The goal of this HRIDAYA project is to see if a digital mobile game can improve knowledge about heart disease among school-going adolescents. The researchers will divide adolescents of public and private schools into two groups. Each group will contain adolescents from both the school types. Knowledge, attitude and practice (KAP) of adolescents will be tested before intervention. One group will receive a mobile game and the other will not receive the game.

After two weeks of game play, the KAP of the adolescents will be tested again. The changes in KAP before and after playing the game in the two groups will be compared.

The participants will need to:

• Give pretest of KAP regarding CVD
• Download the game in their mobile devices.
• Install the game
• Play the game for 2 weeks
• Give post test of KAP regarding CVD

With the rise in non-communicable diseases (NCDs), cardiovascular disease (CVD) prevalence is increasing in Nepal. CVD risk factors (smoking, harmful use of alcohol, insufficient intake of fruits and vegetables, obesity, hypertension, diabetes and dyslipidemia) are common among adolescents. Despite high prevalence, the knowledge, attitude and practice regarding CVD among adolescents is poor. Since CVDs often begin with modifiable risk behaviors established during adolescence which manifest later, it becomes utmost important to target this population. To tackle this growing problem, a possible way to educate the children on heart-health at the community level is through schools.

The overall aim of this HRIDAYA project is to develop a cardiovascular health education and pilot it among school-going adolescents in Nepal to improve their cardiovascular health awareness.

This HRIDAYA project is a school based parallel trial with digital health promotion intervention aimed at adolescents of grades 8-10 in the public and private schools of Jhaukhel and Duwakot Health Demographic Surveillance Site (JD-HDSS). The JD-HDSS consists of two wards Jhaukhel and Duwakot of Bhaktapur district, 13 kms away from Kathmandu, the capital of Nepal.

A baseline study was carried out to identify knowledge gaps regarding cardiovascular disease (CVDs) among adolescents. These gaps defined the learning goals of the game. Then a paper game prototype was developed in collaboration with the School of Informatics, University of Skövde, Sweden and tested among 10 adolescents. The knowledge gaps combined with the visual recognition and preferences from the paper game prototype testing were mapped into the serious game mechanics resulting in a digital serious game called 'Happy Heart'.

For the intervention, adolescents studying in grades 8-10 from one public and two private schools will be selected purposively for each of the intervention and control arm of the study. Pre-intervention testing of the knowledge, attitude and practice (KAP) will be done before the intervention. The adolescents in the intervention arm will receive a link to download the game in their mobile devices. They will play the game for 2 weeks. A post intervention test will again be done regarding the KAP for CVDs.

The data will be entered and analyzed in SPSS version 28. The change in knowledge (primary outcome), attitude and practice (secondary outcome) in the intervention and control group will be identified using the difference in difference analysis.

Inclusion Criteria:

• Adolescents studying in grades 8-10 in public and private schools in JD-HDSS.

Exclusion Criteria:

• Adolescents absent during data collection period

Deidentified individual participant data will be made available after the trial results have been published.

IPD will be available after the publication of the study.

Data access requests will be reviewed by external Independent Review Panel. Requestors will be required to sign a Data Access Agreement.