JMIR Publications

ABSTRACT

Background:

Opportunities in digital distribution place mobile games as a promising platform in games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. While user-centred design is widely advocated in the field; factors, such as; the user’s subject domain expertise, budget constraints and poor data collection methods can restrict the benefits of user involvement.

Objective:

To develop a playable and acceptable mobile game, targeted at adolescent and young adult key populations in the Philippines.

Methods:

Focus group discussions (FGDs) with Filipino gamers, most of whom identified as men who have sex with men (MSM), were used to; identify preferred game features, technical requirements and to assess game playability and acceptability. Discussions were transcribed and analysed thematically. Conceptual frameworks in health intervention acceptability and game design guided the interpretation and use of the data. In-game events were captured through the Unity Analytics service (v.2017.1) to monitor uptake and game use, and identify and fix issues impacting game performance, over a 12-month period.

Results:

Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to these types of games was restricted due to technical and economic constraints. Role-playing games (RPG) with combat elements was identified as the most appealing gameplay style. Findings guided us to a game that could be played offline, which blended RPG elements; including narrative, character customisation and turn based combat with match-3 puzzles. While the resulting game exceeded expectations and was reported to be playable and acceptable, gameplay was at times perceived as repetitive with limited appeal among certain gamer types. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element in the game’s potential influence on behaviour determinants. Uptake of the game was positive; between 01/12/2017 - 01/12/2018, 3,325 unique device installs were reported globally. In-game events provided evidence of game adoption by young adult MSM in the Philippines. Game uptake and use was substantially higher in regions where direct engagement with target users took place and increased after resolution of an access issue on Android devices.

Conclusions:

The inclusion of informants that possessed relevant subject domain expertise provided design solutions that addressed contextual constraints. Multiple data collection methods, to inform the game design and evaluate acceptability, enabled us to triangulate findings so as to mediate the inherent biases of the different techniques. While success on the app stores is not an exact science, factors such as user-involvement, playability and the marketing strategy play an important role. Facilitating meaningful interactions between health professionals, the entertainment games industry and end users will support the games for health industry as it matures.