Exploring the Feasibility of an Innovative Inter-Generational Computer Game for Sexual Health Education in Youth with Autism Spectrum Disorder and Other Neurodevelopmental Disabilities: A Mixed-Method Case Study
- To explore the usability of SSS for sexual health education in ASD/NDD youth.
- To explore the feasibility of using SSS in the home setting.
- To explore the feasibility of SSS to promote parent-youth communication.
Methods: This study is a mixed methods multiple case study of six parent-youth dyads (11-14 years) in a large metropolitan area in Texas. This study is a subset of a larger, randomized control efficacy trial, to evaluate the 18-level home-based SSS computer game and parent website (Figure 1). A stepped development framework, Intervention Mapping, informed the theoretical and empirical foundation of SSS. Parent and youth self-reported data were collected via Questionnaire Development System (QDSTM) survey assessing pre-sexual and sexual behaviors, intentions towards sex and parent-youth communication about sex, and gaming behaviors at baseline and 3-month follow-up. Game progress and time-on-task data were collected from the SSS data base. Usability rating surveys and in-depth semi-structured exit interviews were conducted with parents and youth at 3-month follow-up.
Results: The youth sample (n=6) was male (50%), Caucasian, of mean age 13.04 ± 1.49 years, and with diagnosis of Autism Spectrum Disorder (ASD) (33%) and/or had other Neurodevelopmental Disabilities (NDD) (67%). Youth were sexually inexperienced (100%) but engaged in some pre-sexual behavior (50%) and intending to have sex in next year (33%). Some had ever talked to their parent about sexual topics such as birth control (50%), condoms (33%), HIV/AIDS (50%), and STIs (33%). Parents were female, 46.1 ± 2.43 years old, and Caucasian. By 3-month follow-up most youth had either completed SSS (57%) or completed over half of SSS (14%). Youth and parents rated the game as captivating (67-100%), easy to use (67-83%), understandable (50-100%), credible (67-100%), and helpful for making future healthy choices (83-100%) (Figure 2). SSS rated lower on uniqueness, attractiveness, and motivational appeal (33-67%). Youth reported length and technical difficulties as barriers to game play. Qualitative findings highlighted higher acceptability of the game and website among parent-youth dyads, particularly for ease of navigation, website resources, and parental involvement. Parents indicated benefits of SSS in mediating parent-youth communication regarding sexual health.
Conclusions: Our exploratory analysis indicated that an intergenerational game offers an acceptable and feasible strategy to address the socio-sexual needs of youth with ASD/NDD. These exploratory results suggest that further research with larger samples is indicated.