Project Overview

Summary:

In collaboration with global cleft organization, Smile Train, I designed, developed and evaluated a VR game aimed at providing psychosocial support to preadolescents with cleft.

Problem statement:

Orofacial cleft lip and/or palate (CLP) is often associated with a visible facial cleft, but also with psychosocial challenges, such as low self-esteem and social anxiety.

Accessing a licensed psychologist for psychosocial support can be an obstacle, with 57% of families with a child with CLP reporting that they travel over an hour away to their CLP care clinics.

Team:

I worked with a team of 14 people, including developers, designers, researchers and program managers, to design, develop and test the VR game

Collaborative Storyboarding

Collaborative storyboarding was conducted with psychologists from Smile Train’s global network of clinics and hospitals, using Miro as a remote storyboarding tool, to develop the game’s storyline and content.

The interview themes along with the experiences of the psychologists working with preadolescent patients with CLP were discussed, and together we developed storylines and game content.

The resulting storyline followed a superhero theme, encouraging preadolescent patients with CLP to focus on their positive traits and strengths, and included a Super Pet Pal to guide them through the game.

There were 3 modules developed for the game, aimed at addressing the themes identified from the interviews, providing an opportunity for patients to practice social interactions and working through difficult situations.

Contextual Inquiry

To ensure that the VR game could easily be integrated into existing structures of support within Smile Train’s network of global partnering hospitals and clinics, a contextual inquiry was conducted with psychologists to understand the format and goals of their sessions with preadolescent patients with CLP.

Through this method, we worked together to identify key points in their psychosocial support sessions that would benefit from the incorporation of the VR game, including role-playing exercises during group and individual therapy sessions.

Game Development

Using the information from the collaborative storyboarding and task analysis exercises with the psychologists, the game was developed using Unity and Photon PUN 2, a multiplayer networking package.

I created high-fidelity prototypes using Unity, and received feedback from psychologists on the game’s content, aesthetic and UI.

Using an iterative approach, feedback was incorporated into the game for further review, redesign and development.

The game was translated into the following languages for user testing: English, Spanish, Portuguese and Tagalog.

User Testing

Locations:

• Colombia

• Brazil

• Mexico

• The Philippines

Subjects:

• Preadolescent patients with CLP between the ages of 9 and 15

• Psychologists working with preadolescent patients with CLP on psychosocial development

Procedure:

To evaluate the feasibility of the VR game for psychosocial support as a supplement to sessions with a psychologist, the game will be used during sessions over the course of 4 weeks.

During this time, qualitative and quantitative data on the psychologists’ and patients’ experiences will be collected to determine whether the game would be feasible in providing psychosocial support, and to identify potential improvements to this technology.

Measures:

• Behavioral Assessment System for Children, 3rd Edition (BASC-3)

• Rosenberg Self-esteem Scale (RSE)

• Need to Belong Scale (NBS)

• Module feedback questionnaire on participant experiences

• Post-game interviews with psychologists and preadolescents with CLP

Quantitative Data

Data collected from patients from the BASC-3, RSE and NBS were analyzed using SPSS.

While no significant effects were found, it is worth noting that the data from the BASC-3 reflects a decrease in patients’ feelings of atypicality, anxiety, feeling inadequate and social stress after playing the game, with data presented on the left in Table 2.

Results from the NBS also reflect a decrease in average feelings of needing to belong among participants after playing the game.

Quantitative data collected from the feedback questionnaire on participant experiences demonstrates a positive reception of the game from preadolescent participants, with results shown in Table 3 on the left.

Qualitative Data

Psychologist and preadolescent participant interview data was analyzed using thematic analysis, identifying themes related to participant’s experiences towards psychosocial skill development, relatability of the game content and the game’s aesthetics.

Direct quotes from participant interviews suggest that their experience with the game was positive and promoted the development of psychosocial skills, with one preadolescent participant stating “some of the scenarios I have lived and others I can live” demonstrating the relatability and generalizability of the game’s scenarios.

Data also reflected some of the issues with using the game including the need for stable and reliable internet in order to use the mutliplayer features, which may be challenging in countries where access to internet is not readily available.

Insights and Takeaways