Digital Cardiovascular Health Promotion Among School-going Adolescents in Nepal

With the rise in non-communicable diseases (NCDs), cardiovascular disease (CVD) prevalence is increasing in Nepal. CVD risk factors (smoking, harmful use of alcohol, insufficient intake of fruits and vegetables, obesity, hypertension, diabetes and dyslipidemia) are common among adolescents. Despite high prevalence, the knowledge, attitude and practice regarding CVD among adolescents is poor. Since CVDs often begin with modifiable risk behaviors established during adolescence which manifest later, it becomes utmost important to target this population. To tackle this growing problem, a possible way to educate the children on heart-health at the community level is through schools. The overall aim of this HRIDAYA project is to develop a cardiovascular health education and pilot it among school-going adolescents in Nepal to improve their cardiovascular health awareness. This HRIDAYA project is a school based parallel trial with digital health promotion intervention aimed at adolescents of grades 8-10 in the public and private schools of Jhaukhel and Duwakot Health Demographic Surveillance Site (JD-HDSS). The JD-HDSS consists of two wards Jhaukhel and Duwakot of Bhaktapur district, 13 kms away from Kathmandu, the capital of Nepal. A baseline study was carried out to identify knowledge gaps regarding cardiovascular disease (CVDs) among adolescents. These gaps defined the learning goals of the game. Then a paper game prototype was developed in collaboration with the School of Informatics, University of Skövde, Sweden and tested among 10 adolescents. The knowledge gaps combined with the visual recognition and preferences from the paper game prototype testing were mapped into the serious game mechanics resulting in a digital serious game called 'Happy Heart'. For the intervention, adolescents studying in grades 8-10 from one public and two private schools will be selected purposively for each of the intervention and control arm of the study. Pre-intervention testing of the knowledge, attitude and practice (KAP) will be done before the intervention. The adolescents in the intervention arm will receive a link to download the game in their mobile devices. They will play the game for 2 weeks. A post intervention test will again be done regarding the KAP for CVDs. The data will be entered and analyzed in SPSS version 28. The change in knowledge (primary outcome), attitude and practice (secondary outcome) in the intervention and control group will be identified using the difference in difference analysis.