Game of Choice, Not Chance

Building an immersive decision-making tool for adolescents

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Susan Howard, Project Director
Cynthia Hannah, Sr. Advisor, Marketing & Communication
Howard Delafield International, LLP.

Implementation Partners

Howard Delafield International, LLP (HDI)
Girl Effect
Cycle Technologies
Vihara Innovation Network


USAID, Direct-to-Consumer (DTC) Approaches to Fertility Awareness and Adolescent Reproductive Health grant

Implementation Dates

September 2018 - October 2023

Geographic Scope

India: Bihar, New Delhi (NCR), and Rajasthan, with plans to expand nationally

Target Users

Client, Data Services Provider

Enabling Environment Building Blocks

Services and Applications

Family Planning Program Classification

Demand Generation


Adolescence is a formative time when choices and decisions can chart the course for the rest of a young person’s life. New awareness of their bodies, together with emotional changes and a developing interest in exploring relationships, force adolescents to forge territory they’ve never faced before. However, there is a culture of silence and shame that make these changes taboo and leave adolescents misinformed about correct and safe practices, unaware of risks, and unprepared for the consequences of their behaviors. For many adolescent girls in India, their dreams of education and a career are disrupted by early marriage and pregnancy.

To address adolescents’ need for information, foster improvement in attitudes and agency, and eventually inform behavior towards health relationships and reproductive health, Howard Delafield International has been awarded a multi-year Innovation and Impact Direct to Consumer (DTC) grant from the US Agency for International Development (USAID) to support the creation and testing of a “serious” video game for adolescent girls in India.

Project/Digital Health Solution Overview

The project, Game of Choice, Not Chance, is a pilot program targeting urban and peri-urban adolescents ages 15 to 19 that combines the excitement of an interactive story-based video game and the instruction from reproductive health education e-learning tools with portal features that directly link players to health products and services in real time. Game of Choice, Not Chance is a unique hybrid of interactive story-based video games, comprehensive health education e-learning tools, data analytics tools, and web portals that challenges players to make compelling decisions and choices within a game space based on realistic scenarios.

The game simulation design applies Prensky’s principles of learner engagement, which involves the player in making decisions and choices when confronting specific problems that lead them to reach their desired goals—within a “learning loop” of decision-action-feedback-reflection (Prensky, 2007). The game is being designed to provide a virtual safe space for girls to explore, reflect on, and navigate life choices, learn about things they can’t ask anyone, experience the simulated outcomes of their choices, and connect to information and services they most need.

“Serious” video games can provide a simulated reality for young people to be an active character of their game character’s (avatar’s) life. Studies show a strong correlation between identification of players with the avatars used to represent them, and the consequent real-world decisions (Kapp, 2012). A low bandwidth, low-literacy, scenario-based interactive video game is being developed with the goal of generating substantial impact on fertility knowledge and key reproductive health behaviors—with eventual expansion of scale and reach through government, nongovernmental organizations (NGOs), and social media. The game is in the design and development phase and final testing is scheduled for spring 2021. The game is scheduled for release on the Google Play Store in early summer 2021 and will be free of charge on Android phones.

Evaluation and Results Data

The Evaluation and Results Data Plan is currently in development.

Users of the game are adolescent girls 15 to 19 years old in the Hindi-speaking belt of India. The states of Rajasthan and Bihar as well as Delhi National Capital Region will be the initial target locations. The game will be available for download from the Google Play store and marketing efforts will be initially targeted at this demographic group in a demonstration pilot. 

Links embedded in the game direct users to providers of products and services, such as menstrual hygiene products, contraception, fertility and cycle tracking apps, and safety and skills-building resources. These providers are being identified and partnerships (NGOs, private sector, education, and government) are being established to ensure the inclusion of appropriate links in the game. 

Lessons Learned

Lessons to date are limited to findings from formative research that are currently informing the design of the intervention (the game). Specifically, the formative research findings are being used to develop realistic game characters and scenarios—that the target audience will identify with and relate to—and to select the type of information and services relevant for the target audience.

Formative research efforts included: 

  1. A psychographic research study involving 103 respondents in urban and peri-urban areas in four locations in India (Munger, Patna, Jaipur, and Delhi). Four psychographic profiles of target audience members were developed for use as stimulus for discussion. 
  1. Co-design discovery involving qualitative data-gathering conducted with 30 participants from Delhi and Jaipur—in two strategically selected urban locations, of differing economic tiers, migration patterns, and family and societal setup. The co-design process included facilitated group discussions, activities, and game-play sessions to curate insights and narratives for the game design and understand the nature of conversation, language, and pop-cultural references among the participants.

Research findings revolved around the adolescent girls’ knowledge gaps related to body literacy; menstruation, the woman’s fertility cycle, contraception, sexually transmitted diseases, and sexual health; perceptions, motivators, and barriers around sex negotiation; contraceptive use; fears, desires, and aspirations about their education, vocational, and career opportunities; and identifying the influencers in their lives. Other findings focused on understanding phone availability, specifications, and usage among the adolescent girls, and product/service preferences.


The project is guided by user design principles and best practices to ensure that the intervention is designed for and with the adolescent girls, and responds to their reproductive health and family planning needs. From formative research to design to pretesting, the target audience is engaged. Co-design efforts during formative research and iterative testing conducted with the engagement of the Technology Enabled Girl Ambassador Network (TEGA) helps to guarantee adherence to those principles. 

Other considerations for game design entail a combination of the excitement of an interactive video game with the critical instruction that supports the project’s reproductive health and family planning aims and linkages to essential health products and services in real time.


  • Kapp, Karl M. (2012). The gamification of learning and instruction: game-based methods and strategies for training and education. San Francisco, CA: Pfeiffer
  • Prensky, M. (2007). Digital game-based learning. New York, NY: McGraw-Hill.