More than pills and condoms: How a group of pharmacy students took action in improving sex education in schools through gamification

LuizLuiz GustavoGustavo dosdos SantosSantos Lima,Lima, ErickErick TavaresTavares MarcelinoMarcelino Alves,Alves, CamilaCamila AlvesAlves NovaisNovais DeDe JesusJesus

Sex is more than just a fun activity. According to the Declaration of Sexual Rights, all rights pertaining to human sexuality are human rights, and thus, must be protected 1.

A core principle of that is the right to access to accurate and understandable information, which is usually taught in schools. However, this subject can be quite challenging for health professionals and educators, especially in a conservative and politically unstable country such as Brasil 2. Having that in mind, a group of pharmacy students from FAS, a non-profit organization, decided to take action and create its own sex-ed program to complement schools' curriculum in São Paulo, Brazil

In order to tackle such a difficult subject, gamification was the chosen method. It implies the Introduction of game elements into non-game situations 3, like earning points when learning a language on Duolingo or even competing against your peers on Kahoot. As Dana Salab Alsham states in her master thesis, gamification can be an excellent tool when teaching “difficult subjects” , such as racism, death of sexual education 4..

The reason for that is that games can encourage social-emotional learning, build intrinsic motivation and foster autonomy, critical thinking, and communication skills 4-7. Those abilities are essential for healthy sexual development, as stated by ITGSE 8, the international guidelines to building comprehensive sexual education curricula (CSE). Figure 1. Teens sitting on a circle during the “true or false” activity.

This approach is shown to bring down STI’s and teenage pregnancy rates, as well as improve gender equality, lower LBGBQIA+ violence in schools and empower students to avoid and report sexual assault9. That’s mainly due to its holistic approach that addresses the cognitive, emotional, physical, and social aspects of sexuality.

Keeping in mind CSE philosophy, FAS created a set of activities designed for different age groups. Children from 6 to 10 years of age are taught about body parts in the “yes or no touch” game. Each round, children are asked if it’s ok to touch a rag doll's body part, which is covered in question marks. Intimate parts, like breasts and genitals, are then covered in X marks, meaning that other people shouldn’t touch them.

For the adolescents, whose ages varied from 11 to 15 years old, a different approach is used. In a simple game, teens are asked about some sex-ed topics and asked to answer whether the affirmation is true or false. The goal here is to build communication between the educator and the students, and amongst its peers. Thus, it demystifies the notion that everyone knows everything about sex and

taboo-breaking channel of creates trust a to

those who want to ask questions

without judgment.

Finally, FAS decided to dive deeper into gamification and create an actual board game. IST - informação sem tabu (STI Information without taboo) was developed to foster an accurate risk perception regarding STI’s and also offer teenagers a set of tools to prevent, seek diagnostics and treatment for them.

In order to achieve that, IST

relies heavily on the MDA system 10. The game mechanics and dynamics mimic real life, as, for example, if one has unprotected sex, there’s a certain chance that they won’t contract an STI’s. In that way, participants will learn that they would be playing the odds, and just because they did it once and got away with it, it doesn't mean that they would be lucky a second time.

Additionally, the game is collaborative. The goal is that every player gets to the finish line healthy, and if anyone dies in the process, the whole party loses - as the death of an individual is a loss for the whole community. On account of its collaborative nature, participants are expected to help each other find protection (either vaccine, condoms, or pills) and treatments.

This builds communication skills and wears down the stigma around STI’s, teaching players that instead of judging, they must help those who unfortunately have got infected. Ultimately, the whole approach is tied by aesthetics, that is, the feeling players should get when playing the game. By experiencing the anxiety of playing the odds with unprotected sex, the relief of finding protection or treatment, or even the frustration of a treatment failing, participants are more likely to build new habits around that subject 5, empathize instead of judging their peers and exercise critical thinking when it comes to making safer choices regarding sex. The game’s project was well received by the Latin-American game community and scored a third-place at the VIII Games For Change Festival.

However, due to the pandemic, both FASeduca and IST development were halted for a while. Nevertheless, as the pandemic gets more and more under control, FAS intends to get FASeduca back in schools to teach a whole new generation of sexually healthy kids.

References:

1 Kismodi, Eszter & Corona,

Esther Maticka-Tyndale, Eleanor & RubioAurioles, Eusebio & Coleman, Eli. (2017). Sexual Rights as Human Rights: A Guide for the WAS Declaration of Sexual Rights. International Journal of Sexual Health. 29. 00-00. 10.1080/19317611.2017.1353865.

2. RIBEIRO, Paulo Rennes

Marçal; MONTEIRO, Solange Aparecida de Souza AVANÇOS E RETROCESSOS DA EDUCAÇÃO SEXUAL NO BRASIL: APONTAMENTOS A PARTIR DA ELEIÇÃO PRESIDENCIAL DE 2018 Revista IberoAmericana de Estudos em Educação, vol. 14, núm. 2, Esp., 2019, pp. 1254-1264 Universidade Estadual Paulista Júlio de Mesquita Filho DOI: https://doi.org/10.21723/riaee.v14iesp.2.12 701

3. Araya R, Arias Ortiz E, Bottan N, Cristia J. Does Gamification in Education Work?: Experimental Evidence from Chile. Inter-American Dev Bank Dep Res Chief Econ [Internet]. 2019;(July):45. Available from: https://publications.iadb.org/en/doesgamification-education-workexperimental-evidence-chile

4. Alsham DS. Teaching

Difficult Subjects in a Digital Society: Investigating the Application of Games and Technology for Inclusive Sex Education. [Toronto ]: OCAD University; 2020. 5 .Hamari J, Koivisto J, Sarsa H. Does gamification work? - A literature review of empirical studies on gamification. Proc Annu Hawaii Int Conf Syst Sci. 2014;3025–34.

6. Manzano-León A, Camacho-Lazarraga P, Guerrero MA, Guerrero-Puerta L, Aguilar-Parra JM, Trigueros R, et al. Between level up and game over: A systematic literature review of gamification in education. Sustain. 2021;13(4):1–14.

7. Kim J, Castelli DM. Effects of gamification on behavioral change in education: A meta-analysis. Int J Environ Res Public Health. 2021;18(7).

8. UNESCO, et al. Revised edition of the International Technical Guidance on Sexuality Education. Paris: UNESCO; 2018. Available at < http://unesdoc.unesco.org/images/0026/ 002607/260770e.pdf> . Accessed 15 Feb 2022

9. Three Decades of Research: The Case for Comprehensive Sex Education. Goldfarb, Eva S. et al.. Journal of Adolescent Health, Volume 68, Issue 1, 13 - 27

10. Hunicke, R.; LeBlanc, M.; Zubek, R. MDA: A Formal Approach to Game Design and Game Research. In Proceedings of the Game Developers Conference, San Jose, CA, USA, 23 November 2004.