1

LINA – A social augmented reality game around mental health,

supporting real-world connection and sense of belonging for
early adolescents
Gloria Mittmann
D.O.T. Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society at Karl Landsteiner

University of Health Sciences, Krems, Austria

Department of Developmental and Educational Psychology, University of Vienna, Vienna, Austria, [email protected]

Adam Barnard
Self-employed creative practitioner

D.O.T. Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society at Karl Landsteiner

University of Health Sciences, Krems, Austria, [email protected]

Ina Krammer
D.O.T. Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society at Karl Landsteiner

University of Health Sciences, Krems, Austria, [email protected]

Department of Health and Clinical Psychology, University of Vienna, Vienna, Austria

Diogo Martins
Group of AI for People and Society, Instituto de Engenharia de Sistemas e Computadores: Investigação e Desenvolvimento,

Lisbon, Portugal

D.O.T. Research Group for Mental Health of Children and Adolescents, Ludwig Boltzmann Society at Karl Landsteiner

University of Health Sciences, Krems, Austria, [email protected]

João Dias
Faculdade de Ciências e Tecnologia, Universidade do Algarve and CCMAR and INESC-ID, [email protected]

Abstract
Early adolescence is a time of major social change; a strong sense of belonging and peer connectedness is
an essential protective factor in mental health during that period. In this paper we introduce LINA, an
augmented reality (AR) smartphone-based serious game played in school by an entire class (age 10+)
together with their teacher, which aims to facilitate and improve peer interaction, sense of belonging and
class climate, while creating a safe space to reflect on mental health and external stressors related to family
circumstance. LINA was developed through an interdisciplinary collaboration involving a playwright,
software developers, psychologists, and artists, via an iterative co-development process with young people.
A prototype has been evaluated quantitatively for usability and qualitatively for efficacy in a study with 91
early adolescents (agemean=11.41). Results from the Game User Experience Satisfaction Scale (GUESS-18)
and data from qualitative focus groups showed high acceptability and preliminary efficacy of the game.
Using AR, a shared immersive narrative and collaborative gameplay in a shared physical space offers an
opportunity to harness adolescent affinity for digital technology towards improving real-world social
connection and sense of belonging.
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1 INTRODUCTION

