Recipient Organization
The Julia Group
2111 7th St Number 8
Santa Monica,CA 90405
Performing Department
(N/A)
Non Technical Summary
Methamphetamine use is a scourge of rural communities - and the problem is getting worse. The combination of declining local economies, secluded sites for concealing illegal activities and use of chemicals common in farming result in disproportionately more meth labs located in rural than in urban communities. Not only is meth use greater in rural communities, but barriers to effective treatment and prevention are greater as well. Two barriers exist to reaching youth in rural communities: geographic barriers impede frequent contact between youth and service providers and it is difficult to maintain the interest of youth.Drawing on research from two distinct areas: substance abuse intervention and educational video games, Crossroads: A Game of Choices is an interactive video game that teaches knowledge and skills to improve decision-making by Native American youth affected by methamphetamine use in rural communities, intervening in the intergenerational cycle of addiction.Phase I is focused on prototype development, usability testing, creation of customized assessments and educational resources. Crossroads combines cutting-edge game design and graphics with effective therapeutic methods -- Community Reinforcement and Family Therapy and Motivational Interviewing (MI) - that are adaptable to computer-assisted learning. The result is a product that will engage youth at risk of meth use/abuse and teach/model healthy decision-making. Data collection will be within the context of the game, integrated into the storyline. Positive choices will be rewarded with gameplay, while negative choices will route users to software that allows users to participate in MI remotely, in a media format that accommodates for any below grade-level communication skills. Data is collected continuously throughout the game and used for game improvement, e.g., to raise the rate of module completion. Counselors receive MI feedback from users to incorporate in support and services offered to game users. Users access Crossroads on the devices they are most comfortable using, remotely and at their convenience.In Phase I, we will focus on game and educational design with the emphasis on product creation and refinement based on usability testing feedback. We will conduct two rounds of testing with tribal youth ages 11-18 on the Fort Berthold reservation in North Dakota; an initial 15-person on-site usability testing, followed by a 10-person off-site usability study.The project offers significant short-term benefit applied to methamphetamine abuse, and vastly greater long-term benefit as a successful Phase I project can be extended to other types of substance abuse and other risk behaviors under a Phase II.
Animal Health Component
0%
Research Effort Categories
Basic
5%
Applied
15%
Developmental
80%
Goals / Objectives
The major goal of this project is to draw on research from two distinct areas: substance abuse intervention and educational video games, to create a prototype of an interactive video game that teaches knowledge and skills to improve decision-making by Native American youthaffected by methamphetamine use in rural communities, intervening in the intergenerational cycle of addiction.The project has three technical objectives for Phase I.Develop three playable levels in a virtual world that integrate video scenarios, decisions, game play and instructional videos or web pagesCreate interactive journals modeled on motivational interviewing using audio and video,Develop in-game assessment for substance abuse, risk factors and knowledge.Conduct usability testing on the game developed with adolescents in families affected by methamphetamine abuse
Project Methods
1.1 Create final game design A Game Design Document will be finalized, integrating all sound and graphic assets required, character development, storyline, scenarios, assessment points, choices, educational resources and game play. Data collection will be incorporated in the game in a natural fashion. For example, on Level 1, characters within the game meet the players outside at night. After introducing themselves, since they cannot 'see' the player well, they ask basic demographic questions about age, gender.1.2 Create three playable game levels: In an adventure game format, users select an avatar that will be posed questions throughout the game. Navigating within the game virtual world, a player triggers a video that shows a common scenario in homes affected by methamphetamine addiction, e.g., arriving home alone to a house with no food and inadequate heat. The player is guided through possible choices, with the assistance of motivational interviewing (MI) techniques. After a decision is made, an instructional resource plays. If the answer is correct, the choice is reinforced through the opportunity to play the game. For example, choosing to call grandmother results in an activity driving a tractor across fields strewn with obstacles to arrive at her house before time runs out.Task 1.3 Using local Native American actors, COL staff will create three videos of common scenarios: arriving home alone and finding drug paraphernalia, witnessing domestic violence and drug parties occurring in homes with minor children. Research has shown that student engagement is enhanced when users perceive features of a learning environment to be visually realistic . Likewise, learning in a virtual world, such as in Crossroads, that resembles the player's own reality of belonging to a Native American culture may better sustain his or her interest and persevere with the topic.Task 1.4 COL and 7G staff will create 3 in-game decision points, each with one correct and two incorrect choices. Each decision