Developing and evaluating MindMax: promoting mental wellbeing through an Australian Football League-themed app incorporating applied games (including gamification), psychoeducation, and social connectedness

Gamification is increasingly being used as a behavioural change strategy to increase engagement with apps and technologies for mental health and wellbeing. While there is promising evidence supporting the effectiveness of individual gamification elements, there remains little evidence for its overall effectiveness. Furthermore, a lack of consistency in how ‘gamification’ and related terms (such as ‘applied games’, an umbrella term of which gamification is one type) are used has been observed within and across multiple academic fields. This contributes to the difficulty of studying gamification and decreases its accessibility to people unfamiliar with applied games. Finally, gamification has also been critiqued by both game developers and by academics for its reliance on extrinsic motivators and for the messages that gamified systems may unintentionally convey. In this context, the aims of this thesis were fourfold: 1) to iteratively co-design and develop a gamified app for mental health and wellbeing, 2) to evaluate the eventuating app, 3) to consolidate literature on gamification for mental health and wellbeing, and 4) to synthesise findings into practical guidelines for implementing gamification for mental health and wellbeing. Chapter 2 reports the first study which addresses the first aim of this thesis. Six participatory design workshops were conducted to support the development of MindMax, an Australian Football League (AFL)-themed mobile phone app aimed at AFL fans (particularly male ones) that incorporates applied games, psychoeducation, and social connectedness. Findings from these workshops were independently knowledge translated and fed back to the software development team, resulting in a MindMax prototype. This prototype was further tested with 15 one-on-one user experience testing interviews at three separate time points to iteratively refine MindMax’s design and delivery of its content. The findings of this study suggest that broadly, participants endorsed a customisable user experience with activities requiring active user participation. These specifications were reflected in the continual software updates made to MindMax. Chapters 3 and 4 report the second and third studies which address the second aim of this thesis. As regular content, performance, and aesthetic updates were applied to MindMax (following the model of the wider tech industry), a naturalistic longitudinal trial, described in Chapter 3, was deemed to be the most appropriate systematic evaluation method. In this study, participants (n=313) were given access to MindMax and asked to use it at their leisure, and surveys were sent out at multiple time points to assess their wellbeing, resilience, and help-seeking intentions. Increases in flourishing (60-day only), sense of connection to MindMax, and impersonal help-seeking intentions were observed over 30 and 60 days, suggesting that Internet-based interventions like MindMax can contribute to their users’ social connectedness and encourage their help-seeking. The third study, described in Chapter 4, reports a secondary analysis of data collected for Chapter 3, and further explores participants’ help-seeking intentions and their links to wellbeing, resilience, gender, and age. An explanatory factor analysis was conducted on Day 1 General Help-Seeking Questionnaire (GHSQ) data (n=530), with the best fitting solution resulting in three factors: personal sources, health professionals, and distal sources. In addition to providing more evidence that younger people aged 16–35 categorise apps and technologies for mental health and wellbeing like MindMax alongside other distal social sources such as phone helplines and work or school, our findings also suggest that the best way to target individuals who are least likely to seek help, particularly men, may be through these distal sources as well. Chapter 5 reports the fourth study, which addresses the third aim. In order to consolidate literature on gamification for mental health and wellbeing, this systematic review identified 70 papers that collectively reported on 50 apps and technologies for improving mental health and wellbeing. These papers were coded for gamification element, mental health and wellbeing domain, and researchers’ justification for applying gamification to improving mental health and wellbeing. This study resulted in two major findings: first, that the current application of gamification for mental health and wellbeing does not resemble the heavily critiqued mainstream application that relies on extrinsic motivators; and second, that many authors of the reviewed papers provided little or no justification for why they applied gamification to their mental health and wellbeing interventions. While the former finding is encouraging, the latter suggests that the gamification of mental health and wellbeing is not theory-driven, and is a cause for concern. Finally, to address the final aim of this thesis, all study learnings were synthesised into practical guidelines for implementing gamification for mental health and wellbeing. First, it is important to assess the suitability of implementing gamification into the intervention. Second, this implementation should ideally be integrated at a deeper, systemic level, with the explicitly qualified intention to support users, evidence-based processes, and user engagement with these processes. Third, it is important to assess the acceptability of this gamified intervention throughout its development, involving all relevant stakeholders (particularly representative end user populations). Fourth, it is important to evaluate the impact of this gamified intervention. Fifth, and finally, comprehensive and detailed documentation of this process should be provided at all stages of this process. This thesis contributes to a growing literature on the increasing importance and relevance of Internet-based resources and apps and technologies for mental health and wellbeing, particularly for young people. Given the dominance of games in society and culture across history, and the increasing contemporary prominence of digital games (also known as video games) in particular, gamification is uniquely positioned to have the potential to make large contributions to mental health and wellbeing research. In this context, this thesis contributes a systematically derived operationalisation of gamification, an evaluation of a gamified app for mental health and wellbeing, and best practice guidelines for implementing gamification for mental health and wellbeing, thereby providing frameworks that future implementations of gamified mental health and wellbeing interventions and initiatives may find useful

