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

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. Methods: The serious game was developed through a co-creation process between London and Kathmandu based researchers by email and video-calling, and face-to-face with local stakeholders in Nepal. The process identified core needs, developed appropriate pictograms and mechanics, and tailored the pilot serious game to the local cultural context. Evaluations and feedback from end users took place in rural villages and suburban Kathmandu in Province Three. Field evaluation sessions used mixed methods. Researchers observed game play and held focus group discussions to elicit qualitative feedback and understand engagement, motivation, and usability, and conducted a paired pre-and post-game knowledge assessment. Results: The MANTRA serious game is contextualized to rural Nepal. The game teaches 28 learning objectives in three modules: maternal health, neonatal health, and geohazards, through picture matching with immediate audio and visual feedback. User feedback from focus groups demonstrated high engagement, motivation, and usability of the game.

MANTRA: Improving Knowledge of Maternal Health, Neonatal Health, and Geohazards in Women in Rural Nepal Using a Mobile Serious Game

“…The MANTRA serious game was built upon qualitative research conducted within the MANTRA project. As described elsewhere (29), key elements of the serious game are learning objectives, game mechanics, and design features. The mobile serious game covers three broad topics or modules; maternal health, neonatal health, and geohazards, each with 9 or 10 learning objectives.…”

“…Some of the images are placeholders modified from existing picture card interventions including MIRA's (31) perinatal women's groups intervention (32,33), and some placeholder images are not presented here since they were removed from the game after the field tests for further development (infant with rapid breathing, infant with indrawn chest, and infant with convulsions). Reprinted from Mueller et al (29).…”

“…then interpret and choose one of the square situation images of learning objectives fromFigure 1and finally, drag and drop the chosen square onto the circle. The development process and considerations are presented in(29).…”

“…The results are limited by the small sample size of the study and further division into demographic groups. Reprinted from(29).…”

Following Guidelines for Drug-Resistant Tuberculosis: “Yes, it’s a challenge”

“…Clinical decision support systems (CDSS) are a subset of digital health and one of the nine digital products the WHO has suggested should align with their END TB strategy (28) and a target product profile has been developed (29). CDSS and digital tools have been shown to improve guideline adherence in asthma (30), anti-microbial prescribing (31)(32)(33), infection control (34), and maternal health (35), and can interestingly have 'carry over' benefits when not used anymore (36). We suggest there is a current demand and space for a digital health intervention to further improve use of the national DR-TB guidelines in South Africa.…”