The Union’s Advocacy, Communications and Social Mobilization (ACSM) team worked closely with a small team of game designers, coders and artists to develop a first-of-kind TB-themed virtual escape room to promote health-seeking behaviour.
To ensure it effectively reflects the lived experience of people with TB, over 25 TB champions were consulted to provide input on the game, including the lead game designer, who is a TB survivor herself. This was followed by further testing with over 100 people with and without experience of TB from a wide range of demographics.
The game was divided into levels that addressed barriers to health-seeking behaviour and, through interaction rather than lecturing, encouraged the audience to recognise these challenges and explore ways to address them as individuals and communities.
During the Union World Conference on Lung Health 2025 in Copenhagen, the ACSM team debuted the game. As the Union Conference brings together a diverse range of stakeholders (e.g. healthcare professionals, policymakers, TB survivors, etc.), it provided fertile ground for the beta version of the game to be tested.
Janhavi Mittal, ACSM Manager at The Union, who led the testing in Copenhagen, said: “This game exemplifies how play has the potential to leverage the power of demonstrative communication and the effectiveness of strategic behaviour interventions in tackling misinformation about TB, building community, mitigating stigma, the importance of mental health resources and family support, addressing issues of doctor avoidance, cough trivialisation and much more.”
To properly monitor and evaluate the results of the beta testing, a short pre- and post-game questionnaire was completed, assessing players' perceptions of behavioural barriers to early testing and how these can be overcome.
Indicative patterns of behaviour change were discovered during the testing phase:
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The game had a significant impact in making players realise that the trivialisation of cough is a significant behavioural barrier, showing a 63% increase.
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There was a noticeable shift in the players’ responses towards recognising the importance of hopeful, supportive entertainment-based messaging, instead of fear-based information sharing.
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It was heartening to see the role of practitioner counselling repeatedly underscored after the game was played.
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The game also has the potential to address stigma and blame-based responses to people with TB – after playing the game, there was a lesser tendency to blame people’s behaviour on apathy or ignorance, and a greater understanding of the anxiety, fear and hopelessness that the possibility of a positive diagnosis can induce in a person.
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There was also a 40% drop in the number of players who thought the onus was on the individual to get tested early.
Janhavi concluded: “The key learning from the testing has been that the game has immense potential in helping players recognise and address barriers to health-seeking behaviour, through active learning, rather than passive consumption in collective settings.
“The diverse, though largely positive response to the game also indicates that there is a need to adapt the game into shorter episodes for specific stakeholders. This vital feedback will be incorporated into our next phase of the game development process, as we look to officially launch later this year.