Pass it on: A game about vaccine hesitancy

link to the description video

With "Pass it on", we wish to tackle vaccine hesitancy by developing a video game that trains communication skills. The player is a health worker whose mission is to address the questions and fears of the population. We would like our project to take place within a framework of Open Science and Citizen Science.

Shoot us a message if you want to join ! We are still in the early stages but many talents will be welcome: Coding, Game design, Graphic design, Biology, Psychology, Social sciences, Public health, Health communication etc

The three main rationales behind this project are the poor communication from healthcare workers, the complex and context-specific nature of vaccine hesitancy and the common assumption that individuals are either pro or anti-vaccines. 

Delivering information on vaccine benefits and on the consequences of avoiding vaccination do not necessarily change behaviour (Goldstein et al. 2017). Anti-vaccination views are grounded in a context specific to the individual (MacDonald 2015). The health practitioner must be able to attend to the patient’s concerns with empathy, understand the person’s environment, personal history (Goldstein et al. 2017) and adapt the pro-vaccination discourse accordingly.

Designing and implementing a soft skills training program which encapsulates the complexity of vaccine hesitancy and delivers concise information is both complicated and costly, therefore limited in availability. Our project aims to tackle this problem in a unique way: training through a role playing video game, freely available. Furthermore, the game play is designed in such a way that the general population will also enjoy it, which will expose them in a fun way to carefully curated information about vaccination (to prevent the usual information overload, the usual flyers with statistics, the usual fear inducing messages etc). 

We propose a role-playing video game where the player is a health worker whose mission is to allay fears and tackle vaccination hesitancy. Role-playing is commonly used in communication skills teaching (Baile and Blatner 2014). Our game will expose the player to public opinion fluctuations (e.g. an increase in vaccination refusal following a celebrity’s blog post), as well as patients individual differences. The health practitioner encounters different personality types, different life environments and various personal histories. This approach offers an insight into unspoken thoughts, attitudes and emotions, thus encouraging strategic flexibility and the development of rhetoric and socio-emotional skills.

To ensure the accuracy of the information presented, our team will perform the necessary literature review to identify the determinants of vaccine hesitancy and methods for soft skills training. We will also construct a model of personality types relevant to attitudes towards vaccination, with the help of psychology / social sciences specialists. 

Further considerations are affordability and scalability. A digital training is easy to distribute, can be updated to accommodate new information and can collect data and feed it back into the system for further analysis or improvements. Furthermore, it can automatically detect the location and adapt messages accordingly. 

Finally, to ensure our game offers an engaging experience, we will collaborate with a game development expert. 

Common approaches for training soft skills in healthcare practitioners involve slides presentations, handbooks (e.g. “Best practice guidance //How to respond to vocal vaccine deniers in public” produced by the World Health Organization, available online), video tutorials or a combination of the two (ECDC, 2017; Vyas et al. 2017). These methods are not sufficiently interactive and immersive and it is difficult to incorporate all the complexity of vaccine hesitancy into theoretical lectures. Face-to-face mentoring is sometimes employed too, but it requires skilled trainers (not available everywhere) and it is time consuming and costly. 

For reaching out to the general population, the common methods are oral presentations, booklets, blog posts, interviews (e.g. the PromoVac study) etc. These interventions are performed by various organizations (World Health Organization), NGOs (Vaccinate your Family) or government institutions.

Our approach is a video game aimed both at the healthcare practitioners and the general population. Gamification is increasingly used for health care training (Wang et al. 2016). Large conferences on this topic are being organized in the USA (Games for Health, https://gamesforhealth.org/) and in Europe (http://www.gamesforhealtheurope.org/). Furthermore, digital games development no longer requires large teams of computer games specialists. With the proliferation of game engines (Unity, Godot, Unreal etc) which aim to implement the concept of making games with minimal coding, it became much quicker, easier and affordable to develop a digital game.

We have assembled the team who will develop the project: 

• Jeanne Bonnel (project leader, Biology 4 year MSci, Learning Sciences MSc student). Jeanne is also skilled in graphic design and is studying game design.
• Mihaela Grigore (computer science BSc, entrepreneur, Cognitive Science Research Master alumnus, Learning Sciences MSc student). Mihaela will handle game development, community building and reach out.
• Thea Chrysostomou (Biomedical sciences BSc, Life Sciences MSc student). Science expert and promoter of vaccination practices.
• Selim Ben Slama (Biology BSc, Digital Sciences MSc student). Voice of the team and game developer. 

