A Digital Game and School-Based Intervention for Students in Hong Kong: Quasi-Experimental Design

• Published in: Journal of medical Internet research Vol. 21; no. 4; p. e12003
• Main Authors: Shum, Angie Ky, Lai, Eliza Sy, Leung, Wing Gi, Cheng, Mabel Ns, Wong, Ho Kit, So, Sam Wk, Law, Yik Wa, Yip, Paul Sf
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 05-04-2019; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications
• Subjects: Adolescent; Anxiety; Behavior; Behavior change; Behavior modification; Child; Child psychopathology; Children; Cognitive behavioral therapy; Cognitive-behavioral factors; Elementary school students; Elementary schools; Female; Games; Health aspects; Health information; Health promotion; Health Promotion - methods; Hong Kong; Humans; Interpersonal relations; Intervention; Knowledge; Learning; Male; Mental disorders; Mental health; Mental health services; Original Paper; Perspective taking; Positive psychology; Prevention programs; Quasi-experimental methods; Research Design; Response rates; Responses; School based intervention; Schools; Schools - trends; Self esteem; Students; Symptoms; Teaching; Translation; Video Games; Well being; Hong Kong; China; Hong Kong China; follow-up studies; schools; mental health; non-randomized controlled trials; child welfare; students; digital game-based learning; health promotion; school-based learning; internet access; public health
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/12003

In Hong Kong, with an increasing number of children experiencing mental health issues, there is a need to not only develop innovative interventions but also develop comprehensive prevention interventions so as to reduce their anxiety symptoms and enhance their emotional management and interpersonal relationships.
The aim of this study was to determine the effectiveness of The Adventures of DoReMiFa, an integration model of the cognitive-behavioral approach and positive psychology by using digital game-based and school-based mental health enhancement intervention to magnify the social and emotional health and well-being of the school children in Hong Kong aged 9 to 11 years.
A quasi-experimental design method was used to evaluate this digital game and school-based intervention. The Adventures of DoReMiFa was piloted in 4 primary schools where students were allocated to either an intervention or a control group. The participants were assessed at pre- and postintervention with a 6-month follow-up measuring their mental health knowledge, levels of anxiety symptoms, positive and negative thinking, perspective-taking, and self-esteem.
A total of 459 primary school students from 4 primary schools participated in the study. The response rate on the questionnaires answered on the Web was up to 85.1% (391/459). Compared with the control group, the intervention group was found to have significant association with improved mental health knowledge at the time immediately after the intervention (beta=.46; P=.01) and in the 6-month postintervention period (beta=.66; P<.001); for perspective-taking, the intervention group had exhibited a significant improvement 6 months after the completion of the universal program (beta=1.50; P=.03). The intervention, however, was found not to be effective in reducing the rates of anxiety symptoms and negative thinking among the participating students.
The Adventures of DoReMiFa, an integration of a digital game-based and school-based mental health enhancement intervention, was shown to be effective in elevating the knowledge of mental health and promoting perspective-taking in the primary school students of Hong Kong. Although there was insufficient evidence to support a reduction in symptoms of anxiety and negative automatic thoughts, the overall results were still encouraging in that a preventive effect was found, indicating that the program has the potential to enhance the mental well-being of schoolchildren. It also suggests that knowledge enhancement may not necessarily lead to behavior change, and more focused effort may be needed to achieve the translation. The implications and limitations of this study and suggestions for future research were also discussed.