title: A Systematic Review and Meta-analysis of Interventions for Sexual Health Promotion Involving Serious Digital Games.
abstract: OBJECTIVE
  Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games.
  
  
  METHODS
  A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included.
  
  
  RESULTS
  Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback.
  
  
  CONCLUSIONS
  The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants.
authors.affiliation: 1 Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium .
authors.forename: Ann
authors.initials: A
authors.lastname: DeSmet
authors.affiliation: 2 Center for Health Promotion & Prevention Research, School of Public Health, University of Texas , Houston, Texas.
authors.forename: Ross
authors.initials: R
authors.lastname: Shegog
authors.affiliation: 3 Department of Experimental-Clinical and Health Psychology, Ghent University , Ghent, Belgium .
authors.forename: Dimitri
authors.initials: D
authors.lastname: Van Ryckeghem
authors.affiliation: 3 Department of Experimental-Clinical and Health Psychology, Ghent University , Ghent, Belgium .
authors.forename: Geert
authors.initials: G
authors.lastname: Crombez
authors.affiliation: 1 Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium .
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
mesh_terms: D000293:Adolescent; D000328:Adult; D005246:Feedback; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control; D060728:Reproductive Health / Q000193:education*; D012201:Reward; D021841:Safe Sex; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012985:Software Design; D018910:Video Games / Q000523:psychology*; D055815:Young Adult