Serious game about contraceptives for postpartum adolescents: development, validity and assessment

Abstract

Objective  To describe the development process, validity and assessment of a serious game about contraceptive methods for postpartum adolescents.

Methods  This is a methodological study, carried out based on the development of a serious game, content and appearance validity by 13 health judges, game quality assessment by six game development judges and appearance, language, playfulness and motivation assessment by seven postpartum adolescents. In data analysis, Content Validity Index and Appearance Validity Index ≥ 0.80 and binomial test were used for validity, and descriptive statistics was used for assessment.

Results  The serious game “Pós-parto consciente”, developed in a web quiz format, had a Content Validity Index of 1.0, a total Appearance Validity Index of 0.95 and a binomial test for each item with p > 0.05. It was considered good by 83.3% of judges, and adolescents agreed with 87.5% of the items assessed. Changes were made based on suggestions from judges and adolescents.

Conclusion  The serious game developed, validated in terms of content and appearance, achieved good quality to be used in health education on contraceptive methods with postpartum adolescents.

Contraceptive agents; Contraception; Adolescent; Postpartum period; Educational technology; Play and playthings

Resumo

Objetivo  Descrever o processo de desenvolvimento, validação e avaliação de serious game sobre métodos contraceptivos para adolescentes no pós-parto.

Métodos  Estudo metodológico, realizado a partir do desenvolvimento de serious game, validação de conteúdo e aparência por 13 juízes da área da saúde, avaliação da qualidade do jogo por seis juízes da área de desenvolvimento de jogos e avaliação da aparência, linguagem, ludicidade e motivação por sete adolescentes puérperas. Na análise dos dados, utilizaram-se Índice de Validade de Conteúdo e Índice de Validade de Aparência ≥ 0,80 e teste binomial, para validação, e estatística descritiva, para avaliação.

Resultados  O serious game “Pós-parto consciente”, desenvolvido em formato de web quiz, teve Índice de Validade de Conteúdo de 1,0, Índice de Validade de Aparência total de 0,95 e teste binomial de cada item com p > 0,05. Foi considerado bom por 83,3% dos juízes e as adolescentes concordaram com 87,5% dos itens avaliados. Alterações foram realizadas, a partir de sugestões de juízes e adolescentes.

Conclusão  O serious game desenvolvido, válidado quanto ao conteúdo e aparência, obteve boa qualidade para ser utilizado na educação em saúde sobre métodos contraceptivos com adolescentes no pós-parto.

Anticoncepcionais; Anticoncepção; Adolescente; Período pós-parto; Tecnologia educacional; Jogos e brinquedos

Resumen

Objetivo  Describir el proceso de desarrollo, validación y evaluación de un serious game sobre métodos anticonceptivos para adolescentes en el posparto.

Métodos  Estudio metodológico, realizado a partir del desarrollo de un serious game, validación de contenido y apariencia por 13 jueces del área de la salud, evaluación de la calidad del juego por seis jueces del área de desarrollo de videojuegos y evaluación de la apariencia, lenguaje, cualidad lúdica y motivación por siete adolescentes puérperas. En el análisis de los datos, se utilizó el Índice de Validez de Contenido y el Índice de Validez de Apariencia ≥ 0,80 y la prueba binominal para validación, y estadística descriptiva para evaluación.

Resultados  El serious game “Posparto consciente”, desarrollado en formato de web quiz, tuvo un Índice de Validez de Contenido de 1,0, un Índice de Validez de Apariencia total de 0,95 y la prueba binominal de cada ítem con p>0,05. El 83,3 % de los jueces lo consideró bueno y las adolescentes concordaron con el 87,5 % de los ítems evaluados. Se realizaron modificaciones a partir de sugerencias de los jueces y de las adolescentes.

Conclusión  El serious game desarrollado, validado respecto al contenido y a la apariencia, obtuvo buena calidad para que sea utilizado en la educación para la salud sobre métodos anticonceptivos de adolescentes en el posparto.

