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

Abstract

BACKGROUND Educating children on sexual abuse is one of the most daunting challenges among parents and caretakers. Digital games are increasingly being used to influence health behaviours in children and could be an efficient and friendly approach to educating children about sexual abuse protection. However, little is known on how to develop a culturally sensitive game for the African context, where sexual education is still taboo, especially for younger children. OBJECTIVE In this work, we present a technology-based approach for educating both children and caregivers on child sexual abuse prevention (CSAP) while recognizing society's cultural appropriateness. METHODS HappyToto children’s game was co-designed with 111 parents/caretakers (52% females and 48% male) of children below 18 years, and 24 child experts in Tanzania, through a survey and focus group study. From this survey, we derived an overview of social-cultural practices, ecological settings and issues that should be considered when designing CSAP education interventions. We also conducted paper prototyping and storyboarding sessions of the game’s interface, storylines and options. The application prototype was validated through a survey with 32 parents (56% females and 44% males) of children aged 3 - 5 years and with 5 children (40% female and 60% male) of the same age group, from which we determined the acceptability and usability of the HappyToto mobile game. RESULTS Parents showed interest in the developed game, and each parent could on average navigate through all the parts of the game. The confidence level of parents in talking about CSAPE 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 they included in CSAPE talks with children, also increased from 5.67 out of 10, to 8.8 out of 10, after using the game. Both confidence level and ability scores were statistically significant. Children were interested in the game and wanted to play it again the next day, and a 5-year-old could correctly answer what they do when they are confronted with an unpleasant situation. CONCLUSIONS The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children on child sexual abuse prevention education (CSAPE).