We have also identified and confirmed the availability of a game design consultant for our project: Mourdjen Bari, game designer teacher at CRI Paris. 

We are in the process of finalizing the literature review for identifying vaccine hesitancy determinants and intervention strategies.   

Below is our 6-month plan for developing our project:

• First month: finalizing the literature review, identifying the psychologist / social science consultant. 
• Second month: conceptual development of the game (game design, art concept, narrative, incorporating best practices from theory of learning), identifying the game engine for implementation, starting the game development (programming), reaching out to partners through which we can deploy the game prototype for testing purposes.
• Third month: game prototype development, identifying the platform(s) where the game will be publicly available for download, identifying mechanisms to scale up. 
• Fourth month: testing the game prototype and incorporating the feedback.
• Fifth month: finalizing the game and making it publicly available for download.    

Our project aims to align with the directions outlined by recognised institutions, public health agencies and international organisations, such as the recommended actions for training by the World Health Organisation (2013) in the Global Vaccine Action Plan 2011-2020 .

In order to produce an evidence-based successful pedagogical product, we would like to collaborate with research organisations to use and expand current data and statistics, as well as to test models from the literature for vaccine determinants and soft skills training.  

Through Open Science and Citizen Science, we hope to ensure that the game remains close to the real concerns of the general public and the health care systems and providers to best answer their needs. Data collection can be done through crowdsourcing as the game is digital and online. Via questionnaires, focus groups and the structure of the game itself, we hope to open the processes of data analysis and problem definition too. Citizens may also engage with the project via crowdfunding or by joining the development team.

We will be monitoring the number of partners interested in trying our game as part of their campaigns to promote vaccination and in their training of medical staff.  

We will be collecting feedback both directly from our partners and through our partners from the beneficiaries of our training (e.g. focus groups). We will also incorporate a feedback mechanism into our game, as a questionnaire to be presented when the player has finished the game.

Once the game is deployed and freely available online, we will monitor: the number of downloads, the number of people who finished the game and whether they were health care professionals or members of the general public. We will also assess vaccine related knowledge prior and post-game experience (especially informative in the case of general public players).

Our project is a video game soft skills training. The ethical considerations in this case are the careful depictions of vaccine hesitant individuals (e.g. to avoid derogatory personifications) and our possible contribution to an increase in screen time. We will design our game such that we only include elements we consider relevant for understanding vaccine hesitancy and for training interventions and we do not increase the game duration unnecessarily.

For the next 6 month our project will be developed by the voluntary work of our four core team members. 

Our project leader (Jeanne Bonnel) will be working as a game design intern for 6 months starting in February 2020 under the supervision of our game development advisor, Mourdjen Bari. In this setup, she will be able to contribute (alongside Mihaela Grigore and Selim Ben Slama) to the game development.  

Thea Chrysostomou is already involved in projects for promoting vaccination in African countries and travels there for workshops. She will be able to promote and organize trials for our game as part of her already existing commitments. 

Lastly, our game will be open source. The source code will be published and documented on GitHub and our communication strategy will encourage contributors to join our efforts in game development.

The JOGL page will help us with needs, documentation and possibly the practice of open notebooks.

We will be using different communication media:

• Instagram, Twitter, Facebook, Youtube (JOGL, AIRE Master, CRI)
• GitHub (open source and community)

Through these, we can get credibility to contact stakeholders. Consequently, the networks, platforms and media of potential partners will be key for communication. 

In addition, we are considering a crowdfunding campaign, not only for funding, but also for dissemination and attracting new members. It will be strategic to identify crowdfunding partners that have increased visibility in health and are relevant for donation-based funding (as opposed to reward- , debt- or equity-based), as the project is not-for-profit.

External funding would allow the team to dedicate more time to the project. Hence, during the 6 months of project development we will also try to identify and apply for funding opportunities (call for projects from government institutions, European Commission, the Association for Prevention Teaching and Research, European Centre for Disease Prevention and Control, Crowdfunding). As mentioned above, we will work to identify opportunities for donation-based funding.