Youth Led Design of a Novel Narrative Game, Change My Story, to Support Capacity Building for Mental Health Treatment in Nigeria
1. Abstracts based on Formal Research WorkTemitope Omotosho2, Kehinde Kuti2, Dalton Gray3, Nicholas Fortguno4, Olutosin Awolude2, Carolyn Audet1, Bibilola Oladeji2, Aima A. Ahonkhai1
1 Institute for Global Health, Vanderbilt University Medical Center
2 College of Medicine, University of lbadan
3 Games for Change
4 Playmatics
Abstract
Introduction: Depression and psychological distress are important contributors to poor HIV outcomes for young people living with HIV (Y-PWH). In low-and-middle-income countries, mental health screening is not routine, and few Y-PWH have access to evidence-based mental health care. The objective of this research was to develop an innovative, narrative game, Change My Story, to support the delivery of a psychological intervention for Y-PWH with depression or psychological distress in Nigeria.
Methods: We utilized user-centered design and gamified strategies to identify content for storylines for Change My Story that reflect the lived experiences of Y-PWH and important drivers of psychological distress. We recruited Y-PWH receiving HIV care at one treatment center in Nigeria to participate in an iterative game design process. Demographic, clinical history and symptoms of mental disorders (7-items derived from the Composite International Diagnostic Interview, CIDI screeners for anxiety and depression) were collected. Youth were divided by age (15-19; 20-24) and gender (male; female) into 4 groups of 6-8 participants. Each group chose an “editor” and “authors.” Groups were given three sets of cards developed by study investigators: 1) portrait: described a character facing an HIV-related life challenge, 2) advice: prompted Y-PWH to provide advice for the character, and 3) storytelling: created a triumph or setback for the character. Each group would select a portrait card, the authors would write stories and advice for the character, and the editor would select the “best” option based on realism, inspiration, engagement, and emotional interest. Once primed to give feedback on pre-written storylines, participants were asked to create their own portrait cards. The session was facilitated by trained study staff (including three Y-PWH facilitators) and a professional game designer. Content from youth portrait cards created were analyzed using thematic content analysis.
Results: Twenty-three Nigerian Y-PLWH (57% male, n=13; mean age 20.2 years, 44%, n=10 with perinatally acquired HIV) participated in the qualitative session. Among them, 82.6% (n=14) were students or in a vocational training program, 56% (n=13.0) were orphaned. All participants reported at least one anxiety or depressive symptom; The commonly reported symptoms were loss of interest (60.9%), feeling sad, empty, or depressed most of the day (52%) or feeling discouraged about how things were going in their lives (52%). Y-PWH wrote and submitted 26-character profiles and story arcs to be used to generate the final storylines for the Change My Story game. Story topics fell into three broad categories: disclosure (n=16, in either romantic, platonic, or family/parental relationship), stigma (n=5, primarily internalized stigma), and HIV health knowledge/literacy (n=5). Most were submitted by 20-24yr olds (n=24) and males (n=18). In contrast to the portrait cards created by the study team, trauma from sexual assault and suicidality and unwanted pregnancy were important subthemes in youth portrait cards (n=5); almost all of these traumatic themes (n=4) were submitted by male youth.
Conclusions: Our findings highlight an urgent need for interventions to address the mental health of Y-PWH in Nigeria and underscores the importance of using user-centered design principles to create innovative, youth-co-designed interventions.