Anticonceptivos; Anticoncepción; Adolescente; Periodo posparto; Tecnología educacional; Juego e implementos de juego

Introduction

Adolescence, the period between the ages of 10 and 19, is characterized by significant physical, emotional and social changes, marking the transition from childhood to adulthood.¹Pregnancy during this period is considered a global sexual and reproductive health problem.²Worldwide, 21 million adolescents become pregnant each year.³Even more worrying is the recurrence of pregnancy in adolescence, which is associated with maternal and neonatal complications.⁴In Brazil, the rate of this recurrence is approximately 20%, and is associated with the lack of reproductive planning.⁴,⁵

Reducing adolescence pregnancy rates is a global priority and one of the goals of the United Nations Sustainable Development Goals.⁶The use of contraceptive methods is an efficient strategy for preventing pregnancy and its recurrence.⁷-⁹Thus, a higher level of knowledge increases the likelihood of using these methods.¹⁰The postpartum period becomes an opportune time for adolescents to access contraceptive information, as they are motivated to avoid a new pregnancy. Knowledge about contraception is, therefore, an important component for adolescents to choose the best alternative, according to their needs, and to be leading actors in controlling their sexual and reproductive health.¹¹

In the world, the internet is the main source of information about contraception.¹² Interventions for preventing adolescence pregnancy in different countries included group discussion, videos, websites, magazines and books. ¹³ In Brazil, the topic is addressed mainly in adolescent health handbooks and in technical texts on the internet, which can be exhaustive and unattractive. Therefore, there is an urgent need to develop educational strategies to address contraceptives for adolescents.

Educational technologies are presented as instruments for education in sexual and reproductive health.¹⁴ For health approaches with adolescents, booklets, games, websites, videos, simulations and practical interventions are used and, of these, only one card game and one simulator addressed contraceptive methods.¹⁵Among the technological possibilities for adolescents, games are incorporated into the daily lives of this audience. Games with educational purposes are called serious games, recognized for their dynamism in addressing sensitive topics and achieving greater engagement.¹⁶ Furthermore, they are equally effective as other interventions for improving knowledge, skills and satisfaction.¹⁷

Educational games about sexual health were mapped, and no development of serious games about contraceptive methods aimed at postpartum adolescents was identified.¹⁸ The development and incorporation of this technology into the list of health education tools for adolescents will fill this knowledge gap. It will also offer nurses a new opportunity to meet patients’ educational preferences.

This study aimed to describe the development process, validity and assessment of a serious game about contraceptive methods for postpartum adolescents.

Methods

This is a methodological study, developed from July to November 2023, outlined in four stages: 1) serious game development; 2) content and appearance validity by health judges; 3) game quality assessment by game development judges; and 4) game assessment by adolescents. The serious game was developed in the city of Recife, PE, Brazil. The second and third stages took place in a virtual environment, and the fourth in a maternity ward in the city of Recife.

In the first stage, a serious game entitled “Pós-parto consciente” was developed in a web format, considering its potential appeal for adolescents.¹⁹ It followed five phases: concept, pre-production, prototype, production and post-production.²⁰ To formulate the concept, a script was created to present the idea, which contained game phases, questions and answers, and structure. Content was extracted from documents from the World Health Organization, the Brazilian Federation of Gynecology and Obstetrics, the Brazilian Society of Pediatrics, the Ministry of Health, and studies on the subject.⁷,⁸,²¹ In pre-production, a professional web designer prepared a Game Design Document, which contained technical details and a description of the game’s components. In the prototype phase, a preliminary version of the serious game was built to make the idea concrete. In production, the game’s basic architecture was finalized, graphic and technical aspects were harmonized, and functionality tests were performed. The virtual space was developed in the Joomla!TM content management system. In the post-production phase, the serious game was made available for validity and assessment.

