JMIR Publications

ABSTRACT

Background:

Serious games are increasingly used in professional health education and maternal health promotion. However, most pregnancy-related digital interventions target specific behaviors and do not provide a comprehensive, longitudinal simulation of the pregnancy journey that incorporates psychosocial and administrative aspects.

Objective:

This study aimed to develop and evaluate a narrative-based serious game that simulates the chronological course of pregnancy and assess its educational usefulness, accessibility, and user acceptance across multiple platforms.

Methods:

We developed a nine-chapter interactive serious game covering pregnancy recognition, partner communication, public health consultation, mid- and late-pregnancy check-ups, and home preparation for childbirth. The game was collaboratively created by a pediatrician, six medical students, and a student illustrator using a low-cost visual novel engine (TyranoBuilder). It was released in April 2025 on iOS, Android, and Steam. A voluntary, anonymous post-game survey was conducted between April 2025 and January 2026. Descriptive statistics were used to summarize survey responses and platform analytics. This study was approved by our institutional ethics committee.

Results:

A total of 65 users completed the post-game questionnaire. Most respondents were aged 10–19 years (38/65, 58.5%) and women (55/65, 84.6%). Nearly half of the participants (30/65, 46.2%) completed the game within 1 hour. Gameplay evaluation scores (5-point Likert scale; 3 = neutral/appropriate) were balanced: game length (mean 3.34, SE 0.12), difficulty (mean 2.84, SE 0.11), and interactivity (mean 3.31, SE 0.14). Educational outcomes were rated highly (5-point scale; higher = more favorable): reduced anxiety (mean 3.84, SE 0.13), educational usefulness (mean 3.98, SE 0.13), knowledge acquisition (mean 4.06, SE 0.13), story empathy (mean 3.80, SE 0.14), and overall satisfaction (mean 4.05, SE 0.14). Across all platforms, the game achieved 925 cumulative downloads. iOS and Android downloads were predominantly from Japan, whereas Steam downloads were geographically diverse. Of the 20 Steam reviews, 19 (95%) were positive.

Conclusions:

A serious pregnancy education game developed through a low-cost clinician–student collaborative model demonstrated high educational usefulness, balanced gameplay characteristics, and broad user acceptance, including substantial engagement among teenagers and international users. Narrative-based serious games represent an accessible and scalable approach to maternal health education. Further research using more rigorous evaluation designs is warranted to assess long-term educational and behavioral impacts.