Background: Similar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants. Objective: This study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior. Methods: This is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data. Results: In phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65% (3/20) of participants stated that they would play it again, and 65% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up. Conclusions: An iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development.
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