Positive peer relationships and supportive friendships become increasingly important from early
adolescence [1]. A sense of belonging – defined as “a pervasive drive to form and maintain at least
a minimum quantity of lasting, positive, and significant interpersonal relationships” [2,
p. 497] – plays a pivotal role in mental health. Belonging – and school belonging in particular –
is an important protective factor during the defining years of school, particularly in early
adolescence [3]. There are for example consistent positive relations between a sense of belonging
and academic performance, self-concept, behavioural engagement, and a general sense of
wellbeing [4-7]. In contrast, victimisation and peer-related stress (e.g., physical aggression,
humiliation, exclusion) hinder sense of belonging [8, 9], which often creates peer rejection, resulting
in long-term mental health problems [10]. Positive interactions both in real- life and online
environments can reduce barriers between peers and improve sense of belonging [9]. Likewise,
stigma can be reduced by spending time with ‘outsiders’ in a safe environment,
e.g. undertaking structured, shared and collaborative experiences [11, 12].
In most countries, early adolescence is also the time of transition from primary to secondary
school (e.g. at age 10 in Austria, age 11 in the UK), which involves major challenges such as a new
and larger school environment, more responsibility and academic pressure and often the necessity
to make new friends (when old friends have gone to a different school and because of a substantial
influx of new people), which creates a new social dynamic. This transition can be difficult for some
early adolescents and lead to a decrease in social and emotional health [13]. Positive peer relations
and stable friendships are an important protective factor for successful school transition, while poor
peer relations and low-quality friendships serve as a risk factor[14], making early adolescence an
especially relevant but also fragile time for sense of belonging, and a crucial window for
interventions.
As most adolescent social connections are formed in the school setting [15], classes are an ideal
target for interventions promoting sense of belonging and positive peer relations. Traditional social
skill trainings (SST) and social and emotional learning (SEL) have been shown to effectively
improve adolescents’ social-emotional skills and wellbeing [16]. However, adolescent lives are
increasingly intertwined with the digital world; friendships are formed and maintained online from
early adolescence [17]. Furthermore, most adolescents regularly play and enjoy digital games
[81% aged 10-24 report playing games; 18]. Digital technology thusoffers opportunities for new
ways to implement interventions around SEL and belonging, redeploying adolescent affinity for
technology towards supporting real-world peer relations and group dynamics.
Advances in information technology have led to many new approaches to engaging people with
educational content in settings that are novel and attractive to young people, and potentially offer
pedagogical advantages. Combining the “fun” of games with the “serious”content of education [19]
and using well-established motivational components of gamification (such as clear goals and guided
paths, or direct feedback and rewards) [20] makes gamified interventions and serious games
especially engaging for users and an attractive prospect for both educationalists and
psychologists. A specific direction in serious gaming is the use of augmented reality (AR). AR is a
technology where virtual components are overlaid onto the real world, so that the player engages
with the illusion that this virtual component exists in thephysical world. Made famous by the
popular commercial game Pokémon Go by Niantic in 2016, it has now found its way into
educational settings [for literature reviews see 21, 22, 23]. Although rigorous evaluations remain
rare, recent literature reviews suggest involvement, engagement, motivational, and (tentatively)
pedagogical effects of using AR games for education [21, 24]. There remain many opportunities
to improve the impact of serious games. For example, the majority of serious games are not
designed by a multidisciplinary team [25].
Our aim was to design and co-develop a mobile AR serious game (LINA) to address real-
world social connection and sense of belonging in the classroom with and for early adolescents
(aged 10+). LINA is a shared, immersive, interactive narrative in which players collaborate as they
use augmented reality to uncover artefacts left behind by a fictional classmate, in order to determine,
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collectively, where she has gone and why. The game pursues two outcomes. First, it aims to
strengthen sense of belonging by bringing together classmates to share both immersive and
collaborative gameplay in a structured way, creating positive experiences around successfully
solving puzzles in pairs or groups. Second, it aims to create a safe space for a class and their teacher
to learn about and reflect on prejudice, stigma, and social wellbeing, especially around mental
health. This leads to reduced stigmatisation and marginalisation of peers who present or behave
differently.
In this paper, we describe the concept of LINA, including theoretical background, storyline
and gameplay, and design and (co-)development processes, and present results from an initial
evaluation study, where we quantitatively evaluated usability and qualitatively evaluated efficacy
of the game.

2 RELATED WORK

Gamified interventions and serious games are increasingly used to train and teach users in
various settings such as healthcare [25] or education [26] and have also been implemented
successfully in a therapeutic setting [27], for example as a treatment for depression [28].
Positive outcomes have also been found when looking at serious games for children and
adolescents: in their systematic reviews, Zayeni, Raynaud and Revet [29] show that serious
games can be an effective tool in psychotherapy, while Balaintharanathan, Palmer, Arellano and
Arcand [30] found that serious games are effective especially at imparting knowledge, but also
at changing behaviours.
Few serious games have sought to improve social skills, especially in a classroom setting and
for a general population. Existing social skills games have largely been developed for a target group
of children with autism spectrum disorder (ASD) [for an overview, see 31], but most of these games
are single-player, or played in pairs or with a facilitator. Some other games havebeen developed
for a therapeutic setting. In SIDES [32], a cooperative tabletop computer game, students (in groups
of four) learn group work skills such as perspective-taking or negotiation skills in a social group
therapy setting.
AR learning applications are primarily used in the field of natural science [33, 34]. Again, AR
games that address social skills are mostly targeted at children with ASD. In a systematic review
about AR learning applications for children and adolescents with ASD from Khowaja, Banire, Al-
Thani, Sqalli, Aqle, Shah and Salim [35], 20 out of the 30 analysed studies had outcomes related to
social skills and competences.
The unique characteristics of AR to implement digital content in the real physical environment
of the player allow for an exciting new direction in digital learning – a blended approach, where
players engage both digitally and through ‘real life’ interaction with each other and the AR
components. This is especially suited to addressing sense of belonging via a digital setting while
still implementing real-world contact. One example of how this was donein a commercial game
is Pokémon Go, where players come together and form groups in the real world, in order to fight in
digital arenas. However, Pokémon Go players are not required to communicate or have real-world
social interactions in order to achieve their game goals. It has been shown that AR can encourage
cooperation and collaboration [23] and that collaborative tasks with AR may support learning
outcomes [36]. However, in existing serious games, collaboration is mostly used as a method to
reinforce specific learning outcomes, rather than being an outcome itself. For example, in the
serious game Pathomon [37], players use AR withthe primary aim of learning about viruses, but
also collaborate by sharing with each other the correct ingredient combination for an antidote.
However, players did not feel that their actions influenced the actions of others, which demonstrates
an opportunity for greater emphasis on collaboration.
The importance of sense of belonging in early adolescence and the lack of interventions aimed
at improving belonging led to the development of the presented game LINA. While collaboration is
often used in AR games to achieve other learning goals, few games have tried to improve sense of
belonging as a main outcome, especially targeting an entire group of people at the same time. Thus,
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our smartphone social AR game uses a blended approach of real-world and digital interactions to
improve sense of belonging in early adolescents.

