Transmedia Stories: Narrative Methods for Public Health and Social Justice

Narrative Video Games

The ways that we work and communicate, research and learn, socialize and romance, conduct our finances and communicate with our governments, are all intimately intertwined with complex systems of information — in a way that could not have existed a few decades ago. For such a systemic society, games make a natural fit. While every poem or every song is certainly a system, games are dynamic systems in a much more literal sense. From Poker to Pac-Man to Warcraft, games are machines of inputs and outputs that are inhabited, manipulated, and explored.

—Eric Zimmerman (“Manifesto for a Ludic Century”)

If the key to compelling storytelling in a participatory medium lies in scripting the interactor, the challenge for the future is to invent scripts that are formulaic enough to be easily grasped and responded to but flexible enough to capture a wider range of human behavior than treasure hunting and troll slaughter.

— Janet Murray (Hamlet on the Holodeck: The Future of Narrative in Cyberspace)

To many people, video games remain at best a lightweight entertainment form and at worst a medium responsible for ills such as escapism, addiction, violence, procrastination, and asocial behavior. Given these types of common criticisms, to create a prosocial video game might already seem a contradiction in terms. Additionally, the content element of a game that is specifically about sexual violence, as the cases in this chapter in fact are, might strike a dissonant note. How could one play with a topic that is as serious, terrifying, and difficult to talk about as sexual violence? How could one use the leisure activity or trivial pastime of gameplay to intervene within a topic that is the source of so much suffering and trauma? And then how could a game combine storytelling and interactive elements to address such a serious topic?

This chapter tells the story of a multi-year process during which Ci3’s Game Changer Chicago (GCC) Design Lab took on the task of designing a video game about sexual violence with and for young people. This is not a perfectly teleological narrative: one focused on a final product that explains and justifies the process that led up to it. Instead, our lab was interested in learning from experimental glitches and failures, a process we have followed in many of our programs, including the ongoing multi-year Hexacago Health Academy initiative in which we co-create board games about health topics (such as unplanned pregnancy, sexually transmitted infections, childhood obesity, food insecurity, drug and alcohol use, and structural violence) with youth, integrate these games into educational curricula, and evaluate their efficacy.

Looking back on several years of game design, we followed a process that itself might have value in demonstrating the usefulness and meaningfulness of video games to a field such as public health. Building on the more linear narratives in Chapter 2, this chapter expands the scope of transmedia storytelling by considering the multilinear and participatory category of narrative video games and what this form, as a method of social intervention, might bring to the field of public health and social scientific thought, as well as education, more broadly. While the games we discuss can be understood as digital narratives, they also introduce medium-specific elements of games, such as rules, mechanics, and objectives.

Following a short overview of the expanded role of narrative in games and the rise of the category of serious games in the twenty-first century, this chapter turns to the more focused topic of how narrative games can be used as a participatory and research intervention. Unlike the other chapters, which focus on one core case each, the analysis in this chapter is organized around two case studies that include Lucidity (2013) and Bystander (2014-2016): video game prototypes created by the GCC Design Lab to tackle issues of sexual violence and sexual harassment. This sequence of cases is meant to demonstrate adjustments in process and methods that we have developed, across programs that shared a similar goal. First, Lucidity was the outcome of a collaborative process of discovery in which adult designers co-created a DIY video game based on narratives crafted by high-school-aged youth. The workshop that yielded this game subsequently informed our move toward an intervention designed not merely to raise consciousness but to shift behavioral outcomes. Second, Bystander offers a different model of “participation.” Instead of focusing on youth-created work, this game was designed and developed, first and foremost, by the university-based GCC team but in consultation with youth who represented members of the imagined ideal player base. This mode of user-facing experience design did not begin with youth-created raw material, but instead asked youth to respond to and influence the construction of the narrative, the dialogue, and the style of a game designed by adult designers. In addition to this textual argument made in this chapter, we also include a short documentary video of the Lucidity workshop and both photos and GIFs that feature game mechanics and key features of levels from the Lucidity and Bystander games.

Though the cases in this chapter are digital games, in the conclusion, we turn briefly to how this process informed the flexible analog game design process in our Hexacago Health Academy initiative, which focused on first-order system design through a series of board and card games. We hope this short example demonstrates how narrative game design can be used as a method even without expertise in digital development. Finally, this chapter makes a case for narrative games, in general, as a promising method in areas such as sexual and reproductive health research and public health.

graphic section header: narrative games

Game designers and educators Katie Salen and Eric Zimmerman produce a composite definition of a game based on a survey of definitions from game designers and experts, including David Parlett, Johann Huizinga, Roger Caillois, and Bernard Suits. They ultimately describe a game as “a system in which players engage in an artificial conflict, defined by rules, that results in a quantifiable outcome” (80). This definition of games might direct us most readily toward strategy board games such as Go or chess, parlor games such as charades or “twenty questions,” or simulation video games such as Grand Prix Simulator or SimCity. Each of these games, whether analog or digital, is a system that engages players who use mechanics and act within rules in pursuit of objectives or victory. Yet beyond basic roleplaying or temporal sequencing, none of these games focus heavily on storytelling. Indeed, even if we look toward a broader set of video games, we see that games ranging from Tetris (1984) to Candy Crush Saga (2012) to Baba is You (2019) include anywhere from no narrative to a small degree of decorative storytelling. The fictional scenarios in these games are not the centerpiece of each experience, and they do not put forward elements such as well-drawn characters or navigable storyworlds. Such games are primarily procedural, rule-based, and objective-oriented. So, then, why would we be interested in games in a book about narrative methods?

