Designing A Health-Game Intervention Supporting Health Literacy And A Tobacco-Free Life In Early Adolescence

Objective: The purpose of this study was to explore the design of a health game that aims to both support tobacco-related health literacy and a tobacco-free life in early adolescence and to meet adolescents' expectations. Materials and Methods: Data were collected from adolescents using an open-ended questionnaire (n=83) and focus groups (n=39) to obtain their view of a health game used for tobacco-related health education. The data were analyzed using thematic analysis. A group of experts combined the adolescents' views with theoretical information on health literacy and designed and produced the first version of the game. Adolescents (session 1, n=16; session 3, n=10; and session 4, n=44) and health promotion professionals (session 2, n=3) participated in testing the game. Feedback from testing sessions 3 and 4 was analyzed using descriptive statistics. Results: Adolescents pointed out that the health game needs to approach the topic of tobacco delicately and focus on the adolescents' perspective and on the positive sides of a tobacco-free life rather than only on the negative consequences of tobacco. The adolescents expected the game to be of high quality, stimulating, and intellectually challenging and to offer possibilities for individualization. Elements from the adolescents' view and theoretical modelling were embedded into the design of a game called Fume. Feedback on the game was promising, but some points were highlighted for further development. Conclusion: Investing especially in high-quality design features, such as graphics and versatile content, using humoristic or otherwise stimulating elements, and maintaining sufficiently challenging gameplay would promote the acceptability of theory-based health games among adolescents.