3 DESIGN AND DEVELOPMENT OF THE GAME LINA

3.1 Concept

LINA is a mystery-style interactive narrative experienced by an entire class (and their teacher)
together. Players learn that a fictional classmate called Lina has suddenly left the school. Gameplay
involves solving the mystery of where Lina – whose behaviour often marked her outas unusual
– has gone, and why. Players uncover personal artefacts Lina has left behind in the classroom (using
AR), exchange information with other players, and collaboratively solve puzzles. First alone, then
in groups and finally as an entire class, they piece together the story of a classmate dealing with
an atypical and stressful home life, caring for a mother suffering from depression.
The game has been developed in both English and German; co-development was with early
adolescents in Austria. The name LINA was chosen for its acronymic potential in both languages
– ‘Lina Is Not Alone’ / ‘Lina Ist Nicht Allein’.

3.1.1 Theoretical background of the game LINA. Increasing sense of belonging and reducing
barriers between individuals and groups is a concept primarily addressed in Contact Theory and
stigma research [38-45]. Contact Theory argues that interaction involving (1) equal status, (2)
cooperation, (3) a common goal, and (4) authority support, enhances social interactions and reduces
prejudice between people, especially those perceived as outsiders or belonging to outlier groups
[46]. Based on this, LINA has been designed so that (1) all players (including the teacher) start with
the same amount of information; (2) information needs to be shared via gamified cooperative tasks
and real-world interactions; (3) players are ultimately steered towards solving the mystery around
Lina together; and (4) the game leads players safely and confidently through the game, offering
appropriate support (e.g. in form of hints). Imagined and vicarious contact have also been shown to
have effects [46]; thus, imagined contact with an individual affected by mental illness can lead to
improvements around stigma, attitudes and social distance.
Exposure to the arts in general [47] as well as principles from drama and movement therapy [48,
49] are potent tools to improve mental health. Storytelling in particular has been used successfully
to reduce prejudice and stigma, improving attitudes towards characters with ‘outsider’ status [50,
51]. LINA therefore immerses players in a story about mental ill health, not only educating them,
but letting them play an active role in the story.
In summary, LINA has been designed for school classes to spend time together and improve their
sense of belonging in the whole group. While scripted peer interactions (role-play) and immersive
storytelling provide a space for safe communication and reflection on mental health, gamified
collaborative tasks promote shared positive emotions, breaking down barriers between peers.

3.1.2 Creative co-development with young people. The game was co-developed with our target
group of early adolescents throughout the development process. All workshops with schools were
approved by the Karl Landsteiner University Commission for Scientific Integrity and Ethics (EK
NR. 1025/2020).
At the start of development, we held a series of four exploratory workshops with two classes
(grade 1, age 10-11) in Austria over a period of two months. The aims of these workshops were
to (1) gain factual information about day-to-day life in grade 1 of a secondary school, as this was
where LINA would be set; (2) gain information about the cultural lives of early adolescents such
as likes and dislikes, activities, media, attitudes and language; (3) gain information about social
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dynamics and friendships in their classes, as well as causes and enactments of social conflict;
and (4) explore the impact and consequences of unusual or transgressive behaviour within these
groups. Further, students were introduced to the concept of the game to assess its attractiveness
to them and seek contributions towards storyline and game execution. Information during those
workshops was gathered via group or whole-class discussions, but also by having students
draw, write or act out ideas for the game. Lastly, we invited adolescents to write private,
anonymous letters both to the game development team and directly to Lina, to give them the
opportunity to share thoughts and ideas they might not wish to share publicly. Insights from
these workshops strongly influenced development of the game. The resulting collection of artwork,
for example, helped the lead artist set a style for the game (see Fig. 1 and Fig. 2 for examples of
how student drawings from co-development were translated into the game).

