In this study, adolescents described factors within themselves and people in their lives and their neighborhood that impacted their ability to negotiate high-risk situations. These factors included balancing the tension between individuation and group membership, having stable mentor figures in their lives to teach them essential life skills, and being able to navigate the hazards within their neighborhood. Our findings build upon research that highlights the importance of resilience, role modeling, and mentoring as constructs of particular value in efforts to influence health-risk and health-protective behaviors among adolescents.15
In addition, these findings, specific to our particular target population of young minority adolescents, are potentially “portable” to a videogame intervention focusing on behavior change around risk reduction.
These findings are consistent with the ecological theory of Bronfenbrenner16,17
which describes the progressive, mutual accommodation between an active, growing human being and the changing elements within his or her immediate settings, including peers, family, and neighborhood. Bronfenbrenner emphasized protective processes at different levels that can foster resilience in adolescence. Although adolescents may not have control over various aspects of their larger environment, such as the neighborhood they live in or the school they attend, they may be able to counteract the negative effects of these systems by controlling other, closer aspects of their environment, such as interactions with peers and mentor figures. One of the primary goals of the current videogame intervention is to provide adolescents with risk reduction skills and the venue in which to safely practice these skills in order to better navigate risk in the different levels of their environments.
The qualitative research phase of this study identified themes consistent with previous work.18–22
For example, in a study exploring Latino adolescents' perception of barriers to and facilitators of success, these adolescents identified peers more as potential barriers to success than sources of support and identified mentors outside the family as facilitators of success.18
Our findings are also consistent with findings in the literature examining resilience in youth that argue that any intervention to reduce high-risk behaviors needs to address the three levels of influence described by youth: Self versus group, presence of stable mentors, and the neighborhood in which youth live.23,24
It is notable that our study expands on the existing literature by using qualitative methods to directly inform the development of our videogame, including community-partnered research, which is recognized as important for developing HIV prevention interventions.8,25
We believe that our study is one of the first to use these well-validated methods to inform the development of a novel intervention.
As we incorporate these data into the proposed videogame we are developing, our goal is to first help adolescents recognize the realms in which they do have control over their lives. Our second goal is to help them to develop the skills to modify how they interact with the three levels of influence. In the proposed interactive videogame, adolescents will have opportunities to adopt and practice skills, such as learning how to refuse peer pressure, differentiate positive and negative mentor figures, and negotiate high-risk environments within the game play with the goal that these skills will transfer to real life.
Our study has several limitations. First, our sample was drawn from a single community-based program serving urban, mostly minority adolescents living in high-risk neighborhoods. The experiences and perceptions of older adolescents or those from other racial and ethnic groups and other neighborhoods may be different. Second, participants may not have been as forthcoming in their discussion about their engagement in certain high-risk behaviors. We believe we were able to counteract this, in part, by including trusted staff members of the program as co-facilitators.
Our findings reveal a rich sense of adolescents' perceptions of the three spheres of influence in their ongoing negotiation to avoid risk behaviors. Additionally, these qualitative data provide a practical understanding of the important elements identified by our target audience as being crucial components to be integrated into our videogame intervention. The information collected through our interviews and focus groups provides important content for the development of the proposed videogame that is currently under development and will be evaluated through a large-scale randomized clinical trial. In addition, the process outlined in this article highlights the feasibility and potential utility of using qualitative research methods to inform the creation of a targeted and relevant technology-based intervention for the purposes of skill-building and behavior change. We believe our results offer valuable insights to researchers whose goal is to design effective and tailored interventions to affect behavior change in order to help adolescents better negotiate risk in their environment.