Accepted for/Published in: JMIR Formative Research
Date Submitted: Sep 4, 2025
Date Accepted: Jul 1, 2026
An interactive narrative intervention to increase adolescents’ knowledge and self-efficacy to reduce alcohol use: a pre-post study
ABSTRACT
Background:
Adolescents who drink alcohol may also engage in risky behaviors associated with accidents, injuries or death. Recent advances in interactive narrative learning technologies hold promise for designing games for health that effectively deliver age-appropriate and personalized behavior change interventions. The Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE) is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded alcohol prevention intervention by leveraging the dual mechanisms of interactive narrative and 3D game technologies. Preventing and reducing adolescent alcohol use would contribute to substantial health benefits and prevent major health morbidity and mortality.
Objective:
The objective of this study was to examine the effects of INSPIRE on adolescents’ self-efficacy to avoid risky alcohol-related behavior; and knowledge about alcohol risk.
Methods:
A total of 44 adolescents in high school were recruited from an after-school program in the San Francisco Bay Area. We compared pre-test and post-test pilot study data to examine changes in adolescent self-efficacy and knowledge using a combination of questionnaire and interaction trace log data.
Results:
Participants were half female (22/44, 50%) and were aged 14 to 16 years (mean 15.16, SD .95) years. The largest proportion of participants identified as Hispanic or Latine (15/44, 34%), followed by White, Asian, and multiple racial or ethnic backgrounds. Approximately 24% (11/44) of study participants reported having consumed alcohol at least once, and 22% (10/44) reported alcohol use within the past year. Self-efficacy scale scores significantly increased from 7.97 (SD 2.24) at pre-test to 8.72 (SD 1.58) at post-test (P<.001). Differences were also significant for knowledge scale scores, increasing from 5.09 correct (median 5.0) at pre‐test to 6.11 correct (median 7.0) at post-test (Wilcoxon signed‐rank test = 180.5, P=.003).
Conclusions:
Adolescents enhanced their self-efficacy and knowledge by virtually interacting with a series of increasingly challenging scenarios for handling alcohol-related situations in the intervention’s storyline. These findings suggest that experiences generated by interactive narrative learning technologies have the potential to prepare adolescents to make healthy choices about alcohol use in real life situations. With a focus on reducing adolescents’ alcohol-related risk behavior, INSPIRE serves as an innovative model for preventive interventions. Clinical Trial: NCT04110756
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.