Fig. 1. Locket – Student artwork (left), artwork for the game (middle), AR object in the game (right).

Fig. 2. Teddy bear – Student artwork (left and middle left), artwork for the game (middle right), AR object
in the game (right).

In addition to co-development with adolescents, we conducted focus groups with four female
adult participants who grew up with a parent with mental illness, to ensure our story felt truthful
and reflected their reality. The aim of these conversations was to find out about theimpact of
having a parent with mental illness on their lives as early adolescents, exploring personal stories
of incidents at school and the school-home dynamic. The main insights gained from these focus
groups were that there was not one generic lived experience but many and varied specific
experiences, which were often quite distinct; that young people in this situation do not necessarily
recognise their home life as different because it’s the only one they know; and that they
instinctively seek to protect and normalise their parent(s) and parenting. These insights, as well as
ideas for incidents and situations, influenced the development of the storyline around Lina and
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her mother.

3.1.3 Storyline – De-stigmatising mental health problems. Lina, who joined the school midway
through the academic year, had not moved past newcomer / ‘outsider’ status when, just as
suddenly, she departed. The class is left with an enigma around Lina – who she really was, where
she’s gone, and what to make of her short time with them. But Lina has pre-empted this: each player
finds a (virtual) notepad underneath their desk that Lina has left for them, which reveals a
series of puzzles and challenges she has set around how her classmates saw her. In absence,
Lina leads the players on a journey of discovery around their classroom, finding (virtual)
objects and messages that she has deliberately left behind. Each artefact prompts fresh memories
around how students (including the player’s fictional character) experienced and interacted
with Lina, what kind of person she was, and what happened during her brief time inthe class –
for example, Lina’s conflict with the teacher when she came to school wearing inappropriate
shoes, or her guardedness around her diary, which could only be opened with a key kept on a
string around her neck. The teacher, too, discovers scraps of information about Lina, though
these raise more questions than answers – questions their students will be able toanswer.
By the end of the game, players have discovered that Lina lived with just her mother, and that
the two of them frequently moved, in part as a consequence of her mother’s mental health issues.
Some of Lina’s unusual behaviours in class can be attributed to this life circumstance. For example,
she was cautious about making friends because she anticipated moving again; she was reluctant to
allow people to see where she lived; she had responsibilities towards being prepared for school (e.g.
having the right kit) that other children do not have. At one point she attended parents evening
herself, in lieu of her mother. At the end, it emerges that Lina’s mother has realised that their
situation is neither sustainable nor fair on Lina, and that they have moved one final time, to live
with Lina’s aunt and cousins while her mother seeks long-term treatment.

3.1.4 Gameplay – endorsing sense of belonging. Gameplay, which lasts up to one hour, begins
with every student sat in their usual place. Each player has a smartphone with headphones
attached, through which they hear an introduction about themselves: they are a fictional
student, in a classroom just like the one they are playing in. The teacher (who has also been
introduced to their fictional alter-ego) begins the morning register in a guided roleplay scene,
where smartphone screens tell players what to say and when (Fig. 3). It becomes apparent that
Lina (who is not played by any of the players) has been removed from the register. The teacher
does not know where she has gone or why.
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Fig. 3. Roleplay prompt in the introductory sequence of LINA.

Players then receive a message from Lina, telling them to look under their desk, where they
discover, through the smartphone camera, a personalised (digital) notepad (using floor-detecting
technology and AR) which guides them through the game (Fig. 4). The notepad directs players
towards specific physical (printed) markers which have been preset around the classroom.
Scanning the correct marker reveals an artefact belonging to Lina (AR object, see Fig. 5) which
prompts a voiceover in which the player-character recalls incidents involving Lina’s time in
their class related to that object.

Fig. 4. Screens with messages from Lina: WhatsApp message (left) and notepad (right).
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Fig. 5. Finding objects with AR in LINA.

