Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study

Abstract

Background Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers. Objective This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education.

Artificial Intelligence–Driven Serious Games in Health Care: Scoping Review

“…Therefore, the evidence remains scarce with respect to the compatibility of AI-driven serious games with the sociocultural practices of consumers playing them. Literature indicates that understanding a community’s sociocultural practices can significantly contribute toward designing and building reliable serious games; hence, more studies in the reported countries, as well as others, are needed [ 86 ].…”

Digital games and virtual reality applications in child abuse: A scoping review and conceptual framework

“…Concerning child abuse prevention, most studies have been conducted to prevent child sexual abuse using SGs [20,[25][26][27][28][29]. Additionally, Love et al (2016) examined the feasibility of gamification-based parenting programs to help in preventing child abuse [15].…”

“…SG is defined as any game that is used for purposes other than entertainment, such as education, prevention, and treatment, as well as, gamification was developed to "the use of game design elements within non-game contexts" [17,18]. Studies have shown applications of these technologies in the management of child abuse [15,[19][20][21]. For instance, Malamsha et al (2021) have developed a mobile-based SG to prevent child sexual abuse (CSA) based on the sociocultural context of Tanzania [20].…”

“…Studies have shown applications of these technologies in the management of child abuse [15,[19][20][21]. For instance, Malamsha et al (2021) have developed a mobile-based SG to prevent child sexual abuse (CSA) based on the sociocultural context of Tanzania [20]. Pan et al (2018) designed the immersive VR system to test whether the level of professional experience and cognitive load have any impact on a GP's ability to correctly identify (and devise some strategy to address) child safeguarding concerns [21].…”

Technology-Based Child Abuse and Neglect Prevention Programs: A Systematic Review

“…In conclusion, although there is extensive literature on child maltreatment, child abuse and neglect, and prevention efforts, only a tiny proportion of the strategies adopted to prevent and combat child abuse and neglect deal with the use of technology (e.g., Baggett et al 2017, Fujiwara et al 2020, Guastaferro, 2016, Gülırmak and Orak 2020, Hamilton-Giachritsis et al 2018, Kang et al 2020, Lefever et al 2017, Malamsha et al 2021, Mast et al 2014, Ondersma et al 2017, Schein et al 2022. However, there is no scoping review study evaluating the use of technology tools for the prevention of child abuse and neglect in the literature.…”