JMIR Publications

ABSTRACT

Background:

High levels of mental health (MH) problems and low mental health literacy (MHL) among children and adolescents call for the development and implementation of preventive interventions. Serious games (SGs) may provide a useful approach to reach and engage youth for MH prevention and promotion.

Objective:

This study aims to systematically review the literature on SGs designed to promote aspects of MHL among 10-14-year-olds focusing on game design characteristics, evaluation of user engagement, efficacy/effectiveness and relevant factors for the implementation of SGs.

Methods:

We systematically searched Pubmed, Scopus and PsycInfo for relevant original studies, intervention development studies and study protocols describing the development, characteristics and evaluation of SGs interventions promoting aspects of MHL appropriate for children and adolescents between 10 and 14 years. We included SGs for universal and selected prevention purposes. We coded design elements of SGs described in the included studies using the co.Lab framework which considers aspects of the learning design, game mechanics and game design. We further coded characteristics of evaluation studies, indicators of efficacy/effectiveness and user engagement as well as potentially fostering and hindering factors for reach, efficacy/effectiveness, organizational adoption, implementation and maintenance of the SGs discussed in the studies using the RE-AIM framework.

Results:

We retrieved a total of 1.454 records from database search and other sources. Thirty-six studies on 17 different SGs were finally included in the review. Most SGs were targeted to a universal population of youth with leaning objectives mainly focusing on how to obtain and maintain good MH and on enhancing help-seeking efficacy. All SGs were single-player games but most were embedded in a wider pedagogical scenario. Diverse game mechanics and game elements (e.g., mini-games, quizzes) were used to foster user engagement. Most SGs had an overarching storyline resembling real-world scenarios, fictional scenarios or a combination of both. Evaluation studies provide evidence for the short-term efficacy/effectiveness of SGs in improving aspects of MHL and their feasibility while evidence was mostly based on small samples and user adherence was sometimes low.

Conclusions:

Results of this review may inform the future development and implementation of SGs for children and adolescents. Intervention co-design, involvement of facilitators like teachers, the use of diverse game mechanics and customization fitting diverse users’ needs are examples which may promote intervention success. Although there is promising evidence for the efficacy/effectiveness of SGs for promoting MHL in youth, more rigorously planned studies including randomized-controlled trials and real-world trials are needed involving follow-up measures and the assessment of in-game performance in addition to self-reports.