Objective: The
purpose of this study was to explore the design of a health game that aims to
both support tobacco-related health literacy and a tobacco-free life in early
adolescence, and to meet adolescents’ expectations.

Materials and Methods:
Data were collected from adolescents using an open-ended questionnaire (n=83) and
focus groups (n=39) to obtain their view of a health game used for
tobacco-related health education. The data were analyzed using thematic
analysis. A group of experts combined the adolescents’ views with theoretical information
on health literacy and designed and produced the first version of the game. Adolescents
(session 1, n=16; session 3 n=10; session 4 n=44) and health promotion
professionals (session 2, n=3) participated in testing the game. Feedback from
testing sessions 3 and 4 was analyzed using descriptive statistics.

Results: Adolescents
pointed out that the health game needs to approach the topic of tobacco
delicately, and focus on the adolescents’ perspective and on the positive sides
of a tobacco-free life rather than only on the negative consequences of tobacco.
The adolescents expected the game to be of high quality, stimulating and
intellectually challenging, and to offer possibilities for individualization. Elements
from the adolescents’ view and theoretical modelling were embedded into the
design of a game called Fume. Feedback
on the game was promising, but some points were highlighted for further
development.

Conclusion:
Investing especially in high-quality design features, such as graphics and
versatile content, using humoristic or otherwise stimulating elements, and maintaining
sufficiently challenging gameplay would promote the acceptability of theory-based
health games among adolescents.