Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: Quantitative Study

Abstract

Background The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote the safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually. Objective This study aimed to examine the effect of the SG MedSMART: Adventures in PharmaCity on adolescents’ opioid safety knowledge, awareness, behavioral intent, and self-efficacy. Methods A nationally representative sample of adolescents aged 12 to 18 years were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pregame survey, 30 minutes of gameplay, and a postgame survey. The pregame and postgame surveys included 66 items examining the participants’ baseline opioid knowledge, safety, use, and demographic information. The postgame survey had 25 additional questions regarding the MedSMART game. Gameplay scenarios included 5 levels intended to mimic adolescents’ daily life while educating the players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and the use of Narcan. Survey questions were divided into 10 categories to represent key concepts and were summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using the Kruskal-Wallis and correlation tests. Results A total of 117 responses were analyzed. The results showed significant improvement on all concept scores except for Narcan knowledge (mean change -0.04, SD 0.29; P=.60) and safe storage (mean change 0.03, SD 0.20; P=.09). Female participants had greater improvement than males for safe disposal (female mean 0.12, SD 0.25 vs male mean 0.04, SD 0.17; P=.05). Male participants had higher improvement than female participants for misuse behavior (female mean 0.05, SD 0.28 vs male mean 0.14, SD 0.27; P=.04). Perceived knowledge for participants who had non-White or Hispanic racial backgrounds had higher improvement than for non-Hispanic White participants (non-White mean 1.10, SD 1.06 vs White mean 0.75, SD 0.91; P=.03). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23, 95% CI -0.40 to -0.05; P=.01). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy. Conclusions Our findings suggest MedSMART: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized controlled trial. Additionally, the feasibility of implementing and disseminating MedSMART: Adventures in PharmaCity in schools and health care settings such as adolescent health or primary care clinics, emergency departments, and pharmacies should be investigated.

An Overview of the CRoME Lab’s MedSMA℞T Families Intervention for Promoting Opioid Medication Safety among Adolescents and Parents

“…Results from 117 adolescents demonstrated improvement in key concepts across gender expression, race, ethnicity, and other socio-economic factors. 24 All concept scores measured in this study (via the AOSL) improved except for Narcan knowledge and safe disposal. This effect remained whether the player had completed the game or not (67/117, 57.3%).…”

Evaluating a health system‐wide opioid disposal intervention distributing home‐disposal bags

“…Prior studies have found seasonal trends in opioid prescriptions and prescription opioid-related overdoses and suicides. [53][54][55] Our study has several limitations. First, we relied on participants to report their disposal behaviors and accurately self-report their T A B L E 3 Univariable and multivariable modified Poisson regression analyses examining prescription opioid disposal among survey respondents with leftover prescription opioids that were filled at a health system pharmacy.…”

“…Finally, there may be a seasonal trend in disposal though more data is needed. Prior studies have found seasonal trends in opioid prescriptions and prescription opioid‐related overdoses and suicides 53–55 …”

MedSMA℞T Adventures in PharmaCity Game: Youth Experiences and Recommendation for Use in Opioid Safety Education

“…Initial playtests engaged AYAs to refine the game's prototype, demonstrating the salience of game objectives and early acceptance of this intervention in terms of design features and realism [36,37]. Further evaluation with a national sample of youth demonstrated that MedSMA T can improve adolescents' opioid knowledge, prescription disposal knowledge, behavioral intent, and self-efficacy related to opioid safety behaviors [38]. The study team also engaged with pharmacists, eliciting their feedback on the game, its contents, and implementation factors.…”