Schell’s Elemental Tetrad theoretical framework was adopted to define the game elements:²²a) Narrative – the player judges statements as true or false, with the aim of completing the stages; b) Aesthetics – contains an illustration of a nurse and a different color pattern was assigned to each button on the interface; c) Mechanics – the game has five stages, distributed by topic. Each question has only one correct answer. The game progresses even if the answer is incorrect. After the answer, feedback appears with a comment on the chosen option. There is no time limit; d) Technology – can be used on computers and smartphones.

The second stage began with judge selection, defined based on a framework that recommends participation of six to 20.²³ Judges who were a health professional with experience in adolescent sexual health and a resume registered on the Lattes platform, having developed research on adolescent reproductive health or development of educational technologies, were included. Judges who completed the instrument incompletely were excluded.

To increase the potential reach of the sample of judges, 40 judges were recruited through the Lattes platform and an invitation was sent by email. Upon acceptance, an Informed Consent Form, a link to access the serious game and an online form were sent, which contained the Health Educational Content Validity Instrument (Portuguese acronym: IVCES) and the Health Educational Technology Appearance Validity Instrument (Portuguese acronym: IVATES). ²⁴,²⁵After a period of 30 days, 13 judges sent the validity instruments.

IVCES presents good reliability for content validity of health educational materials. Each of the 18 items is expressed on a Likert scale (disagree; partially agree; and totally agree).²⁴ IVATES presents content validity and convergence for appearance validity of educational health technologies. The result of each of the 12 items is determined on a Likert scale (totally disagree; disagree; partially disagree; agree; and totally agree).²⁵

In the third stage, the same framework adopted in the previous stage was used to define the sample.²³ Judges who were a game development professional with experience in developing or assessing educational games were included. Judges who completed the instrument incompletely were excluded. To increase the potential scope of the sample, 30 judges were selected through a search on the Lattes platform. Upon accepting the invitation by email, an Informed Consent Form, a link to access the serious game and an online form with the Instrument for Assessing the Quality of Digital Games with Educational Purposes (Portuguese acronym: IAQJEd) were sent.²⁶ After a period of 30 days, six judges sent the instrument.

IAQJEd has semantic and functional validity. It contains 18 indicators assessed on a Likert scale (not applicable; never; rarely; sometimes; often; and always). The total score of the instrument is 90 points, classified based on the quality for educational purposes: low (1 to 15 points); regular (16 to 45 points); good (46 to 75 points); and excellent (76 to 90 points).²⁶

In the fourth stage, convenience sampling was adopted, with the inclusion of adolescents aged between ten and 19 years, with a history of pregnancy, previous childbirth and in the early postpartum period (0 to 10 days postpartum) in the maternity ward, during the data collection period. Adolescents with pregnancies resulting from sexual violence, verified in medical records, as well as those who could not read, write and/or were visually impaired, were excluded.

The objective of the research was presented to adolescents and their guardians. The guardians signed the Informed Consent Form, and adolescents signed the Assent Form. Participants were interviewed in a private room to apply a characterization questionnaire. Adolescents then played the serious game on a smartphone in the absence of the researcher. There was no time restriction. They then filled out a printed instrument to assess the game, adapted from studies that assessed technology by the target audience. ²⁷,²⁸ The 16-item instrument contained four dimensions: appearance, language, playfulness and motivation. For each item, the adolescents indicated yes or no agreement.

The data were analyzed using Stata^® software. Absolute and relative frequency were used for characterization. The following Content Validity Index (CVI) calculations were applied: Item-level Content Validity Index (I-CVI), Scale-level Content Validity Index, Average Calculation Method (S-CVI/AVE) and Scale-level Content Validity Index (S-CVI). ²⁹Appearance Validity Index (AVI) for each item (I-AVI) and total AVI (T-AVI) were calculated²⁵ The binomial test was applied to verify the proportion of agreement statistically equal to or greater than 0.80. A significance level of 5% was adopted. ²⁹Game quality assessment was based on the sum of the points awarded by judges in each dimension and classification recommended by IAQJEd. ²⁶ To analyze adolescents’ assessment of the game, absolute and relative frequencies of agreement per instrument item were considered.

