passed on within a clear context	2	1	1	2	2	1	2	2	2	2	1	2	1
Vocabulary uses common words	2	2	1	2	2	1	2	2	2	2	2	2	2
Understanding is facilitated by topics	2	2	2	2	2	2	2	2	2	2	1	2	1
Presentation
Material organization is adequate	1	2	2	2	2	2	1	2	2	2	2	2	1
Font size and type promote a nice read	2	2	2	2	2	2	1	2	1	2	2	2	2
Stimulation/motivation
There is interaction with readers, enabling them to make reflections	2	2	2	2	2	2	0	1	1	2	1	2	0
Prevention methods are well demonstrated	1	2	1	2	2	2	1	2	2	2	1	2	2
There is motivation to identify prevention methods and attitudes to be taken	2	2	1	2	2	1	1	2	1	2	1	2	2
Cultural adaptation
Material is culturally suited to the target audience’s logic, language and experience	2	2	1	2	1	0	2	2	2	2	1	2	2
It presents texts that are easy to understand and culturally appropriate	1	2	1	2	1	1	2	1	2	2	1	2	2
Summation (∑)	26	28	22	30	28	21	24	28	27	30	21	29	19
SAM score* (%)	86,7	93,3	73,3	100	93,3	70	80	93,3	90	100	70	96,6	63,3

ID	Recommendations and Comments	Decision
C01	The item: “What are the ways to transmit HPV?” (“Quais as formas de transmitir o HPV?”) was confusing. I think it is better to say that the route of transmission is through oral, anal and vaginal sex and childbirth. I suggest you put pictures of condoms. Put the pronoun you, making a call to readers to identify with the target audience. For example, in item 3, “You can purchase the condom and vaccine for free at a health center” (“Você pode adquirir a camisinha e vacina gratuitamente no posto de saúde”).	All suggestions have been accepted.
C03	In item 2, I suggest the substitution of “HPV can occur even in the absence of vaginal or anal penetration” (“o HPV pode ocorrer mesmo na ausência de penetração vaginal ou anal”) by “HPV is caught even without contact with the vagina or anus” (“Se pega HPV mesmo sem contato com a vagina ou ânus”). When talking transmission, I also suggest the exchange for “is caught” (“se pega”), because if the roulette is used with a simpler audience the term transmission becomes very technical.	All suggestions have been accepted.
C06	I suggest that at the beginning of roulette, there may be a definition of the goal that it has, as a small introduction to the game and review the agreement, question 4, it is not clear that most do not present symptoms. In question 7, put “which” (“a quais”).	All suggestions have been accepted.
C07	I suggest having a moment or a tab that brings explanations about the rules of this virtual game. I felt the need to score each correct and/or wrong question, or provide some bonus on each number present in roulette for the player.	All suggestions have been accepted.
C09	The dark color of the background can cause disinterest.	The color was kept.
C10	I suggest that in question 6, in the Result, where there are boys from 9 to 16 and girls from 9 to 45 years, insert male and female.	Suggestion have been accepted.
C11	In item 1, how were the response possibilities chosen? I believe that the only alternative that could generate “doubt” (and therefore curiosity) in users is “Hepatitis” since the alternatives have no common point with the acronym HPV. In item 2, why is the word “air” (“ar”) in capital? Still, why do some items appear with the “none of the alternatives” (“nenhuma das alternativas”) option and others don’t? On any item would that be the correct answer?	All suggestions have been accepted.
C13	A roulette presentation card in which the participant is invited and instigated to play and know the objective of the game was missing. In my view, there were no topics that could address relevant issues.	All suggestions have been accepted.
D3	Put a brighter color at the bottom of the roulette. Add initial guidance on how to proceed in the game. Put the alternatives in a larger font.	The color was kept. Other suggestions have been accepted.
D4	Put the answer next to the question.	Suggestion have been accepted.
D7	Introduce introductory part explaining how it works and what it is for (the game). Draw up scoring scheme to make it more attractive.	All suggestions have been accepted.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
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[1] Corresponding author. Kayo Henrique Jardel Feitosa Sousa. E-mail: kayohenriquejardel@hotmail.com