Players learn different information about Lina depending on which markers they have been
directed to scan. In the next part of the game, players are directed to find a specific partner, who
will have acquired different information. Contact happens both on a digital and a physical level.
The two players prove they have found each other by touching their phones together (using Near-
Field Communication, NFC, Fig. 6). They then cooperate to solve a puzzle involving sharing
information about the objects they have found (Fig. 7), so that by working together,each
player finds out more about Lina.
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Fig. 6. Two players touching their phones to connect in-game via NFC.

Fig. 7. A pair of players who need to collaborate to solve a puzzle. They work on Player B’s screen (right)
to determine which objects they have found. The resulting number unlocks the next marker to find on
Player A’s screen (left).

After pair interactions, players are directed towards new groups of three to four people (again,
using NFC) to solve another puzzle; this leads the group to the teacher, with whom they share what
they’ve learnt and who shares a further piece of information with them. Once each group has talked
to the teacher, they take part in a fun challenge, tasked with finding everymarker hidden in
the classroom within a set time. Player then discover a piece of paper (floor- detecting technology
and AR) on the floor – a page of Lina’s diary. Directed to form a circle,each player reads out
their fragment of diary (Fig. 8), bringing together the remaining information and so solving the
mystery around why Lina has left. After this, everyone is askedto return to their desks and be
themselves again. In a guided post-game discussion, the teacher’s smartphone offers a selection of
discussion questions for the class to reflect upon (Fig. 9).
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Fig. 8. One part of Lina’s diary to be read out by a player.

Fig. 9. Teacher’s screen with post-game discussion prompts.

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3.2 Development
3.2.1 Interdisciplinary and international collaboration.The pan-European interdisciplinary research
group D.O.T. was set up to address social connectedness in early adolescents as a protective factor
in mental health, exploring how arts-informed digital interventions could support social wellbeing.
LINA is the product of an interdisciplinary and international collaborative process between a variety
of disciplines and countries, with a focus on the interplay between technical development, arts,
and psychology. The game is written and directed by a professional playwright, theatre director
and creative practitioner from the UK,who worked closely together with Austrian psychologists,
and computer scientists from Portugal and the UK, to implement storyline and psychoeducational
content into the digital game. Additional AR programming and additional cooperation with
industry partners such as a professional illustrator to create visuals (e.g. Lina’s artwork and
handwriting), and a professional composer for the soundtrack, ensured a polished audio-visual
experience. Voiceover was performed by young people equivalent in age to the characters they
were playing, plus adult actors to represent the teacher (see acknowledgements for further
information).
Influences for LINA include immersive theatre (for example the work of the British theatre
company Punchdrunk), participatory theatre and previous experiments around digital-theatre
crossovers; walking simulator narrative games (e.g. Gone Home, Firewatch); and adolescent pop
culture (e.g. the book and television series 13 Reasons Why), encompassing the topic of mental
health in the mystery narrative underpinning the game.

3.2.2 Iterative co-development of prototypes. After development began, different prototypes were
tested with various classes at various time points. In an iterative process, ideas and feedback
were integrated in each subsequent version of the game, thus continuously adapting the game
to early adolescents’ needs and ensuring that the world and story of the game felt convincing and
compelling. In these workshops, we explored initial interactions with the smartphone, difficulty
level (at a technical level, for game flow and understanding of storyline) and general opinions about
the game with early adolescents (see acknowledgements for participating schools). Findings from
these workshops influenced further development (e.g. refinement to puzzle design, refinement to
UI and UX, implementing a time-delayed hint system for phases of gameplay which some players
found difficult).

3.2.3 Technical development. LINA was developed in Unity1 Engine, which provided the quick
prototyping learning curve needed to create an initial proof-of-concept. Augmented Reality is
provided by Vuforia2 Engine in two different ways: Target Recognition uses an algorithm to identify
images (markers) in the camera feed and place 3D models in a position related to the recognized
marker; Ground Plane recognizes where the physical floor is and places digital objects there.
Given the requirement for multiplayer interaction, LINA follows a server-client architecture with
two main components acting simultaneously: (1) The “LINA Master” application, running on a
computer with Microsoft Windows, responsible for creating the game room, setting up, starting and
managing the game, storing the state of the game and synchronizing the game for

