Serious Game as a digital educational technology for HIV prevention among adolescents: a methodological study.
Serious Game. HIV. Adolescents. Educational Technology. Validation Study. Combined Prevention. Nursing.
The HIV epidemic remains one of the most persistent global public health challenges,
with statistics indicating heightened vulnerability among adolescents due to knowledge
gaps and structural barriers. This study aimed to develop and validate the content of a
Serious Game (SG) focused on HIV prevention, aligning adolescent interest in digital
technologies with public health strategies and UNAIDS global targets. This is a multi-
method, mixed-methods research study, grounded in Filatro’s Instructional Design
framework and Pierre Lévy’s theories on collective intelligence. The process was
structured into four fundamental stages: a scoping review, focus groups with
adolescents, educational content development and prototype construction, and final
technical validation. The scoping review mapped 21 international studies,
demonstrating that smartphone and console games are the most effective formats for
youth engagement. Concurrently, focus groups conducted with seven adolescents from a
public school in Natal-RN revealed a critical lack of knowledge regarding the
Combined Prevention Framework (Mandala) and the persistence of transmission myths,
which directly informed the development of the game’s situational questions. Data from
the focus groups were analyzed using IRaMuTeQ software, confirming the centrality of
gamification in the learning process. The resulting product, titled "Entrelaços," was
designed as a situational narrative quiz featuring 15 questions and mandatory
pedagogical feedback that requires a cognitive pause for reading. Content validation
was performed via the Delphi technique, involving expert judges (Master’s and PhD
levels) with expertise in HIV and/or adolescent health. In the first round, 16 judges
evaluated the script based on Pasquali's 12 criteria, leading to essential adjustments for
more inclusive and clear language. In the second round, with 12 judges, the Kappa
concordance index reached 1.00, indicating almost perfect consensus among experts.
The Content Validity Index (CVI) and Content Validation Coefficients (CVC) mostly
ranged between 0.88 and 1.00, confirming the tool's scientific robustness. The research
was approved by the UFRN Research Ethics Committee (CEP) under CAAE
87097125.3.0000.5537. In conclusion, this thesis asserts that the "Entrelaços" SG
content possesses full scientific and pedagogical validity for addressing HIV. The
technology proved to be a strategic resource for nurses, particularly within the School
Health Program (PSE), by mediating dialogues on stigmatized topics in a playful and
safe manner. The game promotes adolescent autonomy and agency, transforming errors
into learning opportunities and strengthening primary prevention. With the prototype
content validated, this study contributes to health innovation and the strengthening of
social control, offering a strategic, reliable, and effective option for reducing adolescent
vulnerabilities.