Notably, the humanistic field of game studies has itself resisted the role of narrative in video games, at least in its early years. One of the originating conflicts within the field, occurring around the late 1990s and early 2000s, had to do with the approach of ludology versus narratology. The ludologists — including scholars such as Espen Aarseth, Markku Eskelinen, Gonzalo Frasca, and Jesper Juul — contended that game studies needed to differentiate itself from other fields such as literary studies or film studies. Ludology insisted on the medium specificity of games that made them distinct from print or screen oriented narrative. To these scholars, the study of games had to be a formalist discipline that could focus on game mechanics and rules as its core elements of study. These turf wars were a response to early new media studies research, especially from literary and performance scholars such as Janet Murray and Brenda Laurel, who treated digital games as an extension of narrative and theatrical drama.

The point of this chapter is not to revivify this scene of disciplinary disagreement — one that looms larger in the imaginary of contemporary scholars than it did at the moment of its genesis (Jagoda and Malkowski). Nevertheless, it is worth noting that the dismissal of narrative as a core element of game studies might fuel resistance to thinking of game design as also serving as an instrument that might be part of the toolbox of someone who wishes to use narrative methods for research interventions. In fact, if we look back at the history of video games, we see extensive evidence of narrative as one of their core elements. More than that, we see video games as a zone of creative experimentation with narrative as it enters a digital, networked, and transmedia ecology.

Even some of the earliest video games, such as Spacewar! (1962) included light narrative premises or frameworks that drew on established genres and invited players to imagine their own stories. Some of the earliest digital games with extensive narratives included text adventure games such as Colossal Cave Adventure (1976), Zork (1977), and Trinity (1986). Beyond single-player experiences, multiplayer text adventure games, called MUDs, or multi-user dungeons, such as MUD1 (1978) and AberMUD (1987), also introduced multiplayer narratives to the space of video games. Without offering a systematic account of narrative in games (which would require its own book and already appears in other scholarship), it is also easy to see that many popular video games have narrative dimensions (Jagoda 2018). To take a well-known example, The Legend of Zelda (1986) tells the story of Link, who traverses Hyrule in search of the Triforce and searches for Princess Zelda who has been kidnapped by the evil Ganon.

Many earlier video games offer little more of a narrative premise or backdrop to gameplay. In the 1980s and 1990s, complex narratives were arguably more common in Japanese roleplaying video games such as Dragon Quest (1986, also published in North America as Dragon Warrior) and Final Fantasy (1987) than in their U.S. counterparts. By distinction to early computer or console games, many popular or acclaimed video games from the twenty-first century, even coming from the U.S., rely heavily on narrative. Some of the most commonly discussed examples include Neverwinter Nights (1991), Baldur’s Gate (1998), Bioshock (2007), Mass Effect (2007), Heavy Rain (2010), Red Dead Redemption (2010), The Walking Dead (2012), The Last of Us (2013), Life is Strange (2015), and Disco Elysium (2019). This short list of high profile games is by no means anomalous and certainly nowhere near comprehensive. Complex storytelling has become more intricately integrated into video games in general. Games across genres convey their stories through character and avatar development, world exploration and spatial storytelling, and decision-making and strategy that determines key narrative branching and outcomes. In other words, there is now good reason to be interested not merely in the role of narrative in video games, but in video games as a medium for telling stories in fundamentally new ways that depend in choice, interface interaction, and participation. Storytelling has been an equally important aspect of the other category that I would like to introduce here: serious games.

graphic section header: serious games

Along with the development of narrative video games, the twenty-first century has also seen the expansion of another approach to games that is crucial to understanding why it would be possible to develop a video game about sexual violence: that is, the serious game. In 1970, Clark C. Abt coined the term “serious game” and contended that a game need not be merely a leisure activity but can also be a way of thinking, experimenting, and solving problems. In the 1960s and 1970s, game-based interventions were largely pen and paper, card, and board games or live-action simulations that might be applied to areas such as education, government, and occupational training. There is also a longer specific history of military uses of games for scenario planning and pedagogy that goes back to Prussian war games such as Kriegsspiel that were developed in the nineteenth century (Peterson). By the twenty-first century, this approach to games had blossomed into a broader constellation of digital game-based social, educational, and political interventions.

A common question raised about serious games is whether they can be both topically serious and  “fun” at the same time. Elsewhere, I have argued that fun often privileges consumer categories such as satisfaction or gratification (Jagoda 2020). Fun is also analytically imprecise insofar as one person's idea of fun might be tedious or uncomfortable to another. Moreover, Amanda Phillips has argued that fun was used amidst the #GamerGate culture wars to mark a purity that “'real' gamers” might engage in as opposed to organizations that duped people into “playing terribly crafted but ideologically innovative games” (9). Without rehearsing the details of this debate, it is worth noting that serious games, at their best, can be both intellectually and mechanically engaging, both informative and fun. Of course there are educational and serious games that amount to little more than interactive quizzes, but that arguably has more to do with flawed design than any inherent shortcoming of the category of games.

