Designing a user-centered mobile game for Indonesian smoking prevention: A qualitative study

Adolescent smoking is still a significant public health problem, and it calls for smoking prevention strategies that are innovative and engaging. Mobile health (mHealth) games have the potential to deliver health education in a way that is more engaging and relevant to adolescents. This study explores adolescents' needs and preferences in developing a mobile game for smoking prevention behavior. This qualitative study employed a descriptive study approach. Data were collected through focus group discussions (FGDs) and the rich picture technique with 28 adolescents aged 13-15 years, selected using maximum variation sampling, as well as interviews with 19 adult informants, including parents, school counselors, and healthcare workers. Data were analyzed using thematic analysis with NVivo 12 software. The findings showed that smoking behavior among adolescents has become normalized, although many adolescents were aware of the health risks of smoking. Smoking behavior was influenced by social and psychological factors, particularly peer relationships. Adolescents preferred an anti-smoking educational game that was interactive, engaging, and challenging. They wanted the game to include information about cigarette contents, the dangers of smoking, healthy lifestyles, future aspirations, and smoking prevention strategies integrated naturally into everyday-life stories. Preferred game features included missions, challenges, rewards, avatars, levels, multiplayer modes, narratives, and educational communication integrated into gameplay.Conclusion: Findings provide design principles for developing user-centered smoking prevention games tailored to Indonesian adolescents. Understanding adolescents' preferences is important for developing effective game-based mHealth interventions for smoking prevention. What is known? • Adolescent smoking remains a public health concern, highlighting the need for age-appropriate smoking prevention interventions. Digital interventions, including mobile games, offer opportunities to deliver engaging health education to adolescents. What is new? • This study uses the Rich Picture method to explore Indonesian adolescents' perceptions of smoking and their preferences for a smoking prevention mobile game, an approach that remains underutilized for exploring these aspects. The findings provide participant-informed design recommendations that address adolescents' smoking status and preferences for game content and features.