Table 2.

Theory of behavior change design choices.

Context-specific learning objective	Game design element
To believe that you can live a fulfilling life after a positive diagnosis	The animated stories depict people living with HIV pursuing their ambitions, being socially active, or spending time with their family. For example, a transgender character enters a beauty pageant and, as she takes her medication in the dressing room, the text reads, “I fought to be my true gender, I can win this fight too.” This particular story line was selected because of the cultural relevance pageantry has in the Philippines and the great esteem in which Filipinos hold the contestants.
To know that HIV treatment makes your immune system stronger and more able to fight off illness; reduces the risk of transmitting the virus to someone else; reduces the effect of the illness on quality of life; and, if started early, leads to a significant reduction in the risk of death	Antiretroviral tablets feature in every animated story except the one where the character dies. Treatment is also shown to improve the physical appearance of the characters in the later missions. Players can earn an extra life during gameplay by answering a multiple-choice question. Some questions address knowledge on treatment effects, and feedback containing the right answer is given. Hyperlinks to websites containing information on HIV treatment are included throughout the game, and the click-through rate is measured.
To know that HIV testing and treatment services are available for free in the Philippines and that results are given on the same day	In the animated stories, the words “Free HIV tests” appear in the background of all the clinic waiting room scenes. The rapid testing procedure is depicted in the first 3 animations. Multiple-choice questions address the availability of free testing and the time taken for the client to receive their results in the Philippines. Hyperlinks to websites containing information on HIV services in the Philippines are included throughout the game, and the click-through rate is measured.
To recognize common coinfections and signs of HIV infection and to know that symptoms may not appear until long after infection	Enemy units in the game include representations of gonorrhea, tuberculosis, hepatitis B, herpes, and cancer. Common signs of HIV infection are depicted in the animated stories, and some characters show no symptoms.
To know that there is a risk of HIV transmission among heterosexuals	The first animated story depicts a heterosexual couple. In several other animated stories, the character’s sexuality is ambiguous.
To know the location of HIV services	A hyperlink to a website containing the contact information and location of all testing sites in the Philippines is featured throughout the game.