To highlight one of the best known earlier serious video games, we might consider The Oregon Trail. Originally developed in 1971 and released in its fully graphical form in 1985, this game invites the player to control a party of settlers that sets off on a journey that exceeds 2,000 miles, leading from Independence, Missouri in 1848 to Oregon’s Willamette Valley. You bring equipment, supplies, and money with you and begin an emergent narrative. At every turn, the player faces challenges such as thieves who steal your supplies, wagon damage that prevents progress, or cholera that kills party members. As a roleplaying game, The Oregon Trail allows the player to select their primary identity (e.g., a banker from Boston or a farmer from Illinois) and the names of all five members of their party. Each in-game day, the simulation gives you information about the state of the world (e.g., the weather, your party's health, your pace, and your rations) and gives you a series of actions from which to choose (e.g., continue on the trail, check supplies, change food rations, or attempt to trade). Throughout the experience, you navigate a series of text menus and engage in occasional mini-games. This serious game offered an interactive history lesson that used historical research to inflect the probabilities of different events occurring. Several versions of the game moved from the original 1971 build created by Don Rawitsch — a history teacher who eventually collaborated with the Minnesota Educational Computing Consortium (MECC) — to the most commonly played 1985 graphical version for the Apple II computer that was developed by designer R. Philip Bouchard’s team. Already, with this case, we see the complex trajectories and collaborations necessary to combine content knowledge (e.g., history lessons) with an engaging design (e.g., a simulation game with an emergent narrative). Though Oregon Trail is an early example of a broadly circulated serious game, this field has expanded in the twenty-first century with companies like Filament Games, which has completed over 160 games about topics such as the Bill of Rights, English language literacy, plant growth, and basic mathematics.

Beyond video games focused on specific educational curricula in disciplines such as history or science, other serious games have focused on areas of cultural, social, or political advocacy. One game that received considerable critical acclaim was the puzzle-platformer Never Alone or Kisima Inŋitchuŋa (2014), which explores indigenous culture through an interactive version of an traditional Iñupiaq story. At the level of development, the game was a collaboration between the Cook Inlet Tribal Council and the educational game company E-Line Media. In other words, the game relied on the expertise of people who were intimately familiar with Iñupiaq narratives and traditions, but also paired them with game designers and artists who had experience in the medium. This story sought to share indigenous stories in an interactive format and popular game genre that would be accessible to younger players.

When the GCC Design Lab began exploring games about sexual and reproductive health, we found several serious games in the space of public health that were aimed at a variety of audiences. A few examples of these games include a decision-making narrative game about adult communication concerning underage drinking (Start the Talk, Kognito), a mobile roleplaying game that seeks to increase adherence to prescribed medication and promotes behavior awareness among HIV-positive men and trans women between the ages of 16 and 24 who have sex with men (Epic Allies, BATLab), and a roleplaying game that raises awareness about sexually transmitted infections and sexual health for an audience of youth in Swaziland (Swazi Yolo, Formula D Interactive).

A smaller number of existing games also included associated research about the effectiveness of the game in changing attitudes and behaviors of players. One example of a game that was created along with a Randomized Controlled Trial is HopeLab’s action game Re-Mission. This third-person shooter video game has the player guide a nanobot that moves through a human patient in order to help them fight cancer. The game is designed to help young cancer patients learn about the disease and its treatments, and to take an active part in combating their cancer. In a study of 375 cancer patients from the ages of 13 to 29, a two-year trial discovered 70% quicker acquisition of cancer-related knowledge, a three-fold increase in cancer-related self-efficacy, and greater adherence to prescribed medication among patients who played Re-Mission as compared to a control group (Kato et al.).

Serious games, which raise consciousness or seek to change behaviors, are also connected to the prominent category of gamification. This term names the use of game mechanics in traditionally nongame activities, which attempt to impact areas such as education, consumption, military training, fitness, and productivity management. Gamification often relies on extrinsic motivation achieved through data tracking, points, badges, and rewards (Reeves and Read; Hunter; Zichermann and Linder; Zichermann and Cunningham). Though this approach has become a highly visible and widespread dimension of serious games, GCC has been interested in challenging certain precepts of gamification by creating games that rely more on intrinsic than extrinsic motivation, and carefully integrate learning objectives into games that are mechanically engaging (Jagoda 2020). Even so, it is worth acknowledging that elements of gamification still find their ways into our designs. To show how we have attempted to combine narrative and serious games in addressing sexual harassment and violence, I now turn to two cases of development workshops and final narrative game designs.

graphic section header: case one: lucidity, an interactive story

Given the longer history of serious games I just reviewed, the idea of a video game about sexual harassment and sexual violence might no longer appear as absurd to readers not previously familiar with the field. Even so, attempts to make interactive experiences about this topic have been limited. Perhaps the most common approach appears in online sexual harassment modules that are now common in institutions of higher learning and workplaces. Such training often asks participants to read narrative excerpts or to watch short videos and subsequently to answer questions about appropriate behavior, usually from a legalistic perspective. While such training modules are not games per se, they incorporate interactive tools in the service of learning and compliance. Some studies of sexual harassment prevention training, for instance, have found that such an approach is ineffective or even has a negative effect on the attitudes of users, especially cis men, who may be inclined to harass women (Robb and Doverspike; Frank and Kalev). Beyond this more common training, there have also been examples of serious games that approach sexual harassment and violence. One example of this kind of game is Decisions That Matter (2015), an interactive narrative game that seeks to teach incoming undergraduate university students about sexual assault on campus.

