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. 2020 Aug;67(2S):S34-S44.
doi: 10.1016/j.jadohealth.2020.04.022.

Fostering Engagement in Health Behavior Change: Iterative Development of an Interactive Narrative Environment to Enhance Adolescent Preventive Health Services

Elizabeth M Ozer  1 , Jonathan Rowe  2 , Kathleen P Tebb  3 , Mark Berna  3 , Carlos Penilla  3 , Alison Giovanelli  3 , Carolyn Jasik  3 , James C Lester  2
Affiliations

Fostering Engagement in Health Behavior Change: Iterative Development of an Interactive Narrative Environment to Enhance Adolescent Preventive Health Services

Elizabeth M Ozer et al. J Adolesc Health. 2020 Aug.

Abstract

Purpose: Accidents and unintentional injuries account for the greatest number of adolescent deaths, often involving use of alcohol and other substances. This article describes the iterative design and development of Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE), a narrative-centered behavior change environment for adolescents focused on reducing alcohol use. INSPIRE is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded intervention for health behavior change by leveraging 3D game engine and interactive narrative technologies.

Methods: Adolescents were engaged in all aspects of the iterative, multiyear development process of INSPIRE through over 20 focus groups and iterative pilot testing involving more than 145 adolescents. Qualitative findings from focus groups are reported, as well as quantitative findings from small-scale pilot sessions investigating adolescent engagement with a prototype version of INSPIRE using a combination of questionnaire and interaction trace log data.

Results: Adolescents reported that they found INSPIRE to be engaging, believable, and relevant to their lives. The majority of participants indicated that the narrative's protagonist character was like them (84%) and that the narrative featured virtual characters that they could relate to (79%). In the interactive narrative, the goals most frequently chosen by adolescents were "stay in control" (60%) and "do not get in trouble" (55%).

Conclusions: With a strong theoretical framework (social-cognitive behavior change theory) and technology advances (narrative-centered learning environments), the field is well positioned to design health behavior change systems that can realize significant impacts on behavior change for adolescent preventive health.

Keywords: Adolescent risk behavior; Alcohol use; Games for health; Health behavior change; Health information technology; Interactive narrative technologies; Narrative-centered behavior change environments; Prevention; Self-efficacy; Social-cognitive theory.

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
INSPIRE Iterative Development Model.
Figure 2.
Figure 2.
Screenshots from the INSPIRE narrative-centered behavior change environment.
Figure 3.
Figure 3.
INSPIRE branching narrative structure examples.
Figure 4.
Figure 4.
INSPIRE goal setting and monitoring features.
Figure 5.
Figure 5.
INSPIRE virtual object and accompanying infographic about the effect of alcohol on the brain.
Figure 6.
Figure 6.
Percent frequency of goals selected by INSPIRE focus group participants (N = 19).
See this image and copyright information in PMC

References

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