Design and Development of a Visual Novel for Public Health Education About Hepatitis B Infection
Authors:   , Majidy Cyrus Alan , Hartmann Sandra U 
Published: July 2021

Hepatitis means inflammation of the liver and can be caused by several types of viruses. In the world today, the hepatitis B virus (HBV) is the most frequently occurring serious liver infection. Globally, 2 billion people are estimated to be infected with HBV. Yearly, the death toll from HBV and HBV related complications is roughly 900,000. The problem is twofold, the lack of knowledge about hepatitis B infection and how to prevent it, and the limitations of the currently existing public health education approaches. Consequently, there continues to be a lack of knowledge among the general population on how to prevent hepatitis B infection. Therefore, there is a need to explore new approaches to educate the general public about how to prevent acquiring hepatitis B infection and its life-threatening complications. Visual novels (VNs) are currently being studied and used as a means of providing information and education. In this project, a VN was developed for the purpose of public health education on HBV infection and its prevention. This thesis project concerns the development of a new product and was therefore accomplished using a new product development approach with a customer discovery interview process, and an assessment of the types of mobile applications that exist for public health education about hepatitis B. Therefore, this project set out to determine the topics public health workers believe would have the greatest impact on improving hepatitis B awareness in the general public if made available in a mobile digital application. To determine what mobile apps focusing on public health education on HBV exist, the Apple and Google Play App Stores were searched. Eight public health workers who address HBV patients on a regular basis were interviewed as potential customers. Of the potential customers, 100% of them specifically addressed challenges they face serving patient populations. 100% of them spoke on barriers to patient care, including cultural barriers, stigma, language barriers, linkage to care, and access issues. 50% spoke about awareness as a public health need, and 100% spoke on education on HBV infection as a public health need. 37.5% spoke of Asian population being highly affected by HBV. The apps on public health education about hepatitis B found on the Google Play and Apple app stores and assessed had a greatly varying number of downloads (10-10,000 downloads). Most of them had high customer ratings (4-5 stars), or no customer ratings. In addition, mobile phones are heavily used by the general population for entertainment purposes, and storytelling has the potential to surmount cultural barriers. Moreover, VNs are very popular in Asia, and are growing in popularity in China and the US. Taking this and the interview data into consideration, the author and the committee felt that a highly suitable approach to designing a public health education intervention to meet the potential customers' needs was to develop a VN. The design approach taken included the drafting of a screenplay, creation of cel-shaded character art, painterly smooth shaded background art, and use of Unity 3D's scripting API. While VNs can be engaging storytelling mediums and useful educational tools, and have potential to surmount certain cultural barriers, they rely heavily on text. Therefore, they have limitations in overcoming language barriers. Ways around this could be to include more informative or animated visuals and artwork, or create multiple text or audio translations. Future directions include the simplification of the screenplay from the 8th grade reading level down to the 5th grade reading level according the Flesch Reading Ease Score, and the development of multiple text and audio translations in Mandarin, Korean, Vietnamese, Swahili, and French.