The emphasis on sexual harassment and violence training usually starts at the university level and extends out into workplaces. While these are important sites, our work at GCC began with the recognition that sexual violence was not merely a problem that began in college, but that impacted youth at earlier moments, especially in high school and even as early as middle school. Of all sexual assaults, the majority happen among younger people with 54% occurring between the ages of 18-34 and 15% between the ages of 12-17 (Department of Justice; Rape, Abuse & Incest National Network). One survey on sexual violence in seventh through twelfth grade found that 56% of women and 40% of men reported experiences with unwanted sexual comments or touch (Hill). Other surveys found a prevalence of violence within romantic relationships. Among 68.6% of students in grades 9 to 12 in the U.S. who dated in the 12 months prior to one survey, 9.6% had been purposefully physically hurt and 10.6% had been forced to do sexual things they did not desire by their dating partner (Kann et al.). This problem had not abated by the end of the 2010s. The U.S. Education Department discovered that reports of sexual violence at K-12 public schools increased from about 9,600 in the 2015-2016 school year to nearly 15,000 in the 2017-2018 school year (Civil Rights Data Collection). While there is research on successful curricular components that can combat sexual violence and harassment, minimal data exists regarding the content and prevalence of sexuality education in middle and high school contexts (Schewe; Wolfe et al.; Eisenberg et al.). Factoring in varied state requirements across the U.S. suggests that such education is limited at best.

Given this uncertain and unsatisfying state of sexual education across the U.S., in 2012, we set out to co-create a game about sexual violence with a group of youth through a workshop hosted by GCC at the University of Chicago. Most serious games are created in a top-down manner by game companies or university design labs for end users to experience. Some of these games benefit from focus groups in which potential end users inform design and development, as well as playtesting later in the process. For example, the frame of “gamification,” which I discussed in the previous section, usually assumes a top-down approach, informed by behavioral economics, which nudges participants toward behaviors that have been identified as favorable by designers (Thaler and Sunstein).

Given the charged and difficult nature of the topic of sexual violence and harassment, our design team did not want to presume to know precisely what high-school-aged youth should be learning or more importantly how they might best learn about this topic. In working through this set of issues, the GCC team developed the Lucidity workshop. This program was as focused on the feasibility and acceptability of the process of using gameplay and storytelling to approach sexual violence as it was on the game that would be the outcome of the shared work. Designers in the GCC Lab aimed to collaborate early and substantially with youth in the creation process of this game by drawing from conceptual models such as “participatory design,” “design thinking,” and “human centered design” that recommend incorporating people affected by the core design issue into the development of responses or solutions (Asaro; Brown; IDEO). As I discuss in the introduction of this book, we also complicated these models in a variety of ways. By co-designing games with young people, we sought also to operationalize asset-based frameworks, such as Positive Youth Development, in order to engage youth as valued and meaningful partners in research that concerns their lives and well-being (Bernat and Resnick; Catalano et al.). The intervention focused on skills such as storytelling and media making, as well specific content about sexual and reproductive health. We worked under the conviction that storytelling can elicit understanding, involvement, and a sense of agency; media creation can sharpen twenty-first century literacies; and discussing sexual and reproductive health topics can increase content knowledge and self-efficacy (Pellegrino and Hilton).

For this project, which came to be known as the Lucidity game, we recruited eleven African-American and one Latino participants (seven female and five male) from high schools and youth-serving programs in Chicago for a three-week workshop that took place in July 2012. Participants worked with GCC Lab staff who included a creative writer to develop the multimedia narrative, a game designer to prototype games, and a filmmaker to create videos and voiceovers. Our method involved a series of sessions that sought to make the topic of sexual violence salient to our audience and collectively to develop the game itself. Before beginning work on the digital game itself, we focused on four primary session types:

Even prior to explicit game design, these informal narrative-oriented sessions yielded several elements that we included in the final game. For example, in a storytelling session, one workshop student revealed that he split his family time between his father in the suburbs and his mother in the city. Young people wanted to include this type of family arrangement in the story, so it became a part of the protagonist's life narrative and a theme within a mini-game. In addition, we tasked a small group with researching reproductive health differences between youth in cities versus in the suburbs, after which the full group discussed disparities in sexually transmitted infection rates by neighborhoods. By drawing from stories and reflections shared by young people of color — an under-represented group in video games and other media, even more at the time of the workshop than at the time of this book's publication — the characters and situations in the game reflected concerns that would be significant to the workshop participants’ peers. Moreover, concrete details from personal stories further motivated research, which might otherwise have seemed abstract or irrelevant to the lives of participating youth.

Discussions and prototypes from the workshop informed a core narrative and four mini-games that became modules of Lucidity: a web-based, multimedia game with a multilinear narrative and two possible endings. The finished game took a player approximately 45 minutes to complete, including the story elements and all four mini-games, which are necessary to make progress to the ending. The overall experience is composed of four mini-games within different gameplay genres, including a room-escape puzzle, a point-and-click adventure, an educational fill-in-the-blank challenge, and a three-dimensional maze.

The Lucidity transmedia game approaches sexual and emotional health through a single narrative made up of video, photography, comics, websites, digital games and other media. The GCC Design Lab team co-authored and post-produced the game based on stories and assets created by youth participants. This video of the Lucidity workshop and game was originally published by "Audiovisual Thinking: The Journal of Academic Videos." As of the time of this book's publication, the journal is no longer online and the video is not accessible in its original location.

