Digital cardiovascular health education among school-going adolescents in Nepal: the HRIDAYA project

Abstract

Background The burden of cardiovascular diseases (CVD) and its risk factors are increasing among adolescents. The life course approach to CVD prevention necessitates targeted intervention among adolescents. Aims This thesis, which reports the results of the HRIDAYA project, aimed to identify gaps in knowledge, attitude and practice (KAP) regarding cardiovascular health among adolescents as well as their perceptions of CVD. It also aimed to assess the prerequisites for and explore their perceptions of digital health education. Finally, the thesis aimed to develop and pilot test a serious game that focused on cardiovascular health and assess its effectiveness and feasibility. Methods A mixed methods approach was used. A total of 649 adolescents participated in a survey and twelve focus group discussions (FGDs) conducted in the schools of the Jhaukhel-Duwakot Health Demographic Surveillance Site. The survey results were analysed using descriptive statistics and quantile regression, and FGDs were analysed using thematic analysis. These findings informed the development and pilot testing of a serious game for adolescents. The test assessed the game’s effectiveness and feasibility parameters – including recruitment, participation and completion rates – and measured game experience, satisfaction, usability and acceptability. Results The survey identified gaps in KAP, with private school adolescents demonstrating better KAP than public school adolescents. The FGDs revealed that adolescents viewed CVD as serious and recognised the importance of a healthy diet and physical activity for prevention. They perceived digital health education positively but faced constraints such as parental permission and technical issues. A culturally relevant serious game called Happy Heart was developed and implemented, leading to improved knowledge in the intervention group compared to the control group. Recruitment, participation and completion rates were 74%, 56% and 25%, respectively. Median scores for positive game experience, satisfaction, acceptability and usability were 69%, 70%, 80% and 74%, respectively. Conclusion Adolescents had limited CVD knowledge but positive attitudes towards digital education. Although Happy Heart improved knowledge and was well accepted, engagement was moderate. Targeted digital education can enhance KAP on CVD among adolescents.