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The Real Deal: A New Card Game Empowers Women to Take Charge of Their Health

July 06, 2015
by Rick Harrison

New Haven, Conn. – You’re a 13-year-old girl living in Elm City. A friend swipes some of her grandmother’s pills and asks you to take some with her. What do you do?

If you are playing “PlayForward: Elm City Stories” on an iPad or desktop computer, you need to take those pills. And then learn the consequences before going back to choose the right path.

“We’re teaching skills for how to get out of risky situations,” said Kimberly Hieftje, an associate research scientist at the Yale School of Medicine and a leader of the school’s play2PREVENT instructive video game lab. “We help kids build their aspirational avatar.”

And now those skills aren’t just for children ages 11-14. A newly minted card game financed in 2013 with a grant from Women’s Health Research at Yale’s Pilot Project Program promises to help young black women navigate the difficulties of dating while remaining protected against HIV/AIDS.

“Knowledge in and of itself won’t change behavior,” Hieftje said. “It’s about confidence, empowerment – empowering women to ask their partners to get tested and use condoms.”

Even though young African American women engage in risky behaviors at rates comparable to or lower than the general population, they acquire sexually transmitted infections and HIV at rates second only to men who have sex with other men, according to the U.S. Centers for Disease Control and Prevention. So even though these women behave similarly to women of other demographic groups, the prevalence of HIV in their communities leaves them at a higher risk for contracting the disease, even after a single unprotected sexual encounter.

Using humorously illustrated cards, the game “One Night Stan” forces players to ask a lot of questions and get to know somebody before choosing whether to safely engage in sex. Based on conversations with 18-24-year-old black women and peer-reviewed literature on how to influence health behaviors, the game seeks to build refusal skills and instill confidence.

“We know that role-playing to practice safer behaviors really makes a difference in changing behaviors,” Hieftje said. “Playing a game is a way to make role-playing less clumsy.”

And the game has already shown signs of effectiveness. In a pilot study with 21 young black women, five participants talked to their partners about getting tested for HIV and other sexually transmitted infections, prompting four to actually get tested. Two of the women who may not have had safe sex decided to get tested themselves.

“We were so excited to see the game have such a direct and immediate impact,” Hieftje said. “People just started taking these safe behaviors to heart.”

Hieftje and Associate Professor of Medicine Dr. Lynn Fiellin, Founder and Director of the play2PREVENT Lab, now hope to raise funds to continue research and development before turning the prototype into a distributable game, suitable for dorm rooms. Eventually Hieftje envisions a multi-player video game that would allow for a larger number of potential “dates,” alternate age ranges, and little-to-no cost so anyone can access it.

For Hieftje, her work at play2PREVENT marries her life-long interest in gaming with her academic pursuit of research.

“This is very visual and very creative,” she said. “I don’t think a lot of researchers get an opportunity to join their personal and academic interests.”

Growing up in Indiana with three brothers and playing “The Legend of Zelda” on a home Nintendo system, Hieftje never thought of combining research with games until she saw an ad at Indiana University for a post-doctorate position at Yale developing educational video games with Dr. Fiellin at her lab, funded by the National Institute of Child Health and Human Development.

The team took two years talking to kids and school counselors to develop “PlayForward” before even creating the digital version of the game.

Players take between 12 and 16 hours to finish, making decisions on balancing homework, friends, sex, studying, and sleep. Learning how to say no while saving face. Discovering how your behavior can be influenced by your friends’ friends. All while being pulled along by natural curiosity to see the consequences of these decisions and how the story ends.

Dr. Fiellin expects to receive a year’s worth of in-game data and follow-up assessments in time for the lab to publish a paper on the results this summer. And then it’s on to more work and more play. With a purpose.

“We hope to show that games can change behaviors,” Hieftje said. “And to have data to support it.”

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For questions, please contact Rick Harrison, Communications Officer, at 203-764-6610 or

Submitted by Carissa R Violante on July 01, 2015