Mixed methods study of Digital MindSKILLZ among young people in Nigeria

DETAILED SUMMARY

Importance

• The 4-2-1 Digital MindSKILLZ game aims to empower young people with engaging, mobile-based mental health information to support continual mental health engagement on any mobile device.
• Evidence on the feasibility, acceptability, and preliminary effectiveness of such mobile-based mental health tools for youth in Nigeria is limited.

Objective

• To assess the mental wellbeing of young people not enrolled in SKILLZ prior to playing the Digital MindSKILLZ game.
• To evaluate the game’s effect on mental health knowledge and attitudes.
• To explore the feasibility, acceptability, and appropriateness of the game, and the barriers and facilitators to its use.

Study details

• Study design: Mixed methods study (no control group)
• Data collection tools: Pre- and post-intervention questionnaires (WHO-5 Well-Being Index, Emotional Processing scale, GAD-7 anxiety scale, mental health knowledge and stigma measures); focus group discussions conducted immediately post-intervention and at 8-week follow-up
• Participants: Young people ages 15–24 not enrolled in SKILLZ programming (mean age 19.84, SD 3.34); 40% male, 60% female
• Implementation setting: Lagos, Nigeria (urban)
• Study period: February 2024, with an 8-week follow-up

Intervention

• 4-2-1 Digital MindSKILLZ game: A mobile network–based interactive game, accessed by dialing a short code or calling a dedicated number, that combines football knowledge with mental health information and coping skills (including a “power hand” technique) to support continual mental health engagement.

Results

• 25 respondents participated in the initial intervention; 22 completed the 8-week follow-up data collection.
• WHO-5 Well-Being Index scores improved slightly from pre- to post-intervention (mean 14.86 to 16.09); mental health knowledge scores increased slightly (mean 6.55 to 6.73); anxiety symptoms (GAD-7) decreased (mean 11.64 to 9.50); and stigmatizing attitudes decreased slightly (mean 11.68 to 11.23). None of these changes reached statistical significance.
• Acceptability was high: the large majority of participants rated the mental health content, game enjoyment, and overall experience positively; the most common complaint was the time required to complete the game, often linked to connectivity issues.
• Qualitative findings described a difficult onboarding process due to network issues, but also gains in mental health knowledge, self-reflection, and coping skills among those who completed the game.
• At 8-week follow-up, 13 of 22 (59%) respondents had not replayed the game independently, most often citing lack of time, phone problems, or forgetting the access code; however, 19 of 22 (86%) had invited peers to play.

Conclusions and implications

• The 4-2-1 Digital MindSKILLZ game was highly acceptable to young people and showed early, non-statistically-significant signals of improved mental health knowledge, wellbeing, and reduced stigma.
• Addressing onboarding and connectivity barriers and expanding content variety may help sustain engagement with mobile-based mental health tools for youth in Nigeria.