Designing Group Based Health Promotion Sessions to Reduce Health Disparities: Lessons from Game Development

Introduction: Game development uses an iterative development approach in which engagement of the target audience is repeatedly assessed and used to guide further development and refinement. This approach was used to create a highly engaging peer resistance skill building intervention classroom session component for the Mighty Girls intervention. This early intervention program targets 7^thgrade Hispanic girls to reduce disparities resulting from risky sexual behavior.

Methods: Session development began with parent focus groups to elicit parent support and tailor intervention classroom sessions in response to their concerns. Content and activities were developed by: (1) adapting keepin’ it REAL program content for the Refuse and Avoid resistance skills, and a Planned Parenthood activity (rating the risk); and (2) consultation with 2 middle school educators, 2 female Hispanic high school students, a feminist, a Planned Parenthood staff sex educator, and a Hispanic parent of a middle school girl. All messages and activities were designed for concrete operations thinking because middle school girls lack fully developed formal operations thinking.

The first version (5 sessions) was evaluated as part of an intervention feasibility trial (n=41). After the trial, the sessions were revised in response to feedback from facilitators who delivered the sessions, and consultation with a behavior change curriculum expert who recommended increasing consistency between classroom session and the skill building game components with respect to messaging and graphic images.

The second version (5 sessions) was evaluated during a week long summer camp (n=13) using highly interactive methods (e.g., writing on board; skits), some of which were later adapted into a new final (6^th) classroom session. Aspects of activities needing refinement were identified and addressed by consulting with a Hispanic middle school girl who had participated in the camp.

The third version (6 sessions) is now being tested as part of a GRT efficacy trial. Eight schools are currently enrolled [4 intervention (n=116), 4 control (n=84)] with classroom sessions taught to 1-2 groups of girls at each intervention school. All classroom sessions are videotaped and coded for engagement as well as other aspects of implementation quality.

Results: Qualitative (facilitator observations; video analysis) and quantitative data (resistance intentions and behavior) support the engaging nature of the classroom sessions and argue for impact.

Conclusions: Findings illustrate how classroom curricula can be developed and refined through an iterative process typically used for game development, and by using a combination of both standard and innovative methods.