User-Centered Design of Game-Based Digital Mental Health Interventions

Mental disorders are a substantial burden to individuals and societies. Digital mental health interventions (DMHIs) show promise in providing accessible, engaging, effective, and scalable treatments, but their adoption is hindered by low user engagement and implementation barriers. This dissertation advances user-centered design (UCD) of DMHIs that leverage video games as a highly engaging but unconventional medium. Topic 1 focused on game-based intervention design process. Through interpretive literature synthesis, Study 1 generated the TEME framework (Target audience, Engagement, Mechanisms of action, and Effectiveness) that bridges the paradigms of healthcare and entertainment through the design process. Topic 2 devised novel methods for evaluating user engagement including user experience (UX) and intervention use. Study 2 evaluated intervention UX using retrospective interviewing (n = 22) and a novel qualitative Ecological Momentary Assessment (EMA) method that was Contextual, One-item, Repeated, Timely, and Open-Ended (CORTO, n = 184). The study found that CORTO generated intervention-specific and actionable data on UX. Study 3 modeled and measured the intervention use with a new user journey method (n = 16,342) that improved the comprehensiveness of use measurement by evaluating all the intervention elements over time. Topic 3 described the qualities of patients interested in using game-based interventions. Study 4 investigated these qualities with interviews (n = 22) complemented with questionnaires (n = 445). The study found that the patients had enduring and diverse psychiatric symptomatology, prior treatment experience, close relationships with gaming, and they used gaming to manage their psychiatric symptoms. Topic 4 studied mental health professionals' (MHPs) practices and views to facilitate intervention implementation. Study 5 investigated MHPs' digital tool use with interviews (n = 19) and found that MHPs used analog, digitized, and digital tools for communication, evaluation, and facilitating therapeutic change. This tool use was heterogeneous, negotiated in client interaction, and offered incremental improvements to existing practices. Study 6 examined MHPs' views on video games using interviews (n = 41) complemented with questionnaire data (n = 80). MHPs viewed video games personally as recreation and clinically as harmful, framed games as adverse technology and beneficial culture, and explored the role of gaming holistically in their client's life context. Collectively, this dissertation provides digital intervention researchers, developers, and designers with a framework to structure the design process, two novel new methods for evaluating engagement, and insights into patient qualities and MHPs' practices and views.