CardioCare Quest is a culturally grounded mobile health game suite built on Twine for hypertension (HBP) self-management. Five medium-fidelity game prototypes target the five pillars of HBP care: medication adherence, nutrition, exercise, education, and blood-pressure monitoring. The project runs parallel design and evaluation protocols in Arizona (with Navajo Nation and other Indigenous communities) and Texas (with Black and Hispanic communities), specifically to study which design features generalize across populations and which need to be culture-specific. CardioCare Quest is a mobile health game platform to combine culturally co-designed mini-games with real-time telemetry for hypertension self-management.
In the U.S., 45% of adults have hypertension, but only 24% have it under control. Indigenous, Black, and Hispanic communities face disproportionately high prevalence and worse outcomes, driven by socioeconomic challenges, limited healthcare access, and historical and cultural determinants of health. Existing mHealth tools often rely on a Western individualist model of self-care that maps poorly onto Indigenous worldviews and relational support systems. Clinicians also lack visibility into patient behavior between visits a clinical-inertia gap CardioCare Quest is specifically designed to close.
Participatory community-based design was used to run a foundational workshop with 14 community participants, producing five medium-fidelity prototypes that range from traditional gamification to reappropriations of existing games infused with Indigenous cultural elements. Methods include bodystorming, brainstorming, and affinity diagramming. Evaluation employs the RITE method to remove usability barriers, the METUX model to measure motivation and engagement with 20 representative users per state, and semi-structured interviews with medical professionals to validate medical intent. The project is currently in clinical trial. CardioCare Quest is built on Twine the same accessible, no-code engine used for NetGauge Games so community members can extend content without needing programmers.
Co-PIs: Jared Duval (NAU) and Creaque Charles Tyler (Texas Southern University College of Pharmacy and Health Sciences) | Postdoctoral Scholar: Tochukwu Ikwunne | PhD Student: Pavan Prasad Gorintla | Undergraduate Researcher: Alison Graham (lead author on ASSETS 2025 paper) | Strategic partners: Texas Southern University College of Pharmacy and Health Sciences and the Hozhoni Foundation.
NIH 5U54MD012388-08 (Subproject) $100,000 PI Duval June 2024 CardioCare Quest: A Co-created Game for Improving Hypertension Treatment Compliance in Arizona | NIH U24MD015970 (Subproject) $150,000 Multiple PI (Duval and Charles Tyler) June 2024 CardioCare Quest: A Telehealth Game to Improve Hypertension Outcomes and Health Disparities
Graham, A., Ikwunne, T., Duval, J. Co-Designing Culturally Grounded Mobile Health Games for Hypertension Management in Indigenous Communities. ACM ASSETS 2025. https://dl.acm.org/doi/10.1145/3663547.3746321
