Yvonne Thies-Brandner Dissertation Lets Play It Safe
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Let’s Play it Safe! Entertainment-Education in the Digital Age – Developing and Testing a Digital Entertainment-Education Game about HIV/AIDS Protection for Female Adolescents by Yvonne Thies-Brandner A Thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology Approved, Thesis Committee _______________________________ Prof. Dr. Margrit Schreier (Chair) Jacobs University Bremen _______________________________ Prof. Dr. Klaus Boehnke Jacobs University Bremen Prof. Dr. Dagmar Unz University of Applied Sciences Würzburg-Schweinfurt Date of Defense: May 3, 2013 School of Humanities and Social Sciences II “Anyone who tries to make a distinction between education and entertainment doesn’t know the first thing about either” Marshall McLuhan (Canadian Philosopher) III IV Table of Contents Summary XIII Acknowledges XV 1. Introduction 1 2. Entertainment-Education – A Strategy 7 2.1 Introduction and History 7 2.2 Definition, Strengths, and Challenges 15 2.2.1 Definition 15 2.2.2 Strengths 18 2.2.3 Challenges – and How to Overcome Them 21 2.3 Theories Underlying Entertainment-Education 26 2.3.1 Introduction 26 2.3.2 Models with Steps/Stages 27 2.3.2.1 Hierarchy-of-Effects Model 28 2.3.2.2 Stages-of-Change Model 29 2.3.2.3 Diffusion of Innovations Theory 30 2.3.2.4 Summary – Models with Steps/Stages 30 2.3.3 Social Psychological Models 31 2.3.3.1 Bandura’s Social Learning Theory – Social Modeling 31 2.3.3.2 Theory of Reasoned Action & Theory of Planned 37 Behavior 2.3.3.3 The Health Belief Model 39 2.3.3.4 The Health Action Process Approach (HAPA) 40 2.3.3.5 Summary – Social Psychological Theories 41 2.3.4 Cognitive Models 42 2.3.4.1 Elaboration-Likelihood Model of Persuasion (ELM) 42 2.3.4.2 Theory of the Triune Brain 44 2.3.4.3 Summary – Cognitive Models 45 2.3.5 Drama and Role Models 46 2.3.6 Audience-Centered Models 46 2.3.6.1 Uses-and-Gratifications Theory 47 2.3.6.2 Two-Step Flow Model 48 V 2.3.6.3 Parasocial Interaction 48 2.3.6.4 Audience Involvement 49 2.3.6.5 Summary – Audience-Centered Theories 49 2.3.7 Contextual Theories 50 2.3.7.1 Agenda-Setting Model 50 2.3.7.2 Cultivation Theory 51 2.3.7.3 Summary – Contextual Theories 51 2.3.8 Hybrid Models 52 2.3.8.1 Sabido Method 52 2.3.8.2 An Integrative Model of Entertainment-Education 54 Processes and Outcomes 2.3.8.3 Summary – Hybrid Models 55 2.3.9 Summary – Theories Underlying Entertainment-Education 56 2.4 Effects of Entertainment-Education 56 2.4.1 Introduction and Ways of Evaluation 56 2.4.2 Examples of Entertainment-Education Effects 61 2.4.2.1 Knowledge 61 2.4.2.2 Interest 62 2.4.2.3 Self-efficacy 63 2.4.2.4 Communication 63 2.4.2.5 Behavioral Change 65 2.4.2.6 Summary 67 2.5 Factors Affecting an Entertainment-Education Outcome 67 2.5.1 Introduction 67 2.5.2 Factors Concerning the Entertainment-Education Media Product 68 2.5.3 Factors Concerning the Environment 71 2.5.4 Factors Concerning the Audience 73 2.5.5 Factors Concerning Accompanying Research 76 2.5.6 Summary 76 2.6 Ethical Considerations Concerning the Use of Entertainment-Education 77 2.7 Summary 90 VI 3. (Digital) Game-Playing 99 3.1 Play 99 3.1.1 Introduction 99 3.1.2 Theories of Play 100 3.1.3 Definition and Classification of Play 104 3.1.4 Play and Game 106 3.2 Digital Games 107 3.2.1 Introduction, History, and