will route to one of three educational resources, explaining either why the decision was correct or incorrect. If a dysfunctional choice is made, the player is returned to the MI activity to reinforce what was learned, and then can select a different decision.Task 1.5 Create 9 in-game educational resources As data have repeatedly shown the difficulty methamphetamine users have with taking accountability for the consequences of their actions , both correct and incorrect decisions will be followed by educational resources emphasizing the connection between decision and results. For example, going to the home of a neighbor known to have a meth lab could result in violence, as the player's appearance is unexpected.Task 2.1 Create motivational interview prompts/guides - To prevent the 'homework' look of many training applications, prompts will be written by COL staff and recorded in brief videos to give the application a 'YouTube' or 'Snap Chat' feel. Characters will be a mix of COL staff, youth and animation. Prior research has found games with variation in format to have high engagement and completion rate by youth, in contrast to the low completion rates of single format games (Neil et al. 2009).Task 2.2 An audio input feature will allow users the option of voice recordings of their answers to MI prompts to be shared with counselors. Given that 37% of Native American students are below basic level in academics by the eighth grade (NCES, 2015) an intervention that relies primarily on written correspondence between counselor and patient will have limited access. Audio input will be incorporated both to accommodate user needs and to assess impact on persistence and hours of use.Task 3.1 Data collection forms will be written in PHP and data stored in a MySQL database. A reliable assessment requires complete data on a relatively large number of items. Data collection forms appear throughout the game in the form of 'conversations' with an animated avatar chosen by the player. Data collection forms appear at logical points so as to not disrupt the flow of the game.Task 3.2 Write program for data analysis Writing the programs before usability testing insures all necessary variables are included in data collection forms. Game usage data is collected continuously. Analyses include descriptive statistics for frequency and duration of game play session and number of modules completed and inferential statistical analysis of relationships between player demographics and persistence. Diagnostic data are collected via assessment data collected through interactions with the avatar. Descriptive statistics will be computed and psychometric analyses performed. Given the small sample size, analyses must be viewed as preliminary and a basis for replication and extension in Phase II.Task 4.1 Recruit Sample The target population is youth aged 11-17 with a household member who is abusing alcohol or drugs, with a particular emphasis on methamphetamine. In Phase I, 30 subjects will be recruited from families of participants in the COL substance abuse treatment and referrals from social service agencies.Task 4.2 On-site usability testing will first be conducted initially with 5 youth participants observed individually for a 45-minute session to identify major issues, e.g., incompatible with older operating system, RAM available results in low performance, Internet connection is inadequate. Testing on-site in a remote community is a key activity. For example, previous research found unacceptable downtime for users; this issue was only regularly observable in remote locations. Second, we will conduct 3 weeks of on-site tests. Youth will play two 40-minute sessions per week. A maximum variation sample of 15 participants will include five participants each in age groups 11-12,13-14 and 15-17, with both genders in each age group. Researchers will observe two selected participants per session for twenty minutes, followed by individual interviews. Observations will be recorded electronically using a usability survey developed by the researchers. The third week, the monitor will select 4 players to individually "think-aloud" as they work through the game. With 9 hours of observations, 15 structured interviews, 4 think-aloud sessions plus quantitative data collected electronically for 60 hours, adequate data will be gathered to identify performance issues under optimal settings. Nielsen and Landauer (1993) found that 85% of usability problems can be found with 5 users and recommended breaking samples into multiple, small, iterative studies of 5 users. With 3 weeks of observation across age groups, observers will be able to assess usability issues early and intermediate term.Task 4.3 After a 3-week break, during which game levels are revised, conduct off-site testing for another 3-week period. An additional 10 users will be recruited both to assess usability for naïve users in remote off-site locations, and to account for probable attrition. For the off-site condition, users will be provided refurbished iPhones with a limited data plan. Data will be collected electronically on frequency and duration of game play sessions, modules completed and accesses of help screens. Project staff will record number, content, duration and resolution of phone and email contacts for customer support. COL staff members will visit 5 new users and 5 experienced users at home to observe usage and individually 'think aloud' as they play the game.Task 4.4 Conduct data analysis Data analysis programs will run weekly to address any problems with data early with minimal loss of data quality. Qualitative data will be summarized in at least 5 user case studies, identifying typical and 'edge' users, e.g., users with zero or extremely high level of experience playing games, users with special needs.