Enhancing reproductive health among adolescent girls in India: results of an individualized RCT to study the efficacy of the go Nisha go mobile game.

Abstract

Background: Adolescent girls in India face significant barriers to accessing sexual and reproductive health (SRH) information and services. Digital interventions, particularly mobile-based ones, promise to deliver SRH education in a fun and engaging manner. These can be offered privately directly to the adolescent, allowing players to 'experience' the outcomes of their choices, receive tailored feedback, and the option to 'try again'.

Methods: This study evaluated the efficacy of "Go Nisha GoⓇ" (GNG), a low-end smartphone-based digital game for adolescent girls in India, using a two-armed, encouragement-led, randomized controlled trial (RCT). The study involved 1950 participants from Patna, Jaipur, and Delhi NCR. The intervention group received encouragement to play GNG, while the control group did not. Key constructs measured included menstrual health management (MHM), contraception knowledge, and agency. Data were collected at baseline and a ten-week follow-up.

Results: The intervention group showed significant improvements in various MHM parameters, contraception knowledge, and agency outcomes compared to the control group. Overall, 1697 out of 1993 participants completed the study after ten weeks (85%). The intervention group's awareness of menstrual hygiene products increased from 33 to 92%, while comprehensive knowledge of oral contraceptive pills (OCPs) rose from 2 to 17% (p < 0.0001). Confidence in negotiating contraception use increased from 60 to 85% (p < 0.0001), and the attitude of refusing sex when not ready improved from 61 to 85% (p < 0.0001).The subjects in the game group showed high levels of satisfaction with the app, with 74% discussing the game with others and 66% recommending it. The belief in negotiating marriage decisions with parents also improved more in the intervention group than in the control group.

Conclusion: The findings of the first-ever RCT outcome evaluation for a digital mobile game app for enhancing SRH education among adolescent girls in low-resource settings support the efficacy of digital games for health like GNG. The game's engaging and interactive format effectively communicated complex and sensitive SRH information, empowered participants, and encouraged (p < 0.0001) critical health behaviors through informed decision-making. Future studies could explore the long-term sustainability of behavior changes induced by such interventions and their effectiveness across different settings and populations.

Trial registration number: CTRI/2023/03/050447. Date: March, 2023.