1 https://unity.com/, last accessed 21.02.2022

2 https://developer.vuforia.com/, last accessed 21.02.2022
 12

all client players; (2) The “LINA Client” app running on smartphones with Android operating
system, where the players interact with the game itself. The communication between these two
components is handled by the Photon3 Multiplayer Game Engine for Unity, a service that provides
a server hosting the game room.
Beyond AR, the game uses Near-Field Communication (NFC), which allows two mobile devices
to recognise and communicate with each other when in close proximity. One device registers as a
sender, the other as a receiver; when devices are held back-to-back, a one-way message is sent.
This is particularly useful in making sure two players have found each other.The game also
takes advantage of the impact of multiple phones in a single contained space by, for example, using
each player’s phone as a separate audio speaker to create a polyphonic soundscape with different
instruments placed in different parts of the room, or by creatingsynchronised ‘choreography’ of
players by sending all players an instruction to move (e.g. stand up, or form a circle) at the same
time.
Iterative development of LINA consisted of three major phases: (1) An initial proof-of- concept,
which explored the augmented reality feature and modes of communicating with multiple players.
(2) A first prototype, that incorporated placeholder 3D models and explored collaborative gameplay
between the players. This prototype had no networking component and was completely offline. (3)
The final prototype, with a complex multiplayer networking component and the introduction of new
features like Near Field Communication, a checkpoint system to allow resumption of progress in
the event of a technical problem, fully-animated 3D models, new music and narration sound files,
and new multiplayer challenges.

4 EVALUATION STUDY

The aim of the evaluation study was to (1) quantitatively assess usability of the prototype of
LINA with a questionnaire and (2) qualitatively assess usability and efficacy of the game by
conducting focus groups. LINA was tested for both usability and efficacy during a series of
workshops with early adolescents in June and July 2021. Five classes participated in the study, with
a total of 91 participants between 10 and 13 years (agemean=11.41; 47% female, 50% male, 3%
missing data). The participants first played the game (~1 hour) and then filled out a questionnaire
about usability of the game. Lastly, they discussed their experiences in small focus groups (~10-
15 mins). The workshops were delivered by five trained workshop leaders, who set up the game,
helped players during gameplay (e.g. with technical difficulties) and led the focus groups.

4.1 Materials and analysis

The German version of the Game User Experience Satisfaction Scale [GUESS-18; 52] was used to
assess usability, feasibility and acceptability of the game. The questionnaire consists of nine
constructs (two items per construct; 18 items in total): usability/playability, narratives, play
engrossment, enjoyment, creative freedom, audio aesthetics, personal gratification, social
connectivity, and visual aesthetics. The answers on the 5-point Likert scale range from 1 (“don’t
agree at all”) to 5 (“totally agree”). Analysis was done with SPSS [53]. We analysed descriptive
statistics with mean scores for all subscales. Considering there are still sex differences in the use

3 https://www.photonengine.com/pun, last accessed 21.02.2022

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of video games (only 36% of gamers were female in the fourth quarter of 2020, see [54]), we also
considered sex differences in the analysis of the questionnaire. Due to missing normal distribution
(tested with Kolmogorov-Smirnov and Shapiro-Wilk test), we analysed sex differences with the
Mann-Whitney-U-Test.
After playing the game, we conducted semi-structured discussions with small focus groups (3-
4 per group). We aimed to qualitatively assess three main questions: (1) how participants enjoyed
the general experience of the game, including elements like storyline, audio-visuals, difficulty level,
and technical adaptation; (2) whether participants understood the storyline and what the game is
trying to convey (de-stigmatisation); and (3) how participants experienced the cooperative parts of
the game and whether they felt it helped their connectedness with their peers (sense of belonging).
Discussions were recorded and later transcribed. We used principlesof thematic analysis to group
themes according to the research questions.