The study was approved by the Universidade Federal de Pernambuco Research Ethics Committee, under Opinion 6,216,180 (Certificate of Presentation of Ethical Consideration 70896723.2.0000.5208).

Results

The serious game, consisting of 30 questions, distributed in five phases, is available at http://ppconsciente.com.br/ and covered the following topics: definition of contraceptive practices and contraceptive methods; functioning of the reproductive system in adolescence; sexual activity and sharing of responsibility between sexual partners in relation to contraception; access to reproductive planning and respect for secrecy, confidentiality and privacy; and reproductive planning in the postpartum period.

Of the 13 judges who validated content and appearance, 10 (76.9%) were nurses; three (23.1%) were physicians; six (46.1%) had master’s degrees; four (30.8%) had doctoral degrees; and three (23.1%) were specialists in obstetrics. Concerning geographic origin, six (46.1%) were from the state of Pernambuco, four (30.8%), from Ceará, one (7.7%), from Alagoas, one (7.7%), from Espírito Santo, and one (7.7%), from Minas Gerais. During the study, nine (69.2%) worked in healthcare and teaching; three (23.1%) only taught; and one (7.7%) only provided care. Regarding experience in research and technology production, eight (61.5%) had published an article on adolescent reproductive health; eight (61.5%) had published an article on educational technologies; and eight (61.5%) had developed and assessed educational technologies.

Table 1 presents the results of content and appearance validity. In terms of content validity, one judge suggested increasing the font size of the quiz name in the home and explanations tabs, and another suggested replacing the terms “male condom and female condom” with “penile condom and vaginal condom”. The changes were made. The S-SCVI/AVE and S-CVI were 1.0.

Table 1
Judges’ agreement on the serious game content and appearance validity

Content validity items	Content validity
	Partial agreement n(%)	Total agreement n(%)	I-CVI*	p-value**
Covers the proposed topic	-	13(100.0)	1	1
Adequate to the teaching-learning process	1(7.7)	12(92.3)	1	1
Clarifies doubts about the topic being discussed	1(7.7)	12(92.3)	1	1
Provides reflection on the topic	1(7.7)	12(92.3)	1	1
Encourages behavior change	5(38.5)	8(61.5)	1	1
Language appropriate to the target audience	1(7.7)	12(92.3)	1	1
Language appropriate to the educational material	1(7.7)	12(92.3)	1	1
Interactive language	1(7.7)	12(92.3)	1	1
Correct information	2(15.4)	11(84.6)	1	1
Objective information	1(7.7)	12(92.3)	1	1
Clarifying information	-	13(100.0)	1	1
Necessary information	2(15.4)	11(84.6)	1	1
Logical sequence of ideas	4(30.8)	9(69.2)	1	1
Current topic	1(7.7)	12(92.3)	1	1
Adequate video size	3(23.1)	10(76.9)	1	1
Encourages learning	1(7.7)	12(92.3)	1	1
Contributes to knowledge in the area	1(7.7)	12(92.3)	1	1
Arouses interest in the topic	1(7.7)	12(92.3)	1	1
Appearance validity items	Appearance validity
	Agree n(%)	Completely agree n(%)	I-AVI***	p-value**
Illustrations are appropriate for the target audience	3(23.1)	9(63.2)	0.92	0.945
Illustrations are clear and convey ease of understanding	5(38.5)	7(53.9)	0.92	0.945
Illustrations are relevant to understanding the content	3(23.1)	10(76.9)	1	1
Colors of illustrations are appropriate for the type of material	3(23.1)	10(76.9)	1	1
Shapes of illustrations are appropriate for the type of material	3(23.1)	10(76.9)	1	1
Illustrations portray the daily life of the target audience	4(30.8)	6(46.2)	0.77	0.498
Image arrangement is in harmony with the text	1(7.7)	12(92.3)	1	1
The images used elucidate the educational material content	4(30.8)	9(69.2)	1	1
Illustrations help in the presentation of the topic and are in a logical sequence	4(30.8)	9(69.2)	1	1
Illustrations are in an adequate quantity in the material	2(15.4)	11(84.6)	1	1
Illustrations are in adequate size in the material	3(23.1)	10(76.9)	1	1
Illustrations help in changing the target audience’s behaviors and attitudes	4(30.8)	6(46.2)	0.77	0.498

