Playing With Conventions; Healthcare via Computer Games
Creators: name: Cheek, CG
Publisher: name: University Of Tasmania
Year: 2023
Subjects: Health informatics and information systems

description: North West Tasmania is characterised by rugged, mountainous terrain, and small rural settlements founded in agriculture, mining and forestry. The major towns at King Island, Smithton, Queenstown, Zeehan and Strahan and the smaller settlements of the Cradle Valley are too small to individually host a full range of community health services. These areas are also often isolated during winter due to flooding, high winds, snow fall and icy roads. It is these smaller towns and settlements of the West and North West in which social determinants associated with health inequity and higher risk of child and adolescent mental health problems are most evident - they have reduced access to health services, have higher Aboriginality, lower Socio-Economic Status, and are under-represented in post school education statistics. Recent investment in internet infrastructure in the region provides an opportunity to support communities and augment existing services. The impact of child and adolescent mental health disorders on individuals, families and communities is significant. Loss of engagement at school, increased substance abuse, family conflict, and teenage pregnancy are common comorbid associations. Early intervention for individuals with Cognitive Behavioural Therapy (CBT) has been shown to be effective in reducing symptoms, and as 75% of adult mental health disorders begin in childhood getting help to young people early has important clinical, social, and policy implications. Sadly, while young people may harm themselves and others, most will not ask for help. Young people in rural areas are particularly vulnerable; as a higher risk population, they are less likely to seek help due to their social visibility, and have fewer services available to them. Computerised therapies show promise in providing tools to empower young people to pursue the best health strategies for themselves and their friends. Most programs currently available online are text-based, relying on higher levels of literacy and have limited interaction with the user. Efficacy studies have noted issues with engagement and attrition. The SPARX program, (<b>Smart, Positive, Active, Realistic X-factor </b>thoughts), was developed by the University Of Auckland School Of Psychological Science, specifically for Polynesian youth. SPARX is a computer game program which engages the user in a fantasy-based world, travelling to 7 different provinces to undertake CBT-based challenges and skill development. A narrator guides the user, and provides encouragement and dialogue promoting the idea that depression is treatable and the expectation that the user will feel better. Randomised control trials in New Zealand demonstrated SPARX to be as effective as face to face therapy. This research project was undertaken as a first step in exploring the translation of a computer game developed for New Zealand youth, for use by youth in rural Australia. In order to assess the acceptability of the program (look, sound, feel) to Australian youth and to inform any potential ‘reskinning’ before a potential implementation trial, a qualitative study, using focus groups with young people located in a small rural Tasmanian town, was conducted. A subjective ontology and positivist paradigm were employed. This method suited both the nature of the inquiry and the way youth were likely to interact. An Inductive Data-Driven approach was used to identify themes in the focus group interviews, and interpretation was supported by demographic data and field notes. The key findings demonstrate that SPARX is suitable for trialling as is, and that it is likely to suit the local community. However, the stigma of depression stops young people asking for help, and the need for protecting an individual’s privacy is paramount. Thus the program must be made available to youth without required initiation by a practitioner but equally can be used in conjunction with seeing a practitioner, and in a variety of places where the individual would not be identified. Computer games do not suit everyone in the community, so safe referral pathways and existing services must be maintained.