Narratively, Lucidity tells the story of a young Black woman, Zaria, who loses her capacity to dream for many years, following a traumatic event. To her surprise, after an intense conversation with a fortune teller that initiates the game, she unexpectedly begins to dream again. These dreams return Zaria to several periods in her life: adolescence, young adulthood, and the present day. The narrative is communicated entirely from Zaria’s perspective, and moves back and forth among different time periods to reflect the constructive process of memory and procedures of working through trauma. The player must make sense of the fragmented story by traversing a series of media — reading text and comics, watching videos, listening to audio clips, playing short mini-games, and navigating websites. This transmedia experience makes up a single narrative about Zaria’s past. The voice of the adult Zaria serves as a mechanism for embedding information about sexual assault and guiding the player through her past experiences while also modelling healthy communication and decision-making skills. By the end of the game, the player learns about a traumatic event in Zaria’s early life: as a teenager, Zaria was sexually assaulted by her boyfriend, Rico, who was later killed, complicating her ability to process and gain closure. Zaria suppresses this memory until, later, she is diagnosed with an unrelated sexually transmitted infection. This event leads her to think back, associatively, upon her past and its connection to her present, and to face the future consequences of her trauma. Each mini-game advances the narrative. One mini-game takes place in her teenage bedroom; a second, in her neighborhood on the night she was sexually assaulted; a third, during her visit to the doctor’s office; and a final dreamlike and surreal maze, in which the player helps Zaria choose her future path by deciding between two major life choices.

While the youth workshop directly shaped the key themes and elements of Lucidity, much of the design and development — including asset creation, assembly, and refinement — took place among professional GCC faculty and staff following the workshop. In those months, the lab designers finalized the narrative, designed and programmed puzzles, created graphic novel pages, recorded additional voiceovers, and embedded links to external websites. Design team professionals with expertise in sexual and reproductive health and rights and young people’s development selected links to well-established local and national resources on relevant topics (e.g., the U.S. Rape, Abuse and Incest National Network website). The game encouraged players to access these websites for aid in completing game challenges, as well as additional independent learning about sexual health and assault. Following production, a medical doctor and social worker reviewed content for medical accuracy and created content warnings about language, images, and audio that might be difficult for some players. After this process, the final Lucidity game and launched online in late 2012.

Though this section of the chapter has focused on the game production workshop, we have written elsewhere about research results regarding the efficacy of the Lucidity game (Gilliam, Jagoda, et al). To briefly summarize the procedure and results, we administered a pre-game questionnaire, the gameplay intervention itself, and a researcher-facilitated focus group for twenty-four young people between the ages of 14 and 18. We then asked participants to play Lucidity again at home. Seven to fourteen days after the initial session, researchers contacted each participant for an approximately ten-minute follow-up telephone interview. Twenty-three of these participants responded (nineteen participants were African-American and 16 were female). This follow-up communication gave us an opportunity to find out whether players had reflected upon the game experience since the initial session.

Overall, the research participants endorsed the game and reported interest in increased public awareness and communication about sexual violence and health. In the initial focus groups, youth communicated overall approval of the game, the acquisition of new knowledge about sexual violence and health, minimal past exposure to education about sexual violence, and an interest in learning more about additional sexual violence topics. One critique that emerged concerned the multilinearity and fragmentation of the narrative, which produced some confusion about the plot and gameplay elements. Admittedly, some of this confusion had to do with the nature of trauma itself, but also extended to specific youth-made decisions about the narrative form. The most consistent theme that the follow-up telephone interviews raised had to do with how Lucidity helped youth communicate about sexual violence. Almost every interview participant reported initiating discussions about the game or sexual violence with parents, teachers, siblings, friends, or romantic partners. A central finding from this game evaluation had to do with Lucidity's effectiveness in facilitating communication between players and their extended communities. This case study suggested that video games and digital narratives might help minimize discomfort or embarrassment regarding a charged topic, augment self-efficacy, and alter social norms through mediated communication.

Given that Lucidity (similarly to many serious games) is a single-player game, we also realized that such a game might be more effective if paired with an opportunity for group discussion and shared reflection following gameplay. In light of this finding, we began more actively to develop curricula alongside our subsequent game projects. The successes, limitations, and possibilities raised by this pilot project also led directly to another game project about sexual harassment and violence, Bystander, to which I now turn.

graphic section header: case two: bystander

As an educational intervention, the Lucidity workshop was effective in giving youth participants a chance to think through and contribute to a finished digital game. At the same time, we found limitations in relying too heavily on youth contributions in creating a final game that would be played by others. For example, the narrative was too complex and convoluted for many players who were not part of the workshop and did not have extended experience with the narrative. As a follow-up game-based intervention about sexual violence and sexual harassment, we next turned to the Bystander project. At a high level, unlike Lucidity, Bystander was created primarily by professional designers working at a university lab, but included ongoing consultations with high school students about elements where their contributions were valuable and in ways that did not rely on a design expertise that they had not yet acquired. Youth also participated as actors who embodied the primary characters within the game.

