Table 2.

Summary of the changes in the design of FightHPV after each evaluation. Character names are in italics.

Feature	Initial design	After beta testing	After focus groups 1	After focus groups 2
Characters	14 characters were created	Appearance of Intercourse and Protection Method needed to be redesigned	—a	—
Episodes	60 levels were organized into 6 episodes. Each level was accessible sequentially, that is, only after the previous level was completed	—	Open access to all 6 episodes at any time. However, the 10 levels within the episode were accessible sequentially	—
Levels	Initial puzzle design	Adjusted difficulty for levels with highest proportion of failures	—	Adjusted difficulty for levels with highest proportion of failures
Textual information	Initial writing of human papillomavirus -related information	—	Reduce childlike tone to appeal to more mature audiences	Reduce technical language to increase understandability. Linked real-world images to characters to ease concept comprehension. Learn more links from game to longer content articles
In-game feedback	Success or failure only	Background music and sound effects added	—	Animations after game actions added
Competitive elements	Achievements and leader boards	—	Social features added to compare player’s performance with others/friends	—
User interface miscellaneous	—	—	Ability to toggle music/sound on and off	Changed text font for readability

^aNo changes were made to this feature at this development stage.