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Mueller S, Soriano D, Boscor A, Saville N, Arjyal A, Baral S, Fordham M, Hearn G, Le Masson V, Kayastha R, Kostkova P. MANTRA: development and localization of a mobile educational health game targeting low literacy players in low and middle income countries. BMC Public Health 2020; 20:1171. [PMID: 32723317 PMCID: PMC7385876 DOI: 10.1186/s12889-020-09246-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 07/12/2020] [Indexed: 11/10/2022] Open
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. CONCLUSIONS This MANTRA study is a unique mHealth intervention of a serious game to teach core health and geohazards messages to low-literacy audiences in rural Nepal. Although the mobile game is tailored for this specific context, the developmental process and insights could be transferable to the development of other games-based interventions and contextualized for any part of the world. Successfully targeting this low-literacy and illiterate audience makes the MANTRA development process the first of its kind and a novel research endeavor with potential for widespread impact and adoption following further game development. TRIAL REGISTRATION This project was approved by the University College London Ethics Committee in London, United Kingdom [10547/001], and the Nepal Health Research Council in Kathmandu, Nepal [Reg. No. 105/2017]. All participants provided informed written consent.
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Affiliation(s)
- Sonja Mueller
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK.
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK.
| | - Delphine Soriano
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrei Boscor
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK
| | - Naomi Saville
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Abriti Arjyal
- Health Research and Social Development Forum, Prasuti Griha Marg, Kathmandu, 44600, Nepal
| | - Sushil Baral
- Health Research and Social Development Forum, Prasuti Griha Marg, Kathmandu, 44600, Nepal
| | - Maureen Fordham
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Gender and Disaster, University College London, Gower Street, London, WC1E 6BT, UK
| | | | - Virginie Le Masson
- Overseas Development Institute, 203 Blackfriars Road, London, SE1 8NJ, UK
| | - Rachya Kayastha
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Patty Kostkova
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK
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Abstract
What consequences does 'everyday violence' have on the abilities of survivors to protect themselves from further risks? This paper seeks to establish the linkages between violence and people's resilience capacities to survive and adapt to environmental changes, particularly those living in fragile economic and political contexts such as Chad. It investigates not only how the adverse consequences of violence against women and girls affect the health status and livelihoods of survivors, but also their capacities, and those of their household and community members, to further protect themselves from other risks. Empirical evidence collected in Chad as part of the BRACED (Building Resilience and Adaptation to Climate Extremes and Disasters) programme shows that 'everyday violence' undermines resilience-building at the individual, household, and community level. These results have serious implications for development programmes and the role they need to play to better promote both gender equality and resilience to shocks and stresses.
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Affiliation(s)
| | | | | | - Giselle Bernard
- Postgraduate student at the University of OxfordUnited Kingdom
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