Before describing the form and narrative of the final game, it is worth discussing the new process that we instituted during the design of Bystander. Instead of an intensive three-week workshop, we convened a youth fellows group made up of ten participants, eight of whom had previously participated in one of our GCC Lab’s game-based summer programs. For this reason, the youth already had an easy rapport with one another, were comfortable with the facilitators, and understood the core mission of GCC. This core of high school students met on the University of Chicago campus for six hours total each week, usually across two separate three-hour sessions. Instead of co-creating the game with youth, the designers of the Bystander game constructed assets that they then shared with the participants. For example, during one session, we focused on the game script and requested feedback about the dialogue. During this meeting, students shared suggestions regarding how they saw the realism and aesthetics of any given scene. For instance, with youth, we discussed a level of the game that takes place at a party and brainstormed clickable objects that might plausibly appear in this scenario such as red Solo cups, a pizza, speakers with a music playlist, and so forth. During a second session, we asked youth to playtest portions of the game in development, including the user interface and game mechanics. Even before putting youth in front of computer screens, we gave them printouts of key materials, highlighters, and red markers to enable a range of responses. After these sessions, designers discussed the feedback among themselves and incorporated some of it into the build.

While Bystander is a game about sexual violence and sexual harassment, the youth fellows in this case did not receive sessions dedicated to this content, unlike the Lucidity workshop which included content-specific conversations with experts. Instead, these issues were incorporated directly into discussions about the game, especially since some of the gameplay required topical knowledge. Certain game levels included right and wrong answers. Occasionally, when a participant learned that they had answered a question in the game incorrectly, they would want to discuss or even debate the answer. When a correct answer was surprising to any of the fellows, our initial goal was not to judge but just to listen, observe, and attempt to understand their underlying logic. Subsequently, we sought to facilitate the discussion in a way that remained generous and enabled everyone to contribute. In response to discussions, we sometimes introduced content-specific resources, such as the “Tea Consent” video, which was circulating broadly online at the time and introduced an accessible shared analogy to our discussion about sexual consent (May 2015).

In these conversations, gender dynamics were frequently evident. In game scenarios that focused on sexual harassment and rape myths, for example, fellows who were cis men much more commonly submitted incorrect answers during playtesting. After noting they were incorrect, these participants would regularly ask follow-up questions about the specific scenario, such as “Is rating girls on their hotness really sexual harassment?” or “A girl isn’t asking for sex by wearing a short skirt?” Essentially, we saw the frequent repetition of the very rape myths that the game was being designed to critique and undermine. In these conversations, even before facilitators could intervene, the young women would often respond with reasons as to why the behavior in question was problematic and hurtful. In these instances, male fellows would sometimes turn to adult facilitators for adjudication. The facilitator would often respond with parallel absurd scenarios that relied on similar logic. For instance, game designer Ashlyn Sparrow frequently asked questions such as, “Are you asking to be thrown in jail for wearing baggy pants?” “Is a person automatically a gang member because they have dreadlocks?” or “Is your sister, cousin, or auntie asking for sex when she wears a shorter skirt?” More than rhetorical questions, these concrete scenarios were successful in complicating underlying assumptions. As the youth fellows program progressed, even participants who initially gave consistently incorrect answers would correct fellows who had missed the previous session. These sessions also inspired us to strive for greater concreteness in the Bystander game itself, knowing that we would not be available to speak with players in all cases when they played the finished game.

The integration of young people in this development process contributed to the final Bystander game. The completed game takes the form of an interactive narrative with mini-games that unfolds across four episodes. These episodes address topics that include sexual harassment, supporting sexual assault survivors, consent, intimate partner violence, laws regarding sexual violence, and pathways for accessing relevant resources. Unlike Lucidity, which focused on the perspective of a survivor, Bystander focused on bystander behaviors as a way of making gameplay less confusing and more accessible to a larger number of players. The player takes the perspective of a high school junior who confronts a series of episodes linked to sexual violence and harassment. Bystander is a theoretically based intervention that aims to increase the skills, attitudes, and awareness that high school youth can use to combat sexual violence. The experience frames sexual violence prevention as a community-based responsibility. Bystander also challenges common rape myths and explores a continuum of opportunities for individuals to intervene before, during, or after a sexual assault.

Even as Bystander involved young people less in the role of primary designers (as was the case with Lucidity) than as focus group members and playtesters, the game was designed to be played by Chicago South Side youth specifically and Black and brown youth more generally. As such, the game departs from the kinds of norms that were common in the mainstream video game industry at the time, and even at the time of this book’s publication. For example, many of our characters are Black youth who inhabit the types of schools and neighborhoods that the youth fellows themselves inhabited at the time. The frame narrative takes the form of a graphic novel that leads to four episodes with unique mini-games. Even as these mini-games include information that one might find in a standard sexual harassment module, that information is integrated into a narrative context that adds realism and depth to the interactions. Moreover, each episode of the game features unique game mechanics that invite a unique interaction with the scenario.

In the first episode, the player navigates a high school environment and identifies instances of sexual harassment. At the level of action, the player must then choose among a number of behaviors that might most effectively disrupt harassment, deciding among options such as expressing empathy, checking in with a friend, and giving a harasser a silent stare.

In the second episode, the player has a conversation with a friend who reveals that she was sexually assaulted by her boyfriend. As the conversation unfolds, the player must listen attentively, reassure her friend, identify any cultural myth about sexual violence, and demonstrate supportive behaviors toward this survivor. This mini-game involves branching decision trees that move the conversation in a variety of directions.

In the third episode, the player arrives at a friend’s party and witnesses an acquaintance coerce a friend using alcohol. The player encounters several sexual assault myths related to alcohol. The mini-game involves adopting the part of an active bystander, identifying opportunities for intervention across the navigable space, and acting upon those possibilities.