Definition 107 3.2.2 Classification 110 3.2.3 Why People Play Digital Games 113 3.2.4 Effects of Digital Games 121 3.2.4.1 Negative Effects 121 3.2.4.2 Positive Effects 125 3.2.5 Serious Games – The Use of Digital Games for Education 128 3.2.5.1 Introduction, Definitions, and Classification 128 3.2.5.2 Effectiveness of Serious Games 132 3.2.5.3 Specifics of Serious Games Compared to 133 Traditional Education 3.2.5.4 Possible Advantages of Using Serious Games as 137 Educational Tools 3.2.5.5 Possible Disadvantages of Serious Games 143 3.2.6 Digital Entertainment-Education Games 145 3.2.7 Digital Games for HIV/AIDS Prevention 149 3.2.8 Digital Games and Girls 150 3.2.8.1 Girls’ Use of Digital Games 150 3.2.8.2 Girls and Common Digital Games 152 3.2.8.3 Girls’ Favorite Games and Genres 154 3.2.8.4 Conclusion 156 3.3 Summary 157 4. Female Adolescents 164 4.1 Introduction 164 4.2 Developmental Stage 166 4.2.1 Physical Changes 166 VII 4.2.2 Psychological Changes 168 4.2.3 Cognitive Changes 175 4.3 Female Adolescents in Germany 179 4.3.1 Living Conditions 179 4.3.2 Health 182 4.3.2.1 Introduction 182 4.3.2.2 Somatic Diseases: Acute & Chronic Illness 183 4.3.2.3 Mental Health 184 4.3.2.4 Risk Behavior 184 4.3.3 Sexuality 187 4.3.3.1 Introduction 187 4.3.3.2 Sex Education 188 4.3.3.3 Sexual Orientation of 15-Year-Old Girls in 189 Germany 4.3.3.4 Sexual Experiences of 15-Year-Old Girls in 189 Germany 4.3.3.5 Use of Contraception 189 4.3.3.6 Consequences of Unprotected Sexual Activity 191 4.4 Need for new HIV/AIDS Prevention Ways 191 4.5 Summary 194 5. The Present Study 198 6. Methods 206 6.1 Deduction of Hypotheses 206 6.1.1 Hypotheses concerning Dependent Variables 206 6.1.2 Hypotheses concerning Moderator/Mediator Variables 208 6.1.3 Explorative Questions 209 6.2 Operationalization of the Independent Variable 212 6.2.1 HIV/AIDS as Topic for this Study 212 6.2.2 The Game – Creating a Digital Entertainment-Education 213 Game about HIV/AIDS for Teenage Girls 6.3 Operationalization of the Dependent Variables 222 6.3.1 Introduction 222 6.3.2 Knowledge about HIV/AIDS 223 VIII 6.3.3 Interest in HIV/AIDS 224 6.3.4 Communication about HIV/AIDS 226 6.4 Operationalization of Moderator and Mediator Variables 227 6.4.1 Involvement 227 6.4.2 Personal Risk Perception 228 6.4.3 Experience with Digital Games 229 6.5 Other Measurements 229 6.5.1 Demographic Facts 229 6.5.2 Sexual Behavior 229 6.5.3 Measurements for Explorative Purpose 230 6.5.3.1 Self-Efficacy 230 6.5.3.2 Behavior Intention 230 6.6 Measurements – Overview 231 6.7 Empirical Hypotheses 232 6.8 Qualitative Pilot Study 233 6.9 Design – The Solomon-Four-Group Design 236 6.10 Sample 240 6.10.1 Recruitment 240 6.10.2 Description of Sample 241 6.11 Research Procedures 243 6.12 Ethics and the Present Study 244 7. Data Preparation and Analysis 246 7.1 Introduction 246 7.2 Data Preparation 246 7.2.1 Box Plots 246 7.2.2 Comparison of Subsamples (Bremen/Cologne) 246 7.3 Reliability Analyses – Cronbach’s Alpha 247 7.4 Data Reduction 248 7.4.1 Factor Analysis 248 7.4.2 Sum Variables and Indices 249 7.5 Results 251 7.5.1 Descriptive Statistics 251 7.5.2 Analysis of the Solomon-Four-Group-Plan 260 IX 7.5.2.1 Assumption 260 7.5.2.2 Concerning Hypothesis 1 (Knowledge) 263 7.5.2.3 Concerning Hypothesis 2 (Interest) 264 7.5.2.4 Concerning Hypothesis 3 (Communication) 268 7.5.2.5 Concerning Hypothesis 4 (Involvement) 269 