• *I-CVI – Item-level Content Validity Index; **p-value – binomial test; ***I-AVI – Appearance Validity Index for each Item.

In terms of appearance validity, the T-AVI was 0.95. Judges suggested adding images to all questions. Images were added to questions regarding practical aspects, such as identifying types of contraceptive methods. Other judges reported that many adolescents do not have access to the reality of illustrations and that it would be premature to state the potential for behavior change in illustrations, and did not suggest adjustments. Furthermore, there was no statistical significance in the binomial test for these items and they were considered valid.

Of the six judges who assessed the game quality, three (50.0%) were graphic designers; two (33.3%) were software developers; one (16.7%) was computer support analyst; three (50.0%) were specialists; two (33.3%) had master’s degree; one (16.7%) had a post-doctoral degree; three (50.0%) had worked in the area for at least two years; one (16.7%) had worked in the area for 12 years; one (16.7%) had worked in the area for 13 years; and one (16.7%) had worked in the area for 20 years. All judges were from the state of Pernambuco and had experience in game development; two (33.3%) had published articles in the area of educational games; and four (66.7%) participated in the process of assessing educational games. In assessment, five (83.3%) judges classified the game as good quality for educational purposes and one (16.7%) as excellent. The total score given by each of the six judges was 50, 54, 57, 60, 72 and 90 points. No suggestions for modification were recorded (Table 2).

Table 2
Serious game quality assessment by judges according to the dimensions of usability, user experience and learning principles

Indicators	Answers
	0	1	2	3	4	5
	n	n	n	n	n	n
Usability assessment
Does the player understand the gameplay from the buttons that are displayed on the screen?	0	0	0	0	3	3
Are the tutorials effective in helping the player understand the gameplay?	0	0	0	1	1	4
Will the players be able to achieve the proposed educational objectives?	0	0	1	0	1	4
Does the interaction with the game allow the user to explore the interface safely?	0	1	1	2	1	1
Do the challenges and information allow the player to do what they need and want?	0	0	0	0	4	2
Does the sequence of challenges in the game take into account what the player has already learned about how to play?	0	0	0	0	4	2
User experience assessment
Does the game’s aesthetics allow the player to explore their potential in a pleasant way?	0	0	1	2	1	2
Does the interaction with the game allow the player to encounter an attractive scenario?	0	0	1	3	1	1
When interacting with the game, does the player encounter a challenging narrative?	0	0	3	1	1	1
Does the interaction with the game allow the player to have a fun experience?	0	1	1	2	1	1
Does the game have challenges that gradually increase in complexity in a fun and motivating way?	0	0	2	1	2	1
Does the interaction with the game allow the player to encounter an engaging scenario?	0	0	2	2	1	1
Learning principles assessment
Does the game allow the identification of spaces that reflect the reality related to the game’s topic?	0	0	1	1	2	2
Does the interaction with the game allow the exploration of different learning strategies?	0	0	0	3	1	2
Does the interaction allow for fantasies and desires to be expressed in the gameplay process?	0	1	1	3	0	1
Does the game allow characters to be manipulated so that the game’s objectives are achieved?	2	1	1	0	1	1
Is the game intuitive and allows the player to explore new possibilities when they do not pass a level?	1	1	1	0	2	1
Are the challenges presented encouraging and do they provide feedback?	0	0	0	1	2	3

• 0 – Not applicable; 1 – Never; 2 – Rarely; 3 – Neutral; 4 – Frequently; 5 – Always.

