The CYOA format is a promising tool for sexual health promotion among immigrant and refugee youth, as carefully designed interactive stories can significantly improve young adults' understanding and communication regarding sexual health.
Key Findings
Results
A choose-your-own-adventure (CYOA) story intervention significantly improved understanding of sexual health among immigrant and refugee young adults through engaging scenarios that simulated real-life interactions and decision-making processes.
Sample size was 32 immigrant and refugee young adults recruited through a community organization in Central Ohio
Participants were predominantly female (87.5%) and aged 18-25 years
The study used semistructured interviews that were audio-recorded, transcribed, and analyzed using thematic analysis
The intervention targeted reproductive and sexual health disparities and prevention engagement
Background
Immigrant and refugee youth face specific barriers to sexual health education including cultural silence around sex, contraception stigma, and knowledge gaps.
These barriers were identified as making immigrant and refugee youth particularly vulnerable to sexual health challenges
The study was conducted specifically to address these disparities among immigrant and refugee youth
The CYOA intervention was designed to address these culturally specific barriers
Participants were recruited through a community organization serving this population in Central Ohio
Results
The CYOA intervention's inclusive design and interactive elements were pivotal in enhancing understanding of sexual health, though minor technical and navigational issues were identified as areas for improvement.
Inclusive design was identified as a key feature contributing to the intervention's effectiveness
Interactive elements were highlighted as contributing to learning outcomes
Minor technical and navigational issues were noted by participants
Key design features and player experiences were explored through the semistructured interview process
Results
Realistic scenarios, peer interaction, and customization features were particularly effective in promoting engagement and learning within the CYOA intervention.
Three specific elements were identified as most effective: realistic scenarios, peer interaction, and customization features
Realistic scenarios were noted for simulating real-life interactions and decision-making processes
These features were identified through thematic analysis of interview data
The intervention addressed both understanding of sexual health and communication regarding sexual health
Methods
This was a pilot study using qualitative methodology to explore the potential of a CYOA story intervention for sexual health education.
The study is described explicitly as a pilot study
32 participants were recruited through a community organization
Semistructured interviews were the primary data collection method
Thematic analysis was used to analyze the qualitative data
The study did not include a control group or quantitative outcome measures
What This Means
This research suggests that interactive 'choose-your-own-adventure' (CYOA) style stories can be an effective tool for teaching sexual health topics to immigrant and refugee young adults in the United States. Researchers interviewed 32 young adults (mostly women, ages 18-25) from immigrant and refugee communities in Central Ohio after they engaged with a CYOA story intervention focused on dating and sexual health. Participants reported that the interactive format helped them better understand sexual health topics and how to communicate about them, particularly because the stories presented realistic scenarios that mimicked real-life decisions they might face.
The study found that certain design features made the intervention especially effective, including realistic scenarios, opportunities for peer interaction, and the ability to customize choices within the stories. Participants also appreciated that the intervention was designed to be inclusive of their backgrounds and experiences. Some minor technical and navigation problems with the digital format were noted as areas needing improvement.
This research matters because immigrant and refugee youth often face unique obstacles to receiving sexual health education, including cultural norms that discourage open discussion of sex, stigma around contraception, and limited access to culturally appropriate health information. The findings suggest that interactive digital storytelling may be a promising way to bridge these gaps by making sexual health education more engaging, relatable, and accessible. However, since this was a small pilot study using interviews rather than a controlled experiment, larger studies with more rigorous methods would be needed to confirm these findings.
Aidoo-Frimpong G, Nayem J, Adekunle T, Thomas S, Adekunle T, Asfaw S, et al.. (2025). Exploring interactive stories for sexual health education among young adults in the USA.. Health promotion international. https://doi.org/10.1093/heapro/daaf031