Designing Gamified Elements for Teen Pregnancy Prevention: An Interventionist’s Guide to Process, Evaluation, and Lessons Learned (Preprint)

BACKGROUND Despite recent declines in unintended teen pregnancies attributed to family planning services, socioeconomically disadvantaged and highly mobile youth (HMY)—those experiencing frequent residential transitions—remain disproportionately at risk. Traditional teen pregnancy prevention (TPP) programs often fail to effectively engage these youth due to their unstable life circumstances and limited access to conventional prevention resources. OBJECTIVE This paper describes the design, usability testing, and key lessons learned from the development of gamification elements involving interactive narratives for "My Future-Self (MFS)," an innovative, hybrid intervention tailored specifically for HMY. This manuscript highlights the experience of interdisciplinary collaboration in the development of gamified elements of behavioral change interventions. METHODS We employed a User-Centered Design (UCD) framework, emphasizing iterative collaboration among adolescent unintended pregnancy prevention intervention scientists, game designers, and HMY advisors (N=96; mean age=19.86, SD=1.41). Initial surveys assessed HMY’s game aesthetics preferences, technology access, intimate relationships, and specific life experience with medical professionals and use of contraception in order to guide prototype development of gamified interactive content. Two 10 minute gaming activities were developed; one around visiting a physician office to discuss contraception and one using scenarios to practice healthy communication with an intimate partner. Iterative usability testing involved structured playtesting sessions with 12 youth with HMY experience utilizing think-aloud protocols, semi-structured interviews, and thematic feedback analysis. Throughout development, distinct goals representing a) intervention developers (i.e. contributions to behavior change) and b) game designer/producers (i.e. user engagement) were clarified, aligned, and operationalized to optimize gaming elements’ contribution to the small group intervention’s behavior change effectiveness. RESULTS Playtesting revealed high user appreciation for realistic and immersive scenarios; however, feedback also underscored the necessity for clearer context and increased user agency within the intimate partner gaming element. Iterative refinements resolved usability barriers and significantly enhanced gaming elements’ acceptability. Key lessons learned included the critical importance of clearly defining and aligning interdisciplinary goals early in the design process, positioning intervention scientists as lead designers, adapting gamified interventions to realistic user-engagement expectations, and proactively integrating cultural relevance throughout inclusive content. CONCLUSIONS Explicitly addressing interventionists’ and game designers’ distinct goals was crucial to achieving successful interdisciplinary alignment. Employing a collaborative, iterative UCD approach significantly strengthened interdisciplinary understanding of the gaming elements’ purpose, enhancing the design relevance and usability of the MFS gamified intervention for HMY. The identified lessons learned provide valuable insights for future development and production of gamified health interventions through the partnering of intervention developers with game designers and end users of resultant intervention program.