Seven adolescents participated in game assessment by the target audience, of which five (71.4%) were 17 years old; one (14.3%) was 15 years old; and one (14.3%) was 14 years old; four (57.1%) had not completed elementary school and three (42.9%) had not completed high school. The menarche of one (14.3%) adolescent occurred at eight years of age, one (14.3%), at 11, two (28.6%), at 12, one (14.3%), at 13, and two (28.6%), at 14. One (14.3%) adolescent had her first sexual intercourse at 12 years of age, two (28.6%), at 14, one (14.3%), at 15, and three (42.9%), at 16. Regarding reproductive history, all were primiparous, one (14.3%) had her second pregnancy; four (57.1%) had had a normal delivery; three (42.9%) had a cesarean section; and one (14.3%) had an abortion. All adolescents agreed with 14 (87.5%) items of the assessment instrument (Table 3). Only two items were disagreed with. Participants suggested increasing image size, and this change was made. The comments recorded by adolescents were: “it’s really cool to play”, “it was great to play, I even got quite distracted” and “will there be another game later? I thought it was really fun”.

Table 3
Serious game assessment by adolescents according to appearance, language, playfulness and motivation

Items	Agreement
	Yes	No
	n(%)	n(%)
Appearance
Is screen size good for playing?	7(100.0)	0(0.0)
Do colors used in the game make it easy to read?	7(100.0)	0(0.0)
Is font size good?	7(100.0)	0(0.0)
Is the number of images good?	7(100.0)	0(0.0)
Is image location good?	7(100.0)	0(0.0)
Is image size good?	5(71.4)	2(28.6)
Do images make it easier for you to understand contraceptive methods?	7(100.0)	0(0.0)
Language
Is language clear?	7(100.0)	0(0.0)
Are the game rules clear?	7(100.0)	0(0.0)
Does the game help you understand the topic?	7(100.0)	0(0.0)
Playfulness
Did you learn anything new from the game?	7(100.0)	0(0.0)
Did the game make you reflect on your attitudes?	4(57.1)	3(42.9)
Is the game fun?	7(100.0)	0(0.0)
Did you feel motivated to keep playing during the game?	7(100.0)	0(0.0)
Motivation
Does the game encourage the use of contraceptive methods in the postpartum period?	7(100.0)	0(0.0)
Would you recommend the game to someone?	7(100.0)	0(0.0)

Discussion

As far as we know, “Pós-parto consciente” is the first serious game about contraceptive methods developed in Brazil for postpartum adolescents. This technology enables educational health activities with reduced costs, expanded teaching strategies and closer ties to digital health. ¹⁶ Considering the growth in smartphone use among adolescents, it is important that this technology be made available as a tool to prevent repeat pregnancies.

In this study, the theoretical basis of Schell’s Elemental Tetrad contributed to structuring the game elements, which allowed clarifying the educational strategy’s objective. Although there are other games on the subject, the adoption of a theoretical framework in their development is not unanimous. ¹⁸ Considering the game’s educational purpose, the use of theory in its development increases the possibility of achieving this objective and strengthens the potential for remodeling the target audience’s behavior.

Content validity demonstrated agreement among health judges. The technology addressed the proposed topic and contained clarifying information. These aspects were also considered in other technologies for adolescents. ¹⁴ This demonstrates the relevance of the topics covered and the importance of judgment on content, with a view to avoiding incorrect information or neglect of necessary information.

Among the topics covered, the approach to sharing responsibility for contraception between sexual partners stands out. This can encourage disseminating information between adolescents and their partner and prevent negligence in adopting protective reproductive behavior. The inclusion of confidential access to reproductive planning services is a differentiator in the game, since the fear of the lack of confidentiality and privacy can be a determining factor in adolescents’ difficulty in accessing contraceptives in health services. Incorrect reproductive attitudes of adolescents may be related to seeking information from peers, who expose personal experiences without scientific basis. ¹⁰ Emphasizing this information can encourage decision-making to seek professional help and avoid new pregnancy.