4.2 Results and discussion

Results of the GUESS-18 can be found in Table 1 (see Appendix for analysis on item level). Internal
consistency was good with Cronbach alpha α= .83. The overall usability score was
33.64. The highest ranked construct was enjoyment (mean score=4.42), closely followed by
social connectivity (mean score=4.37). The high scores in narratives, audio, and visual aesthetics
might reflect the advantages of collaborating with industry professionals when creating a serious
game. Looking at the medians of the subscales (see boxplots in Fig. 10), four subscales had a
median value of 3.5. The lower scores in the subscale creative freedom could be expected,as the
game is delivered in a structured way (including scripted roleplay and clear instructions)and was
not intended to leave a lot of freedom during gameplay, though this is a decision that could be
reassessed in future work. Engrossment scores might have been lower due to the fact that players
are not supposed to be completely submerged in the game. One item reads, “I forget what is
happening in the outside world while I play”, but due to the blended approach, players are also
playing in the ‘outside world’. Lower gratification scores may also be due to the game being
collaborative rather than competitive, though may also suggest more could be done to reward
progress. Usability scores might have been affected by technical problems during gameplay of what
was still a prototype of a complex piece of new software (see results of focus group discussions for
further information).
There were no significant sex differences for the overall score, yet some subscales revealed
sex differences. Female participants showed significantly higher scores in visual aesthetics,
enjoyment and narratives, while males showed higher scores in usability/playability, which
suggests that boys found the game easier to control while girls appreciated the overall experience,
visuals and story of the game more. This shows that we succeeded in creating an experience that
appeals to both sexes, but also indicates that males may have an advantage in controlling the game
more easily, perhaps due to being more experienced in gaming, but may be less receptive to its
narrative and aesthetics.
Although our aim was to assess usability (not efficacy) with the GUESS-18, the results also
look promising in terms of expected efficacy and outcomes of LINA. The two highest-ranked
constructs were enjoyment and social connectivity, which reflects our aim to bring students
together and increase sense of belonging (reflected by the high score in the social connectivity
subscale) in a fun way (reflected by the high score in the enjoyment subscale).
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Table 1. Results from the GUESS-18

Subscale Mean M Standard Mann-Whitney-U-Test (Sex differences)

deviation
SD
Overall score 33.64a 4.87 n.s.
Enjoyment 4,42 .84 U(Nf =43, Nm=45)=, z=-2.915, p=.004*
(females show higher scores)
Social connectivity 4,37 .66 n.s.
Narratives 4,32 .75 U(Nf =43, Nm=45)=, z=-2.057, p=.04*
(females show higher scores)
Audio aesthetics 4,07 .96 n.s.
Visual aesthetics 4,02 .71 U(Nf=43, Nm=45)=, z=-2.511, p=.012*
(females show higher scores)
Usability/playability 3,70 .85 U(Nf =43, Nm=45)=, z=-2.323, p=.02* (males
show higher scores)
Personal gratification 3,46 1.01 n.s.
Play engrossment 3,42 .98 n.s.
Creative freedom 3,32 .97 n.s.
aOverall scores are calculated by adding up all subscales. Scores range from 9 to 45, see [52]

Fig. 10. Boxplot for the subscale scores of the GUESS-18: each plot shows one subscale (2 items).

For the focus groups, the feedback about the game was very positive in general. Almost all
adolescents enjoyed playing it and would play this or a further episode of the game again. There
was some critical feedback for specific parts of the game. The main problems adolescents had
 15

during gameplay were due to technical problems and waiting times (especially in the group phase,
where some groups were faster with puzzle solving than others), which interrupted the flow and
led to some players feeling bored. In terms of storyline, some wished for more explanation at the
end, or mentioned what could be further explained in putative subsequent “episodes” of the game.
Lina’s home life, her relationship with her mother, and how her life is now that she has moved back
were topics of interest. However, adolescents realised that the storyline was about de-stigmatising
(see quotes in Table 2). Answers relating to sense of belonging showed that adolescents were aware
that the main aim of the game is to bring players together and improve class climate, and also
thought that the game was able to achieve that (see Table 2).

Table 2: Example quotes from adolescents from focus groups discussions

Topic Example questions asked Quotes from adolescents

by the researchers
General How did you like the R: How did you like it? Tell me!
game? A1: Nice, very nice.
A2: Very good, very very good.
A3: 100 out of 10!
A4: I say 8 out of 10.

What did you like/dislike? Sometimes it was complicated when something

didn’t work, but apart from that I really liked it.

The only difficult thing was that we had to wait

for everyone, because they needed more time for
something.

When I heard about it, I thought that only the

children were playing and I thought it was cool
that the teachers were also playing.

I also thought it was cool that we got the names,

because then we also played the role, that we had
to stand up in the classroom and say "Good
morning, Mr. Gruber”.