In the fourth episode, a male friend relates a sexual assault by older teenagers and is unsure of what how to respond. The player must support his friend by researching facts and resources regarding sexual violence on his phone. The mini-game involves closely reading versions of fictional resource sites and summarizing findings.

In pilot research that we summarize elsewhere, our lab attempted to assess the game’s feasibility, acceptability, and efficacy. To briefly share the procedure and results, trained facilitators implemented the game across four sessions in two twelfth-grade classrooms in November 2016. After the program ended, 46 students — the majority were Black/African American (66.6%) and female (55.5%) with a mean age of 17 — filled out a post-intervention survey about their experience, acceptability of the program, and attitudes toward bystander behaviors. Overall, we found that the Bystander game and curriculum were feasible and acceptable to twelfth-grade students. The young people who played Bystander reported themselves as being significantly more likely to support a survivor and engage in sexual assault prevention. Among students who completed the game, 97.6% expressed a belief that the program was “valuable,” 83.3% reported that it taught them new information, and 60% found it relevant to their personal lives. Only two students (4.7%) reported feeling uncomfortable with the program content (Rowley et al.).

In terms of process, beyond the role of youth, it is worth noting that Bystander marked GCC’s first close integration of designers and researchers throughout the design process. Previously, as in the case of Lucidity, GCC staff would design or develop a game with youth before handing it off to researchers who would subject the game to research via surveys and qualitative methods. For this project, at least one researcher was present at most design meetings. Even early in the design process, the difference between perspectives and approaches was notable. Consistently, researchers began with tested frameworks and methods for attitude and behavior change. By contrast, game designers began by playing and dissecting the existing catalog of content or genre adjacent games to imagine a novel and emotionally resonant route into the topic. While our ongoing discussions led to greater agreement over time, there was an initial split in which the researchers approached games as problem solving vehicles (e.g., media for embedding critiques of rape myths), while the game designers approached games as conversation starters that animated problems (e.g., ways into dialogue about concepts such as consent that do not define but open up different possibilities). A consistent debate within the group had to do with how didactic a game should be to be most effective with its players.

Overall, the GCC Design Lab learned a great deal from the design process and final version of the Bystander game. While most universities offer Title IX and sexual harassment training modules, these remain uncommon at the high school level. Moreover, existing training is frequently top-down in its approach or limited in the interactivity (or the meaningfulness of the interactivity) that it affords. We believe that games about sexual harassment and violence, especially with embedded narratives that mirror the experiences of young players, might make these crucial conversations more accessible to young people and give them chances to experiment with and reflect upon their feelings and beliefs.

Despite everything we learned, the Bystander project also had a number of limitations. We determined that in order to move from gameplay to rich discussion about topics such as consent, as well as distribution through schools, we would need to pair the game with a vibrant curriculum. Unlike Lucidity, Bystander already incorporated curricular elements directly into the gameplay itself, but this did not substitute for valuable corresponding discussion about the game, following the experience. Additionally, while we conducted some initial research on the game’s feasibility and acceptability, this game would benefit from a longitudinal study that explores how a video game might effect youth in the longer term, including how it impacts the types of discussions they are likely to have with peers and adults. Even so, given our existing resources, we were able to incorporate youth as playtesters, while still allowing professional designers to develop the bulk of the game. Compared to the Lucidity project, this process produced a more polished and engaging game.

graphic section header: coda: toward embedded design

The discussions between GCC designers and researchers, which started haphazardly during the Lucidity project and took a more systematic form during the Bystander game, raised questions about how serious narrative games might promote learning and behavior change. During these years, the members of GCC began to think more about earlier educational video games such as Reader Rabbit (1983), The Oregon Trail (1985), and Number Munchers (1986), which adopted a design strategy predicated on overt transmission of information. Similarly, in the early years of the GCC Lab's formation, we actively played and discussed serious social and political games such as 3rd World Farmer (2005), Darfur is Dying (2006), and PeaceMaker (2007), which sought to inform players about a topic or induce empathy. We saw our games, including on topics such as sexual harassment and violence, falling at the intersection of education and sociopolitical advocacy. Yet both the approaches of information delivery and consciousness raising seemed insufficient (if necessary) as components that could achieve integrated learning and thoughtful behavior change. Though Lucidity and Bystander both integrated more complex questions of sexual trauma and identity into a game that conveyed concrete information, the balance did not yet seem ideal to us.

Around this time, the GCC Design Lab grew inspired by Geoff Kaufman and Mary Flanagan’s writing, which proposed a concrete method for achieving behavioral change through games. They describe an “embedded design” technique “through which potentially sensitive, controversial, or challenging ideas or themes in games are crafted in a less overt and less obviously didactic or ‘message-driven’ way” (Kaufman and Flanagan). By filtering prosocial content or even an entire curriculum through a layer of mechanical abstraction, narrative allegory, or mixing of on and off topic content, this method suggests a powerful approach to difficult and sensitive issues. One challenge of embedded design, within the field of public health generally or sexual and reproductive health specifically, is that this approach targets attitudes and actions that are not always proximate to a particular behavior. In cases such as contraceptive usage or sexually transmitted infections, specific knowledge is important to shaping behaviors. At the same time, embedded design could be useful as a way of addressing social determinants of health: that is, the larger life contexts within which people make decisions about health, wellness, and sexuality. Instead of the more focused approach taken by traditional educational or serious game design, embedded design takes a more holistic or ecological design approach that opens up to feelings, emotions, affects, social relations, and connections to broader communities and identity groups. This technique is particularly well aligned with an issue like sexual harassment and violence, which links to a variety of topics such as gendered entitlement and peer beliefs that exceed mere information.

