Abstract P641: Gaming the Way to Cardiovascular Health in Nepal: A Digital Approach in Adolescents

Abstract

High prevalence of behavioral risk factors for cardiovascular disease (CVD) warrants a life course approach for efficient prevention. Our previous HARDIC trial in semi-urban Nepal shows conventional CVD educational interventions for mothers improved knowledge, attitude, and practice (KAP). Digital cardiovascular health promotion provides opportunities to efficiently reach adolescents. Our aim was therefore to develop such digital health promotion through a serious game that is educational and entertaining, as an innovative way to reach adolescents. We conducted a mixed-method study to assess adolescents’ KAP and perception regarding CVD, explored opportunities for digital cardiovascular health promotion, and developed a concept for a serious game prototype. In total, 649 adolescents grades 8-10 in two government and seven private schools in a semi-urban community of Nepal were surveyed cross-sectionally following parental consent. A self-administered questionnaire assessed KAP of CVD, mobile phone use, internet availability at home and gaming behaviors. For deeper understanding of adolescents’ perception on CVD, we conducted eight focus group discussions (FGDs) separately among boys and girls (n=76). The health belief model and the technology acceptance model guided FGD development and analysis. Eighty percent of adolescents were aged 13-15 years, 49% were girls and 40.4% studied in government schools. The median (IQR) percent scores for KAP were 70.6 (10.59), 78.5 (8.46) and 69.5 (11.59), respectively. Good KAP (median percent scores >75%) was found in 27.7%, 69% and 27.8% adolescents, respectively. Knowledge ( p <0.001), attitude ( p =0.025) and practice ( p <0.001) was higher among adolescents in private than government schools. Girls had better attitude than boys (<0.001). Furthermore, 98% adolescents had smartphone access and 91.6% had internet access.Preliminary FGD analyses show that adolescents mentioned physical, nutritional, mental, environmental, and hereditary causes for CVD. Financial and work-related burdens, as well as psychological, mental and family-related issues were perceived to influence CVD severity. Temptations for junk food and physical inactivity were barriers to follow heart-healthy behavior. Adolescents perceived serious games as beneficial and easy to use for creating CVD awareness. The game should offer challenge and exhibit increased levels of difficulty to remain stimulating throughout its intended use.We conclude that the existing gaps in knowledge and practice, with good attitude and excellent mobile and internet prerequisites, provide great opportunity for serious games in Nepal. The prototype of “Happy Heart” is being pilot-tested among adolescents, suggesting a promising way forward for digital cardiovascular health promotion.