JMIR Publications

ABSTRACT

Background:

The emergence of novel coronavirus (COVID-19) has introduced additional pressures on an already fragile mental healthcare system due to significant rise in depression, anxiety and stress among Canadians. While Cognitive Behavioural Therapy (CBT) is known to be an efficacious treatment to reduce such mental health issues, few people have access to it in an engaging and sustainable manner. To address this gap, a collaboration between The Centre for Addiction and Mental Health (CAMH) and the National Research Council of Canada (NRC) developed CBT based self-led, online, clinician-tested modules in the form of a videogame, Legend of Evelys, and evaluated its usability in the attenuation of COVID-19 related increase in stress.

Objective:

We discuss the conceptualization and design of new self-care modules in form of a videogame, its implementation in a technological infrastructure, and inclusivity and privacy considerations that informed the development of the videogame. A usability study of the modules was conducted to assess the videogame’s usability, user engagement and user perceptions of the videogame.

Methods:

The development of the videogame involved establishment of a technology infrastructure for secure implementation of the software for the videogame modules and a clinician-led assessment of the clinical utility of these modules through two “whiteboard” sessions. The usability study was informed by a mix-method sequential explanatory design to evaluate the intervention of the mobile application through two distinct phases including a quantitative data collection analysis using in-application analytics data and two surveys followed by a qualitative data collection by semi-structured interviews.

Results:

A total of 32 participants trialed the app for two weeks. They used the videogame an average of six times and rated the game as good based on the Systems Usability Score. In terms of stress reduction, the study demonstrated a significant difference in the participants’ Perceived Stress Score at baseline (mean 22.14, SD 6.187) compared to the two week follow-up (mean 18.04, SD 6.083); t(27)=3.628, P=.001. Qualitative interviews helped participants identify numerous functionality issues and provided specific recommendations, most of which were successfully integrated into the videogame for future release.

Conclusions:

Through this collaboration, we have established that it is possible to incorporate CBT exercises into a videogame and have these exercises adopted, to address stress. While videogames are a promising strategy to help people with their stress and anxiety, there is a further need to examine the real-world effectiveness of the Legend of Evelys in reducing anxiety.