Towards a Conceptual Participatory Framework to Promote Health Literacy in Adolescents by Integrating Self-Determination Theory and Game Design

Abstract

Highlights: Public health relevance—How does this work relate to a public health issue? High exposure to online content combined with limited critical skills can contribute to mental health problems, unhealthy body image, risky behaviours, and reduced self-esteem among adolescents, with consequences that can persist into adulthood. Health literacy is a key factor in disease prevention and behavioural change. Public health significance—Why is this work of significance to public health? The use of a theory-driven serious game provides a scalable, engaging, and prevention-oriented intervention that can be implemented in school settings, aligning with population-level health promotion strategies. The One Digital Health (ODH) framework, which integrates the One Health approach by leveraging digital technologies to collect, process, and share data, information, and knowledge across multiple health-related sectors, provides a meaningful contribution to advancing adolescent mental health promotion and modernizing public health strategies in digital environments. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? The development of policies that promote inter- and transdisciplinary thinking across different sectors of society more effectively address complex health challenges. Adolescent’s involvement in decision-making roles ensures that research reflects their unique needs and perspectives and empowers young people as agents of change, thereby increasing the relevance and impact of adolescent health promotion. Adolescents are heavy users of digital media but often lack critical skills, increasing their vulnerability to harmful online content. The integration of game elements into learning and training offers a promising strategy to support positive behavioural change and strengthen adolescents’ skills. This paper describes the development of a conceptual framework for Dress-DIGITARIAN, a serious game aimed at improving health literacy, coping skills, and self-esteem, grounded in Self-Determination Theory (SDT). The framework was constructed to generate higher-order understanding through a multi-level process: analyzing general theory (SDT), integrating mid-range models (the Octalysis framework), and incorporating empirical insights derived from two data collection phases with the target population. This integrative approach informed and guided the game’s design through participatory methods. Developed through collaboration between schools and research institutions, this approach bridges theory and practice by aligning game mechanics with adolescents’ psychological needs. It also underscores the value of involving adolescents in research, not only to enhance scientific rigour but also to empower them as agents of change capable of contributing to health promotion policies and educational innovation. This study does not report the results of a completed intervention or outcome evaluation, which will be conducted in the sixth phase at the end of the current school year. Future research is needed to assess the model’s effectiveness and scalability and to identify areas for further refinement.