Embedded Narrative in Interactive Game Design for Improving Medication Adherence of Schizophrenia

Embedded Narrative in Interactive Game Design for Improving Medication Adherence of Schizophrenia：Exploratory Research

This study explores the potential of an interactive narrative game to enhance medication adherence among stable schizophrenia patients. Employing participatory design methods, game's development and testing process actively involved patients and individuals closely connected to their daily lives. Artificial Intelligence-Generated Content (AIGC) facilitated swift iterations in game's visual style and content. During game therapy, patients are tasked with making decisions based on presented situations, which influence the course of the narrative.

Study Overview

• Status: Completed
• Conditions: Medication Adherence; Schizophrenia and Related Disorders; Gamification; Mental Health Issue
• Intervention / Treatment: Combination product: Healing Town: Embedded Narrative in Interactive Game (Psycho-education Tool) Design

Detailed Description

Our game design is inspired by Cognitive Behavioral Therapy (CBT), specifically the autonomic engagement and emotion regulation for the treatment of stable schizophrenic patients. This design aims to motivate patients to practice the basic principles of CBT in a virtual environment with the aim of producing positive psychological and behavioral changes in real life.

To ensure that the interactive design in the game can effectively promote cognitive reconstruction and emotional regulation in patients, the investigators used the following game interaction strategies:

1. Situational simulation: By simulating real-life situations, patients face challenges and make decisions in the game that are similar to those in real life, so as to train their cognitive and emotional regulation.
2. Immediate feedback: Provide patients with immediate feedback during the game so that they can understand the impact of their decisions on the outcome of the game, thus encouraging them to make more positive decisions in real life.
3. Role-imitation: Encourage patients to take an in-depth look at their thoughts and behaviors from a third-person perspective by having them take on the role of a therapy practitioner.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shanghai Municipality
    • Shanghai, Shanghai Municipality, China, 200240
      • Shanghai Jiao Tong University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Stable Phase Schizophrenia
• on long-term medication
• medication adherence was problematic

Exclusion Criteria:

• Serious Schizophrenia
• Lack of basic cognitive abilities

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Healing Town: Embedded Narrative in Interactive Game Design; The game-based medication intervention game "Wanping Town" in this study employed a multidisciplinary participatory design approach rooted in narrative theory and behavioral psychology models. The game consists of two perspectives: narrative decision stories and cognitive games. The investigators initially employed participatory design methods to determine the plot and elements within the game, then embedded the conclusions into the therapeutic elements of the game.

Combination product: Healing Town: Embedded Narrative in Interactive Game (Psycho-education Tool) Design; The narrative-based medication intervention game "Healing Town" in this study employed a multidisciplinary participatory design approach rooted in narrative theory and behavioral psychology models. The game consists of two perspectives: narrative decision stories and cognitive games. The investigators initially employed participatory design methods to determine the plot and elements within the game, then embedded the conclusions into the therapeutic elements of the game

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medication Adherence	Medication Adherence - Morisky Medication Adherence Scale-8 (MMAS-8): This scale assesses medication adherence through 8 items, providing a comprehensive evaluation of adherence.	10 minutes
Medication Attitude	Medication Attitude - Drug Attitude Inventory (DAI) : This scale evaluates patients' attitudes toward medication, with higher scores indicating better attitudes.	10 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Game Experience	the In-Game Core Scale (iGEQ): a standardized tool used to measure a player's experience while playing a video game. It was developed by researchers to understand how players feel during gameplay, based on psychological and emotional factors.	10 minutes
Anxiety	Anxiety - Generalized Anxiety Disorder 7 (GAD-7) : This scale measures the level of anxiety in individuals, categorizing the severity into mild, moderate, and severe levels.	10 minutes
Depression	Depression - Patient Health Questionnaire-9 (PHQ-9): This scale assesses the severity of depressive symptoms, categorizing the level of depression from mild to severe.	10 minutes
Patients' Quality of Life	World Health Organization Quality of Life-BREF (WHOQOL-BREF) : This scale evaluates overall quality of life and health status, with a focus on physical, psychological, social, and environmental domains.	10 minutes
Social Functioning	Social Disability Screening Schedule (SDSS): This scale assesses the degree of social disability, with higher scores indicating more severe social dysfunction.	10 minutes
Clinical Symptoms	Clinical Symptoms - Brief Psychiatric Rating Scale (BPRS): This scale evaluates clinical symptoms across five factors, including anxiety-depression, lack of vitality, thought disturbances, activation, and hostile suspicion.	10 minutes

Collaborators and Investigators

• Sponsor: Zhu Dian
• Investigators: Study Director: Zhao Liu, Prof, Shanghai Jiao Tong University School of Medicine

Publications and helpful links

General Publications

• Liu Z, Zhu D, Zhang Z, Liu Y, Yang H, Chang F, Zhang W, Cai J. Effects of a narrative-based psychoeducational intervention on medication adherence in individuals with schizophrenia: a multicentre, parallel-group randomised controlled trial. EClinicalMedicine. 2025 Sep 4;88:103483. doi: 10.1016/j.eclinm.2025.103483. eCollection 2025 Oct.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2023
• Primary Completion (Actual): August 1, 2024
• Study Completion (Actual): September 1, 2025

Study Registration Dates

• First Submitted: December 8, 2023
• First Submitted That Met QC Criteria: December 17, 2023
• First Posted (Actual): December 19, 2023

Study Record Updates

• Last Update Posted (Actual): April 30, 2026
• Last Update Submitted That Met QC Criteria: April 25, 2026
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders; Behavior; Treatment Adherence and Compliance; Health Behavior; Patient Compliance; Patient Acceptance of Health Care; Schizophrenia; Medication Adherence; Investigative Techniques; Methods; Research Design
• Other Study ID Numbers: Sjtu0002

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: You can contact the author to obtain data, including patient medication adherence data before and after the experiment, interview data, and questionnaire data.
• IPD Sharing Time Frame: After the article is accepted
• IPD Sharing Access Criteria: zhudian@sjtu.edu.cn
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No