Graduation Year

2025

Document Type

Thesis

Degree

M.S.P.H.

Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Global Health

Major Professor

Deborah Cragun, Ph.D., M.S., CGC

Committee Member

Marleah Dean Kruzel, Ph.D., FSBM

Committee Member

Tuya Pal, M.D., FACMG, FCCMG

Keywords

Cancer predisposition, Decision-making, Engagement, Family communication, Genetic literacy, Motivation

Abstract

Hereditary cancer syndromes increase cancer risks for individuals with pathogenic variants and their family members, yet many at-risk individuals do not pursue genetic testing due to barriers in family communication. Serious games—interactive tools designed to educate through gameplay—offer a promising approach to addressing these barriers by engaging users and creating supportive learning environments. LIFE with Hereditary Cancer is a serious game designed to improve genetic literacy, promote informed decision-making, and encourage family conversations about hereditary cancer risks and genetic testing. This evaluation used a mixed-methods approach to assess participant emotions, perceptions, and experiences with LIFE with Hereditary Cancer and identify ways to enhance its impact on family communication and education about hereditary cancer. Participants were 18 or older and had experienced hereditary cancer firsthand or through a family member, except for one genetic counseling student. Participants played the game, completed surveys assessing emotions, perceptions, and experiences using Likert-scale items and the Net Promoter Score (NPS), and participated in focus groups to provide feedback on the game. Descriptive statistics summarized quantitative findings, while key categories and quotes were pulled from focus group discussions. Likert-scale ratings (1-5) indicated high usefulness (M = 4.65), high appropriateness (M = 4.40), moderately favorable emotions (M = 3.90) and anticipated outcomes (M = 3.70), but revealed lower scores for having learned new information (M = 2.20). The highest-rated item was the game’s ability to encourage conversation about hereditary cancer (5.00). Net Promoter Scores (NPS) revealed a strong likelihood of participants recommending the game to others with hereditary cancer (NPS = 60, which is typically considered great). However, a lower willingness to use the game with their own family (NPS = -20), primarily because they have already shared most of the information in the game, highlights potential barriers to using this as a way to follow-up with family. Focus group feedback highlighted the game’s potential to spark conversations about hereditary cancer in the family, while also identifying areas for improvement. Recommendations included simplifying complex content in the character books and transitioning to an in-person board game format. Participants identified emotional and practical barriers, such as the challenge of initiating and sensitivity of discussing hereditary cancer, as key obstacles that might prevent families from using the resource. It was suggested that the game be better suited for training healthcare providers, while others felt that using the character booklets that go along with the game as an individual guide might be more appropriate. LIFE with Hereditary Cancer shows promise as a tool for initiating conversations about hereditary cancer; however, its current format as a game may not be ideal for individuals with hereditary cancer and it may not add value for our highly engaged and knowledgeable individuals who piloted it. Incorporating participant feedback to refine the game and explore alternative formats—such as an individual “choose your own journey” format or repurposing it as a resource for healthcare provider training—could enhance its usability and impact.

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