Adolescents´ Perceptions and Experiences of Digital Health Education Games for Health Promotion: Implications for Feasibility

Abstract

Background: Non-communicable disease (NCD) risk factors are increasing among adolescents worldwide. Digital health education games for health promotion can provide a way to address these risk factors due to adolescents’ familiarity with this technology. Aim: The purpose of this thesis was to gain a comprehensive view of adolescents’ perceptions and experiences of digital health education games for health promotion and these games potential feasibility. Methods: Paper I, a meta-synthesis, used the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) criteria to report the results. The databases PubMed, Scopus, Web of Science, Cinahl, PsycInfo and ERIC Ebsco were searched for qualitative and mixed-method articles. Thematic synthesis was used to analyse the data. In Paper II, a qualitative study, 12 focus group discussions (FGDs) were performed with adolescents between 13 and 17 years old from two public and four private Nepalese schools. The goal was to determine their perceptions of cardiovascular disease (CVD) and preparedness for a digital health education game for CVD health promotion. A deductive vi thematic analysis was conducted, guided by the health belief model (HBM) and the technology acceptance model (TAM). Results: In Paper I, 13 studies on a variety of digital health education games and health conditions were included, mostly conducted in high and upper-middle-income countries. Three themes and 14 subthemes were determined. The themes centred on adolescents’ views on the perceived learning process, interaction and engagement in game play and the educational value of digital health education games. In Paper II, the analysis resulted in 6 themes and 13 subthemes concerning perceptions of CVD and 5 themes and 10 subthemes on perceptions and preparedness for a digital health education game for CVD health promotion. Themes were related to the advantages and barriers of a healthy lifestyle for the heart. A serious game for CVD health promotion was considered desirable but with several constraints. To discuss and reflect on the combined results and implications of the two papers in this thesis, an integrated framework on the social determinants of health (SDoH) and digital determinants of health (DDoH) was used. Conclusion: This thesis contributed to the individual-level factors that adolescents consider to be important aspects of digital health education games for health promotion. In addition, factors on the individual, interpersonal, community and societal or structural levels with regards to CVD and a potential digital health education game for CVD health promotion provided implications for such a game’s potential feasibility in a Nepalese adolescent health context.