Content judges recommended using the terms “vaginal condom” and “penile condom”. Although there is no consensus in the literature on the use of this terminology, the recommendation aimed to include non-binary people as possible users of the technology. ¹³,³⁰ The change was made and it is expected that the game will follow the trend of using these terms.

Appearance validity allowed us to attest to the adequacy of the aesthetic and harmonic representation of technology elements. However, disagreement was identified in items related to illustrations. The technology used images of contraceptive methods, inserted to facilitate understanding of questions and visualization by participants. In this regard, illustrations should contribute to understanding, construction of meanings and aid in understanding together with the texts, as they are important elements in health education. ²⁵ It is therefore believed that, together with other elements of the game, illustrations can contribute to understanding the content.

Among the indicators that were not scored positively by technical judges, the item related to safe usability stands out. The attributes of a safe interface are related to the execution of commands, such as “save” or “back”. ²⁶ Planning considered the importance of not saving answers, as this function could reduce curiosity in returning to the content and limit the challenging nature of the game. Thus, to access the content, adolescents must answer the quiz again. Repetition represents a new opportunity for contact with the content. Negative assessment of items may be related to elements that could not be measured by judges.

When assessing the serious game by the target audience, excitement was observed in adolescents’ records. Experiencing emotions during educational activities is important, as it is an aspect that influences behavior. Excitement is associated with motivation, an important dimension in the educational process and an influential factor in learning. ³¹ The items on motivation had total agreement, which may indicate the potential of technology to instigate the search for new information. It is expected that the game will contribute to autonomy in decision-making regarding reproductive planning and new reflections for pregnancy recurrence prevention. Reflection has a protective function and encourages the adoption of new health practices or changes in behavior. ¹⁸ Reflections on attitudes may, however, require more time and other stimuli. However, obtaining knowledge itself can prompt new reflections.

Despite the existence of a serious game about contraception for Brazilian adolescents, the development was carried out with adolescent students, therefore, in a different scenario and population from the present study. ³² This study provides a new technological product for postpartum adolescents, developed based on a robust methodological and theoretical framework, with assessment by professionals from different areas and target audience assessment. In nursing practice, the serious game is, therefore, an educational technology option that can be implemented in obstetric care services. Its use can be encouraged by presenting the technology by a nurse or by accessing it via QR code, made available in strategic spaces of health services or on social media.

As a limitation, we highlight the inclusion of adolescents with similar demographic, economic and cultural characteristics, which may differ from the results of assessments in other cultures. New studies can be carried out to broaden technology assessment by the target audience in a different cultural context and to assess the game effectiveness on adolescents’ knowledge, attitude and practice regarding contraceptive methods in the postpartum period.

Conclusion

The serious game “Pós-parto consciente”, developed based on a consistent methodological and theoretical framework, was considered valid in terms of content and appearance through a Content Validity Index of 1.0 and a total Appearance Validity Index of 0.95. Assessment by judges attributed good quality to the game for educational purposes, and postpartum adolescents agreed with aspects of appearance, language, playfulness and motivation. The game, therefore, is a reliable resource to be used in health education about contraceptive methods for postpartum adolescents.

Acknowledgements

To the Coordination for the Improvement of Higher Education Personnel (In Portuguese, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES), with post-doctoral scholarship granted for Guilherme Guarino de Moura Sá).

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Edited by

• Associate Editor:
  Marcia Barbieri (https://orcid.org/0000-0002-4662-1983) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil

Publication Dates

• Publication in this collection
  13 June 2025
• Date of issue
  2025

History

• Received
  28 June 2024
• Accepted
  14 Oct 2024