A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial.

BACKGROUND: Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. OBJECTIVE: The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. METHODS: A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. RESULTS: Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). CONCLUSIONS: The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. TRIAL REGISTRATION: Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/11255.

Dark Play of Serious Games: Effectiveness and Features (G4HE2018).

Objective: Choosing inappropriate or unethical actions in games is referred to as dark play. For a serious game on delirium for medical students, we aimed to investigate the potential differences between dark play and normal play on game effectiveness regarding abilities in advising care, learning motivation and engagement, and attitude toward delirious patients. Furthermore, we aimed to explore the use of different game features between the two types of play on empathy, self-efficacy, and consequences of care. Methods: We performed a two-arm randomized controlled trial including an exploratory qualitative approach with 157 medical students, who played the serious game "The Delirium Experience." Participants were randomly allocated to either the dark play or normal play group. Participants had to give three recommendations for taking care of delirious patients, and complete both the Delirium Attitude Scale, and Learning Motivation and Engagement Questionnaire to study game effectiveness. To explore game features, open questions were asked. Results: We did not find difference between the two types of play in game effectiveness. "Patient's and nurse's perspective" seem to be an important game feature for being able to empathize with a patient in both groups. To support self-efficacy, "practice how to care" and "feedback in the game" were important in both study groups. "Being able to see the importance of good interaction with the patient" was reported important for self-efficacy in the dark play group, whereas this was "seeing the consequences of care" in the normal play group. Conclusions: There seems to be no change to game effectiveness when providing players the opportunity to use dark play in a serious game. A realistic view of another person's perspective could be an important game feature to increase empathy.

A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial.

BACKGROUND: The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. OBJECTIVE: Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. METHODS: Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. RESULTS: Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. CONCLUSIONS: If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. TRIAL REGISTRATION: Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11255.

A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students: Randomized Controlled Trial.

BACKGROUND: Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. OBJECTIVE: In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. METHODS: We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient's experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students' skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. RESULTS: In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). CONCLUSIONS: The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture.

Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm.

Background: Vivid trauma-related intrusions are a hallmark symptom of posttraumatic stress disorder (PTSD), and may be involved in its onset. Effective interventions to reduce intrusions and to potentially prevent the onset of subsequent PTSD are scarce. Studies suggest that playing the videogame Tetris, shortly after watching aversive film clips, reduces subsequent intrusions. Other studies have shown that taxing working memory (WM) while retrieving an emotional memory reduces the memory's vividness and emotionality. Objective: We developed TraumaGameplay (TGP), a gaming app designed to reduce intrusions. This paper describes two successive experiments to determine whether playing TGP without memory retrieval (regular TGP) or TGP with memory retrieval (dual-task TGP) reduces intrusion frequency at one week compared to a no-game control. Method: For both experiments, healthy university students were recruited. Experiment 1: 92 participants were exposed to a trauma film and randomized to (1) regular TGP1 (n = 31), (2) dual-task TGP1 (n = 31) or (3) control (n = 30). In experiment 2, 120 healthy students were exposed to a trauma film and randomized to (1) regular TGP2 (n = 30), (2) dual-task TGP2 (n = 29), (3) recall only (n = 31) or (4) control (n = 30). Results: We found no significant difference between conditions on the number of intrusions for either playing regular TGP or dual-task TGP in both experiment 1 and experiment 2. Conclusion: Our results could not replicate earlier promising findings from preceding experimental research. Several reasons may underpin this difference ranging from the visuospatial videogame used in our experiments to the method of the experiment to the difficulties of replicability in general.

Antecedentes: las intrusiones vívidas relacionadas con el trauma son un síntoma característico del trastorno por estrés postraumático (TEPT) y pueden estar involucradas en su aparición. Hay escasez de intervenciones efectivas para reducir las intrusiones y prevenir potencialmente la aparición de TEPT posterior. Los estudios sugieren que jugar al videojuego Tetris, poco después de ver fragmentos desagradables de películas, reduce las intrusiones posteriores. Otros estudios han demostrado que gravar la memoria de trabajo (WM) mientras se recupera un recuerdo emocional reduce la intensidad y la emotividad del recuerdo. Objetivo: Desarrollamos TraumaGameplay (TGP), una aplicación de juego diseñada para reducir intrusiones. Este artículo describe dos experimentos sucesivos para determinar si jugar al TGP sin recuperación de recuerdos (TGP normal) o TGP con recuperación de recuerdos (TGP de doble tarea) reduce la frecuencia de las intrusiones una semana después en comparación con un grupo control sin juego. Método: Para ambos experimentos, se reclutaron estudiantes universitarios saludables. Experimento 1: Se expuso a 92 participantes a una película de trauma y fueron asignados aleatoriamente a (1) TGP1 normal (n = 31), (2) TGP1 de doble tarea (n = 31) o (3) control (n = 30). En el experimento 2, 120 estudiantes sanos fueron expuestos a una película de trauma y asignados aleatoriamente a (1) TGP2 normal (n = 30), (2) TGP2 de doble tarea (n = 29), (3) solo recuerdo (n = 31) o (4) control (n = 30) Resultados: No encontramos diferencias significativas entre las condiciones en el número de intrusiones tanto en la de jugar al TGP normal o al TGP de doble tarea en el experimento 1 y 2. Conclusión: Nuestros resultados no pudieron replicar previos hallazgos prometedores previos de investigaciones experimentales anteriores. Varias razones pueden sustentar esta diferencia, desde el videojuego visuoespacial utilizado en nuestros experimentos hasta el método del experimento o las dificultades de replicabilidad en general.

Formación del lenguaje: Imprenta de lenguajes, una breve introducción

Contiene: ¿Qué es la metodología de imprenta de lenguajes?; Las etapas de metodología de imprenta de lenguajes; Etapas y sus formas de trabajo; Círculo de contar e introducción al tema; Buscando un tema; Círculo de contar; Hacer una lista y contar dos a dos; Escribir/dibujar; Redactando y copiando en limpio, Imprimir; Buscado el título; Elección de tapa; Impresión del título; Encuadernando, el proceso de formar el libro; Mostrando y leer el libro/los textos juntos; Exponer, poner en le biblioteca; Resumen de 1 hasta 5 en breve