Beyond the cases of Lucidity and Bystander discussed in this chapter, the processes we explored during the years of these projects changed our design philosophy going forward. First, in several projects over the subsequent years, we started to experiment actively with embedded design, including in The Test, a mobile game prototype used to promote HIV testing by providing information and influencing motivations among young men who have sex with men (Gilliam et al.). The modest successes and lessons of the Lucidity workshop and the Bystander youth fellows program also made us aware that participatory narrative game design might be even more powerful than gameplay in educating and eliciting conversations about difficult topics such as sexual violence. This approach could be effective either by encouraging youth to create finished games that are less polished and likely not ready for peer players (as in the case of Lucidity) or incorporating youth into a process led by professional adult designers that could yield a more accessible game (as in the case of Bystander).

Combining lessons from both projects, GCC began a multi-year program (ongoing at the time of this book's publication) that we called Hexacago Health Academy. This program built on the lesson that it is not merely gameplay but the conversations that make up collaborative game design that constitute an ideal context for working through the complexities and difficulties of a topic such as sexual violence. In this program, which launched in 2015 and unfolded through an initial series of multi-week summer workshops in 2016 and 2017, we taught high school students about health issues through a combination of gameplay, embedded game design principles, health research, and interactions with STEM and health professionals and adult mentors. The core of the curriculum focused on Hexacago: a game board that GCC first prototyped in 2013. This board represents a map of the city of Chicago with an overlay of hexagons. It encourages the development of games that grapple with health promotion at individual, interpersonal, community, and policy levels.

In collaboration with adolescents on Chicago’s South and West Sides, these gameplay and game design interventions use human centered design to develop games that can be used as educational tools to improve adolescent health and wellbeing. The resulting game prototypes of Hexacago Health Academy focused on health topics that included unplanned pregnancy, sexually transmitted infections, childhood obesity, achievement of educational goals, urban planning, and alcohol and drugs. Moreover, in 2022 we expanded to approach topics that include food insecurity and structural violence. Moving forward, we also plan to develop curricula that can help integrate these games into high school classrooms focused on science and health. In 2018, GCC collaborated with the Center for College Access and Success (CCAS) to recruit educators to form the Hexacago Advisory Group. Building on the youth fellows program from Bystander, we asked GEAR UP educators to participate in a group discussion to provide feedback and brainstorm ways games might be used in their classrooms. In the summer of 2019, we worked with South Side Chicago teachers to run and study a week-long curriculum organized around five of the board games created in previous workshops and optimized by professional designers. The early years of this ongoing program yielded a number of games, most of which have a roleplaying and narrative dimension, for which I offer brief descriptions here:

Baby Town: This resource management board game invites players to traverse different elements of high school life, including balancing their GPA, finances, and social life with the possibility of becoming parents and attending to a baby’s health and happiness. This game explores the challenges of unplanned pregnancy without stigmatizing this route. Through embedded design, Baby Town incorporates pregnancy into a teenager's broader set of possible life experiences.

Clinic Quest: This competitive trivia game invites players to adopt the role of health researchers who collect data about six common sexually transmitted infections. Players answer topical questions as they move across the board.

Hearsay: This cooperative narrative card game asks players to team up to tell a complex, even playfully convoluted, story about human relationships, emotions, and social networks. Special contraception cards, which are embedded into the deck instead of being the focus of play, integrate sexual and reproductive health education into each story.

Infection City: This cooperative board game invites players to roleplay as a team of epidemiologists who try to contain a meningitis outbreak. Players build clinics and vaccinate populations while meningitis spreads around a city. While focusing on sexually transmitted infections in both the game and associated curriculum, Infection City became even more salient as an interactive approach to epidemiology in the COVID-19 era.

Pipeline: This board game explores structures that contribute to violence across an urban space, especially as related to drug networks. Players take on the role of the police commissioner, the mayor, or a drug dealer who all seek to balance their own self-interest with the interests of the city.

Smoke Stacks: This competitive anti-smoking board game invites players to take the role of tobacco executives whose profit motive is to get as many prospective customers as possible addicted to tobacco products. As customers die, executives have to craft advertising campaigns, select media through which to share those campaigns, and invest in particular products. This inversion uses embedded design tools to produce a more compelling gameplay experience.

Though the early Hexacago Health Academy games were not digital or transmedia based, like the other projects featured in this book, they represent the collation of years of lessons across numerous programs and game design cycles. Our process of making new board games, integrating them into high school curricula, and evaluating their efficacy continues even at the time of this book’s publication with projects such as Lineage (2021), an analog game about the history of reproductive justice. We are also conducting research on Caduceus Quest (2022), a digital roleplaying game in which players build up teams of doctors, policymakers, researchers, youth advocates, and educators to solve a medical mystery en route to STEM learning.

While the lessons explored in this chapter were initially learned through GCC projects, they also inspired the formation of a second lab in 2015: the Transmedia Story Lab. This lab took the lessons of participatory and embedded design beyond narrative games toward other storytelling methods to which we turn in the next two chapters of this book.

Works Cited
Full Project Team

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