Efficacy of a Mental Health Game-Board Intervention for Adolescents in Remote Areas: Reducing Stigma and Encouraging Peer Engagement

Abstract

Background A good understanding of health-related information is crucial for people to make informed decisions about their well-being. Mental health disorders like depression and anxiety can have a significant impact on one's quality of life. Unfortunately, not everyone has equal access to resources and health education, hindering their health literacy. Adolescents in remote areas with mental health issues have more difficulties in addressing their disorder due to the limited resources available, which can have long-term consequences. Peer support interventions have successfully promoted behavioral changes and addressed mental health problems. Digital and online game-based learning has widely been used in mental health education. Board games have several advantages over digital game-based learning in improving the effectiveness of game-based learning in mental health education among adolescents in remote areas. Objective This study examined the effectiveness of game-based learning using a board game called “Carpe Diem” in adolescent mental health intervention. Our focus was to assess the effect of board games on awareness, peer involvement, and stigma about adolescent mental health. Methods We used a mixed-methods approach with an embedded experimental model involving 45 senior high-school students chosen using cluster random sampling to represent the variety of school characteristics in Kupang City, Indonesia, in January 2020. Quantitative data were collected through a non-control group quasi-experimental design using pre- and post-tests with open-ended and post-exposure questionnaires. Qualitative data were collected through a focus group discussion and further analyzed using content analysis. Results The quantitative pre-post test results showed an increased average score with significant differences in stigma and awareness of mental health problems. The content analysis showed that the Carpe Diem board game could help decrease stigma, increase awareness of mental health problems, and encourage peer engagement in health-seeking behavior. However, we also discovered that the board game needed improvements in its integration with the formal curriculum and real-life situations. Conclusion Adding adjuvant interventions, such as game-based learning, to conventional psychoeducation strategies can improve awareness, decreasing stigma and positive peer involvement in health-seeking behaviors for adolescents' mental health in similar characteristics regions. Further improvement is still needed to improve the efficacy of the Carpe Diem.