Design and Development of the “POD Adventures” Smartphone Game: A Blended Problem-Solving Intervention for Adolescent Mental Health in India

Abstract

Introduction: Digital technology platforms offer unparalleled opportunities to reach vulnerable adolescents at scale and overcome many barriers that exist around conventional service provision. This paper describes the design and development of POD Adventures , a blended problem-solving game-based intervention for adolescents with or at risk of anxiety, depression and conduct difficulties in India. This intervention was developed as part of the PRemIum for ADolEscents (PRIDE) research programme, which aims to establish a suite of transdiagnostic psychological interventions organized around a stepped care system in Indian secondary schools. Methods and Materials: Intervention development followed a person-centered approach consisting of four iterative activities: (i) review of recent context-specific evidence on mental health needs and preferences for the target population of school-going Indian adolescents, including a multiple stakeholder analysis of school counseling priorities and pilot studies of a brief problem-solving intervention; (ii) new focus group discussions with N = 46 student participants and N = 8 service providers; (iii) co-design workshops with N = 22 student participants and N = 8 service providers; and (iv) user-testing with N = 50 student participants. Participants were aged 12–17 years and recruited from local schools in New Delhi and Goa, including a subgroup with self-identified mental health needs ( N = 6). Results: Formative data from existing primary sources, new focus groups and co-design workshops supported a blended format for delivering a brief problem-solving intervention, with counselors supporting use of a game-based app on “offline” smartphones. User-testing with prototypes identified a need for simplification of language, use of concrete examples of concepts and practice elements to enhance engagement. There were also indications that participants most valued relatability and interactivity within real-world stories with judicious support from an in-app guide. The final prototype comprised a set of interactive and gamified vignettes and a structured set of problem-solving questions to consolidate and generalize learning while encouraging real-world application. Discussion: Findings shaped the design of POD Adventures and its delivery as an open-access blended intervention for secondary school students with a felt need for psychological support, consistent with an early intervention paradigm. A randomized controlled trial is planned to evaluate processes and impacts of POD Adventures when delivered for help-seeking students in low-resource school settings.

Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study

“…As this was a pilot study with the primary goal of determining feasibility and acceptability of the training programs and to inform improvements to the instructional content and delivery of the training programs, we did not conduct an in-depth thematic analysis of the qualitative data. Rather, we followed guidance from the person-based approach to intervention development [ 33 , 62 ], which enabled the combination of quantitative and qualitative data to inform modifications to the training programs. Specifically, we used a framework analysis approach [ 63 ] to guide our identification of common topics within the qualitative data, following a coding framework with the four core domains outlined from the satisfaction and acceptability questionnaire (i.e., appropriateness, acceptability, adoption, and feasibility) [ 55 ].…”

“…Additionally, prior studies have demonstrated promising findings using digital technology to support task-sharing mental health services in low-resource settings through the use of digital tools for diagnosis, guiding clinical decision making, and facilitating supervision [ 25 ]. Specifically in India, recent studies have reported on a successful digital decision-support platform for supporting community health workers and primary care providers in the screening, diagnosis, and management of common mental disorders [ 31 ]; the use of an Android app with tailored video content for training community volunteers about mental health, connecting individuals with available services, and raising awareness [ 32 ]; and the initial feasibility and acceptability of a digital game accessible from a smartphone app involving a problem-solving intervention for adolescent mental health [ 33 ]. These studies highlight the viability and promise of digital interventions for mental health in low-resource settings such as India; however, there remains an immediate need to generate evidence on the feasibility, acceptability, and potential effectiveness of using a fully remote digital training program delivered on a smartphone application to non-specialist health workers in a rural area of a low-resource setting.…”

Editorial: Designing Technologies for Youth Mental Health

“…By employing a collaborative person-centered approach, it was possible for the researchers to optimize various features throughout the development of this digital game-based mental health intervention. This included simplification of language to meet the needs of a lower literacy student population, accommodating the need for offline access to the digital intervention content given the poor Internet connectivity in the region, incorporating sufficient risk assessment and management features into the mobile app to respond to participants' low mood, and the inclusion of low-intensity human support to offer instruction and personalized support to participants as they complete the game (9).…”

Co-creating a large-scale adolescent health survey integrated with access to digital health interventions

“…The workshops provided further opportunities for the end-users to engage with and discuss ways to optimise the delivery of the intervention-integrated survey in ways that would work for them. Previous studies 24,25,30,31 that engaged with young people in developing digital interventions have also identified that using co-design processes has highlighted the value of usercentred design that allowed for meaningful engagement and enabled focus on user need. For example, Nakarada-Kordic et al (2017) 31 conducted co-design sessions to develop an online resource for young people experiencing psychosis and found that participants discussed matters that were not expected by clinicians.…”