Conflicts, integration, hybridization of subcultures: An ecological approach to the case of queercore

This paper investigates the case study of queercore, providing a socio-historical analysis of its subcultural production, in the terms of what Michel Foucault has called archaeology of knowledge (1969). In particular, we will focus on: the self-definition of the movement; the conflicts between the two merged worlds of punk and queer culture; the \u201cinternal-subcultural\u201d conflicts between both queercore and punk, and between queercore and gay\lesbian music culture; the political aspects of differentiation. In the conclusion, we will offer an innovative theoretical proposal about the interpretation of subcultures in ecological and semiotic terms, combining the contribution of the American sociologist Andrew Abbot and of the Russian semiologist Jurij Michajlovi\u10d Lotma

A Mixed Methods Study Exploring Brazilian and United Kingdom University Students’ Pre-Drinking Behaviour and Alcohol Use During Nights out

This thesis explores students’ drinking behaviour in nightlife settings. In many parts of the world, much of the burden of alcohol is related to risky alcohol consumption amongst students, which often occurs during a night out, including during pre-drinking (drinking at home or other private settings before going out). In several countries, creating a safer nightlife environment has become synonymous with reducing levels of violence, injury and other health problems associated with high levels of alcohol use. This research was conducted in England, where policies and interventions to prevent nightlife-related harms have been implemented, and in Brazil, where there is no well-established prevention activity in place. A high prevalence of pre-drinking and related harms can be found across many countries, including Brazil and the UK. Hence, it is important to understand this phenomenon in more detail considering the different policy and cultural factors that might affect such behaviour, in order to inform effective policies and practices aimed at preventing and reducing pre-drinking and its associated harms across countries with diverse nightlife environments and drinking cultures. Thus, a mixed-method research study was undertaken, comprising a survey, completed by 1,151 Brazilian university students and 424 UK university students, and focus group interviews with 25 Brazilian students currently living in the UK, aimed at exploring cross-cultural differences in drinking behaviours within nightlife settings from a socio-ecological perspective. Differences in the prevalence of pre-drinking and alcohol consumption were found between Brazilian and UK respondents. The findings suggested that more UK students pre-drink, yet Brazilian students drink more than UK students when they do pre-drink. Students’ attitudes and perceptions towards existing alcohol policies (e.g. drink-drive incidents; restrictions on alcohol sales and drunk and disorderly behaviour) differed between the two countries, which might have an influence on their drinking behaviour in a nightlife context. Brazilian students’ views suggested that the UK’s heavy drinking culture is influenced by the interaction of many factors, including the perceived British students’ cultural drinking norms focused on drinking large amounts of alcohol when compared with Brazilian students and the fact that according to Brazilian participants’ views British students have more positive outcome expectations towards drunkenness. Brazilian participants’ views also iii suggested that the acceptance of drunkenness amongst students is higher in the UK, with an emphasis on British students intentionally getting extremely drunk for entertainment. For Brazilian participants getting drunk was suggested not to be a priority for having a good night out, rather it was perceived to be a consequence for losing control of drinking. Moreover, Brazilian students’ perceived effectiveness of alcohol policy also differed between the two countries, with emphasis on lax law enforcement in Brazil. Effective policies targeted towards reducing drunkenness and its risks within nightlife settings need to be put in place particularly in Brazil, where law implementation and strict enforcement are not the rules, resulting in a culture of drinking that can be harmful to university students

Developing intelligence to understand and prevent violence and alcohol-related harms in nightlife settings

