Advancing the acceptability of game-based digital mental health interventions: A qualitative study on clinicians’ views

Abstract Background: Mental health professionals’ (MHPs) views on video games are crucial for game-based digital mental health interventions. These interventions are actively developed, their successful implementation depends also on clinician acceptability, and they are related to the divisive topics of technological transformation and video games. Objective: This qualitative study investigates how MHPs view video games. This aims to inform the user-centered design of game-based digital mental health interventions. Methods: The study combined three (n = 19, n = 16, n= 6) distinct qualitative interview datasets, which explored the views of Finnish MHPs on video games. The combined data (n = 41) were analyzed using Reflexive Thematic Analysis (RTA). Then, two post hoc analyses were designed using complementary qualitative questionnaire data (n = 80), which was gathered together with the first interview dataset. Results: The RTA generated three themes. 1) Personally games are recreation, clinically they are harmful. The MHPs’ personal gaming experiences were positive and associated with recreation, whereas their professional gaming experiences associated their clients’ gaming with harms. 2) Gaming is framed as adverse technology and meaningful culture. The MHPs made sense of gaming as a complex societal phenomenon with two complementary and conflicting frames. 3) Clients’ gaming is explored holistically. The MHPs evaluated all activities, gaming included, per their influence on other fields of life. They identified two courses where gaming could evolve from a solution to a problem: from connection to loneliness and from comfort to avoidance. The first post hoc analysis provided further evidence of the self-client attitude asymmetry identified in the first theme. The second post hoc analysis described the benefits MHPs expected from game-based interventions and for whom. Conclusion: MHPs’ views on video games are characterized by self-client attitude asymmetry, conflicting framings, and holistic exploration. Thus, their views cannot be meaningfully simplified to a positive-negative -continuum. Game-based intervention researchers, designers, and developers benefit from considering these stakeholder perceptions when designing and implementing novel game-based digital mental health interventions.