MANTRA: a serious game improving knowledge of maternal and neonatal health and geohazards in Nepal

Abstract

Background Mobile technology is increasingly important for delivering public health interventions to remote populations. This research study developed, piloted, and assessed a serious game for mobile devices that teaches geohazard, maternal, and neonatal health messages. This unique mHealth intervention aimed at low-literacy audiences in low resource settings is part of the Maternal and Neonatal Technologies in Rural Areas (MANTRA) project: Increasing maternal and child health resilience before, during, and after disasters using mobile technology in Nepal. Specifically, we assess impact of the serious game to improve knowledge gain in our target audience. Methods Co-creation with the MANTRA team and local stakeholders in Nepal identified core needs, developed appropriate pictograms and mechanics, and tailored the pilot game to the local cultural context. Through picture matching with immediate audio and visual feedback, the game teaches 28 learning objectives in three modules: maternal health, neonatal health, and geohazards. To assess the game, 35 participants were recruited in Kathmandu and villages in Kavre district. Sessions consisted of pre-test assessment, playing the game, post-test assessment, and a focus group to elicit qualitative feedback. Results The knowledge assessment quantified knowledge gain. Overall, the group averaged a normalized 6.8 point improvement (p = 0.000022). Change in the geohazard module was 9.5 points (p = 0.001), followed by maternal health (7.4 points, p = 0.007), and neonatal health (4.3 points, p = 0.83). Four learning objectives had statistically significant change (p < 0.05). Feedback demonstrated high engagement, motivation, and usability of the game. Conclusions This MANTRA study is a unique mhealth intervention of a serious game to teach core health and hazards messages to low-literacy audiences in rural Nepal. The pilot intervention demonstrated statistically significant knowledge improvement among participants. Key messages The pilot MANTRA mobile serious game intervention is a novel idea, to bring public health knowledge to difficult to reach vulnerable populations, including often ignored illiterate audiences. The pilot MANTRA mobile serious game intervention demonstrated a statistically significant knowledge improvement of geohazard, maternal, and neonatal health learning objectives among participants.

Linking Disaster Risk Reduction and Healthcare in Locations with Limited Accessibility: Challenges and Opportunities of Participatory Research

“…Consequently, rather than knowing that a location necessarily has limited accessibility, accessibility can increase or decrease swiftly, as further illustrated by the COVID-19 pandemic by locations from Melbourne to Manchester experiencing local lockdown in July 2020. Despite this challenge, an opportunity emerges in that participatory research can assist in preparing people through training, scenarios, exercises, and serious gaming [ 43 , 140 , 141 ]. This work yields an opportunity to link DRR and healthcare more robustly to cover any directions and rates of changes in a location’s accessibility, while balancing what and who needs to get into a location with suddenly limited accessibility (e.g., aid supplies and first responders) compared to what and who might need to get out (e.g., visitors or people requiring specialized healthcare).…”

“…Plenty of research on linking DRR and healthcare in locations with limited accessibility can be conducted conceptually (such as this paper), for modeling [ 66 ], in laboratory conditions [ 67 ], and in controlled field conditions [ 43 ]. Other research approaches involve examining real situations in real time [ 68 ] or post-hoc analyses [ 69 ].…”

“…Instead, the choice of which method to use to conduct participatory research should be based on the appropriateness for answering a well-defined research question or questions. Examples of participatory research for healthcare are women’s groups for reducing material and infant mortality [ 42 ] and developing mobile phone games to improve health awareness [ 43 ]. Improving such approaches is suggested as being needed to reduce HIV infection and intimate partner violence in Southern Africa [ 44 ].…”

Do Women in Nepal Like Playing a Mobile Game? MANTRA: A Mobile Gamified App for Improving Healthcare Seeking Behavior in Rural Nepal

“…MANTRA aimed to increase maternal and child health resilience before, during and after disasters, using mobile technology (75). The MANTRA serious mobile game project was carried out in Nepal after the 2015 earthquakes, with the serious mobile game component led by UCL-IRDR dPHE Centre.…”

MANTRA: development and localization of a mobile educational health game targeting low literacy players in low and middle income countries

“…The project in Nepal entitled "Maternal and Neonatal Technologies in Rural Areas (MANTRA): Increasing maternal and child health resilience before during and after disasters using mobile technology" investigated building women's resilience by improving access to information and communications before, during, and after environmental disasters by developing an mHealth intervention to support and expand existing participatory learning public health interventions, social protection mechanisms, and awareness of everyday geohazards [6][7][8][9][10][11][12].…”