User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study
BackgroundThere is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adol...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-11-01
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| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2023/1/e51423 |
| _version_ | 1827629806551826432 |
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| author | Julia R Pozuelo Bianca D Moffett Meghan Davis Alan Stein Halley Cohen Michelle G Craske Meriam Maritze Princess Makhubela Christine Nabulumba Doreen Sikoti Kathleen Kahn Tholene Sodi Alastair van Heerden Heather A O’Mahen |
| author_facet | Julia R Pozuelo Bianca D Moffett Meghan Davis Alan Stein Halley Cohen Michelle G Craske Meriam Maritze Princess Makhubela Christine Nabulumba Doreen Sikoti Kathleen Kahn Tholene Sodi Alastair van Heerden Heather A O’Mahen |
| author_sort | Julia R Pozuelo |
| collection | DOAJ |
| description |
BackgroundThere is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa.
ObjectiveThis study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing.
MethodsAn iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development.
ResultsA total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (“episodes”) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement.
ConclusionsThe Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention’s feasibility, acceptability, and efficacy in reducing depressive symptoms. |
| first_indexed | 2024-03-09T13:56:38Z |
| format | Article |
| id | doaj.art-f710756b5ea945d0b22c81376191ca71 |
| institution | Directory Open Access Journal |
| issn | 2561-326X |
| language | English |
| last_indexed | 2024-03-09T13:56:38Z |
| publishDate | 2023-11-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Formative Research |
| spelling | doaj.art-f710756b5ea945d0b22c81376191ca712023-11-30T14:01:06ZengJMIR PublicationsJMIR Formative Research2561-326X2023-11-017e5142310.2196/51423User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing StudyJulia R Pozuelohttps://orcid.org/0000-0002-3058-0371Bianca D Moffetthttps://orcid.org/0000-0002-8887-1374Meghan Davishttps://orcid.org/0009-0007-8497-2171Alan Steinhttps://orcid.org/0000-0001-8207-2822Halley Cohenhttps://orcid.org/0009-0005-0156-374XMichelle G Craskehttps://orcid.org/0000-0002-3704-5240Meriam Maritzehttps://orcid.org/0009-0001-3403-8731Princess Makhubelahttps://orcid.org/0009-0008-5660-7529Christine Nabulumbahttps://orcid.org/0000-0003-2845-0380Doreen Sikotihttps://orcid.org/0009-0005-5846-0573Kathleen Kahnhttps://orcid.org/0000-0003-3339-3931Tholene Sodihttps://orcid.org/0000-0001-7592-5145Alastair van Heerdenhttps://orcid.org/0000-0003-2530-6885Heather A O’Mahenhttps://orcid.org/0000-0003-3458-430X BackgroundThere is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. ObjectiveThis study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. MethodsAn iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. ResultsA total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (“episodes”) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. ConclusionsThe Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention’s feasibility, acceptability, and efficacy in reducing depressive symptoms.https://formative.jmir.org/2023/1/e51423 |
| spellingShingle | Julia R Pozuelo Bianca D Moffett Meghan Davis Alan Stein Halley Cohen Michelle G Craske Meriam Maritze Princess Makhubela Christine Nabulumba Doreen Sikoti Kathleen Kahn Tholene Sodi Alastair van Heerden Heather A O’Mahen User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study JMIR Formative Research |
| title | User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study |
| title_full | User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study |
| title_fullStr | User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study |
| title_full_unstemmed | User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study |
| title_short | User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study |
| title_sort | user centered design of a gamified mental health app for adolescents in sub saharan africa multicycle usability testing study |
| url | https://formative.jmir.org/2023/1/e51423 |
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