7.5.2.6 Concerning Hypothesis 5 (Risk Perception) 270 7.5.3 Explorative Results 271 7.5.4 Summary of Results 277 8. Discussion and Conclusions 284 8.1 Discussion of Supergöre and the Results of the Present Study 284 8.1.1 The Game Supergöre 284 8.1.2 Effects on Dependent Variables 285 8.1.3 Moderator- and Mediator Effects 288 8.1.4 Other Variables 290 8.1.5 Ethics Statement 290 8.2 Limitations of the Study 291 8.2.1 Limitations Concerning Methodology and Design 291 8.2.2 Checking Required Procedures for Evaluating 293 Entertainment-Education Interventions 8.3 Future Research Directions and Indications for Practice 295 8.4 Conclusions 299 References 302 Appendices Appendix A – Focus group topic guide Appendix B – Photographs Appendix C – Recruitment letters Appendix D – Instruction and questionnaires Appendix E – Statistical analyses X List of Tables Table 1 Matrix Visualization of the Potential Effect Mechanisms Underlying 142 Playing Serious Games on Social Change Table 2 Overview of measures used for the present study 231 Table 3 Schema of the Solomon Four-Group Design 237 Table 4 Allocation of sample into the Solomon Four-Group Design 242 Table 5 Frequencies of girls participating in the experiment and post-tests sent per 242 mail Table 6 Level of school education participants aimed for 243 Table 7 Study design 244 Table 8 Scores of the reliability analyses 248 Table 9 Risk perception – Items 3 to 6 254 Table 10 Self-efficacy – Results for Items 3a to 3i 256 Table 11 General interest items 257 List of Figures Figure 1 Conceptualizations of entertainment and education 17 Figure 2 Stages of change model 29 Figure 3 Sub-processes of observational learning and influencing factors 34 Figure 4 The relation between self-efficacy, outcome expectancy, and behavior 36 as mentioned by Bandura Figure 5 Schematic presentation of the theory of reasoned action 38 Figure 6 Schematic presentation of the theory of planned behavior 38 Figure 7 The health belief model by Rosenstock, 1974 40 Figure 8 The health action process approach (HAPA) by Schwarzer 41 Figure 9 Schematic diagram of the elaboration-likelihood model 43 Figure 10 The theory of the triune brain 45 Figure 11 The uses and gratifications theory 47 Figure 12 The two-step flow model 48 Figure 13 The agenda-setting model 50 Figure 14 Entertainment-education model by Wilkin and Fernandes 55 XI Figure 15 Schematic representation of hormonal regulation of girls’ puberty 167 Figure 16 Screenshot Level 1 (Discotheque) 217 Figure 17 Screenshot Level 2 (Camp) 218 Figure 18 Screenshot Level 2 – Pop-up window with information 219 Figure 19 Screenshot Level 2 – Pop-up window with positive feedback 219 Figure 20 Screenshot Level 2 – Pop-up window with negative feedback 220 Figure 21 Screenshot Level 3 (Underwater World) 221 Figure 22 Screenshot Level 4 (Scary world) 221 Figure 23 Screenshot Level 5 (Jungle World) 222 Figure 24 Flowchart – Solomon Four-Group Design analysis procedure 239 Figure 25 Risk perception – Item 1 253 Figure 26 Risk perception – Item 2 254 Figure 27 Process sequence – Hypothesis 1 264 Figure 28 Process sequence – Hypothesis 2 266 Figure 29 Process sequence – Hypothesis 3 268 Figure 30 Process sequence – Exploratory questions 1 and 2 272 Figure 31 Flowchart of main findings 279 XII Summary Entertainment-education is a method to educate people through entertainment media products.