Sense of What do you think was the A: That we build up more contact with the class.
belonging purpose of playing LINA R: Did that work?
with your class? A: Yep

What, if anything, do you I think this has also strengthened the class
think LINA has helped you community a bit because we all worked together.
and your class with?
So, you play it together in the class. Because then
everyone worked closer together and that was also
 16

Topic Example questions asked Quotes from adolescents

by the researchers
fun and that you simply do more together as a
class.
De- What, if anything, do you It’s also fun, because you also do something with
stigmatisation think LINA has helped you those you actually do not have so much contact
and your class with? with

I think with Lina it was also a little bit that you

learn that you do not have to exclude people and
should not.

R: And why do you think we are here today to

play the game with you?
A: So that the kids who play it realize that they
shouldn't bully others. Or judge them for
anything.

What was the story about? And Lina has left all these items that if you have
solved the puzzle you can also understand why
she had to leave now and in any case I really liked
the game and it was very great.

5 CONCLUSION

In this paper we introduce LINA, a smartphone AR serious game that is played by a whole class
of early adolescents to reduce stigma around mental health and improve sense of belonging. The
game was developed by an interdisciplinary and international team and involved early adolescents
as co-developers throughout development. Both quantitative and qualitative data from the
evaluation study showed high acceptability of the game, and qualitative data show promising results
regarding efficacy. A limitation of the study is that the data for efficacy areonly preliminary
due to their qualitative nature. We plan to conduct a further evaluation studyto quantitatively
test efficacy of the game.
A major strength of LINA lies in the interdisciplinary co-development process: collaborating
with professional industry partners especially for narrative, visuals and audio increased the chance
of a high-quality game. Involving early adolescents throughout the development process created a
game that reflects the voices of its target group.
For future work, co-development left us with an abundance of material and ideas that could still
be implemented, suggesting that gameplay and narrative could be sustained across multiple
episodes. While the current version of the game is played in one session, there is the potential
to rework and expand LINA as an intervention lasting several weeks, playing a new episode each
week.
The impact of LINA may surpass the current game, in that it showcases the general potential
of this form of social AR gameplay in educational, psychotherapeutic or entertainment settings
– a collective experience that fosters a greater sense of belonging while creating a safe
environemnt in which to engage players in a potentially challenging topic. The fact that an
 17

increasingly ubiquitous digital device such as a smartphone acts as the facilitator of the game makes
it cost-effective: easy to distribute digitally, and easy to implement without externalfacilitators. The
affinity of adolescents for digital media makes them an especially appropriate target for this kind
of intervention; the format might also be used for building sense of belonging in other
environments, for example in a workspace with a group of adults or withany other group that
wants or needs an entertaining way to connect both digitally and in thereal world. In that sense,
beyond being a stand-alone intervention, LINA could be seen as a prototype for “Augmented Social
Play” interventions, which could be adapted to the specific needs of the target group while always
endorsing sense of belonging.

A APPENDIX

Table: Results of the GUESS-18 on item level.

Items (Audio, Creative, Visual, Enjoyment, Social, Mean Min Max Standard Variance
Narratives, Usability, Gratification, Engrossment) Deviation
I like the sound effects in the game. 3,98 1 5 1,14 1,30
I think the sound in the game (e.g. sound effects 4,19 1 5 ,95 ,90
and music) improves my gaming experience.
I think the game allows me to make changes. 3,59 1 5 1,09 1,18
I think I can be creative while playing the game. 3,06 1 5 1,14 1,29
I like the game’s graphics. 3,99 1 5 ,89 ,79
I think the game looks nice. 4,04 1 5 ,81 ,66
I think the game is fun. 4,52 1 5 ,86 ,74
I am bored while playing the game. (re-coded) 4,37 1 5 1,05 1,10
I think the game promotes communication (e.g. 4,38 2 5 ,71 ,51
talking, chatting) between players.
I like playing the game with other players. 4,36 1 5 ,90 ,82
The story of the game got me excited from the 4,25 1 5 ,82 ,68
start.
I like the story of the game. 4,43 2 5 ,77 ,59
I find the game easy to control. 3,66 1 5 ,98 ,96
I find the in-game interface easy to use. 3,73 1 5 ,94 ,90
I want to do as well as possible during the game 3,50 1 5 1,20 1,44
I am very focused on my own performance while 3,46 1 5 1,11 1,24
playing the game.
Sometimes I lose track of time while playing the 3,69 1 5 1,06 1,12
game.
I forget what is happening in the outside world 3,16 1 5 1,27 1,61
while I play.

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