Violence and alcohol place huge burdens on public health, affecting individuals, widersociety and public services. Many of the harms associated with violence and alcohol occur in nightlife settings and preventing these harms is a priority for the UK government.Increasingly, a public health approach to prevention is evident in both national and localpolicies and strategies. The use of data and evidence to understand the nature of the problem and to inform, target, monitor and evaluate preventive activities is fundamental to this approach. This thesis and supporting publications illustrate how my research has supported the public health approach to the prevention of violence and alcohol-related harms in nightlife and other settings.Health data, such as emergency department (ED) attendance data, has a key role to play in the public health approach to prevention. The submitted articles illustrate how I have developed the use of ED data through establishing an injury surveillance system to inform prevention policies, strategies and practice at local and national levels. My analyses have been used to: identify the extent of alcohol-related harms; inform a nightlife management strategy; target prevention activity in nightlife areas where harms were more prevalent; and monitor trends in violence and alcohol-related harms over time. Further, my work has informed national policy; the collection of enhanced ED data on the circumstances of an assault is now being promoted by the UK Government.Whilst routine data sources such as ED data can provide a vast array of intelligence onnightlife violence and alcohol-related harms they do not provide the level of detail necessary to illustrate patterns of alcohol consumption during a night out, individuals’ experience of harms that do not come to the attention of authorities, or the wide range of risk and protective factors associated with these harms. Primary research is crucial to developing this knowledge. Thus, through studies conducted in England and cross-nationally, my research has identified that nightlife settings are the scenes of excessive alcohol consumption with preloading a common feature. Subsequently, many nightlife patrons enter nightlife areas already drunk. Over-serving of alcohol to drunks is common. A range of harms are experienced by nightlife patrons including verbal and physical aggression, sexual molestation and excessive drunkenness. Both individual and environmental (i.e. venue) factors can increase the risks of nightlife patron involvement in alcohol-related harms.In the UK, the prevention of harms in nightlife settings has primarily focused on developing safe nightlife environments. Few interventions have been developed that aim to tackle the culture of drunkenness, risky drinking behaviours (e.g. preloading) and the over service of alcohol to drunks that have been evidenced in my studies. With the links between alcohol and harms, such as violence, being well established, addressing the culture of drunkenness within nightlife settings has to be a key public health priority. Both primary research and analyses of routine data sources can support this approach by identifying at-risk communities where primary prevention interventions should best be targeted

ICNS Proceedings

The night has been the subject of multiple readings by the social and human sciences, as well as it has inspired multiple narratives throughout history, literature and popular culture. However, the study of nightlife, practices, and actors only gained attention in recent years. The appearance of “mayors of the night” with the intention of improving urban governance during this period and thus guaranteeing needs, rights and services is the result of a progressive change in the local political paradigm, which begins to face this space-time as a “new” opportunity for its economic, social and cultural development. We could say that the night and the activities that take place in it begin to be projected as forms of tourist attraction, whether for their leisure activities such as discos, parties or other forms of fun; or because of its cultural potential, such as the White Nights. Contemporary urban night implies having active professionals, capable of reacting to any incident, such as the case of health professionals, but also maintaining those professions – often illegal – that tend to be considered problematic or hidden as could be prostitution. Surveillance and control during this period is also a good example of active professions, such as the case of the police, surveillance companies, video-doorman, or firefighters. It has never been so easy to commute in the urban space, public transport normally meets the needs of users, and the emergence of new forms of transport resulting from the circular economy, both of people and goods, completes the demand, not without controversy. There are many different ways to approach the night, but here we collect some of the communications that participated during the I International Conference on Night Studies, that took place on-line, due to the COVID-19 pandemic, on July 2 -4, 2020. These communications are also on-line on the official account of the conference.info:eu-repo/semantics/publishedVersio

More-than-human Nights:Intersecting lived experience and diurnal rhythms in the nocturnal city

The contemporary nocturnal city is characterised by the interplay of luminosity and darkness, a chiaroscuro tableau inhabited by a myriad of flora and fauna—including, of course, humans. What patterns, rhythms, and indeed disturbances can be detected in this patchwork i.e. how do humans, non-humans, and wider natural cycles and rhythms co-produce the nocturnal urban environment? How is this coexistence of light and darkness inhabited by these multiple species? In short, how is the night moved through, and how does it move through us and our non-human companions? This paper is sited at the intersection of two perspectives on the urban night—first, lived experience and the affective dimension of the nocturnal city; and second, the wider rhythms of the city and the sky above that inscribe themselves into us and our companions. It asks how we, as researchers, can be attentive to the urban night so as to bring these two perspectives together. To do this, we will discuss two methods that the authors have used to inhabit and describe the urban night—one a perambulatory autoethnography of urban edgelands described through text and photography, the other an ethnography of urban temporality using photographic and sonic field recording techniques. Together, the authors’ different approaches pay close attention to both the human and non-human dimensions of the environment. We examine the diversity of nocturnal atmospheres, ambiances, and soundscapes to better understand their meanings and uses. Furthermore, we do this in a way that is attentive to the various spatial and temporal scales of darkness and light—from the palpable immediacy of lived experience or the daily tides of rush hour traffic to the changing phases of the moon or the activities of migrating birds or foraging beetles. By bringing these methods together, our aim is to contribute to a toolkit for situated fieldwork that can be used to create a rich description of the nocturnal urban environment—particularly one that includes but does not privilege the human. Furthermore, the work aims to make such descriptions legible and accessible within and beyond academia