A Narrative-Driven VR Serious Game for Type 1 Diabetes Self-Management: A Child-Centered HCI Approach (Preprint)

BACKGROUND Self-management of Type 1 Diabetes (T1D) in children remains a persistent challenge for both families and professionals, highlighting the urgent need for effective, engaging, and age-appropriate educational interventions. OBJECTIVE This study aimed to develop and evaluate an original, narrative-driven virtual reality (VR) serious game, systematically designed through a child-centered participatory approach to enhance self-management behaviors among young children with T1D. METHODS A needs assessment informed the participatory development process, which actively involved children, caregivers, and clinical experts in shaping the game’s narrative, mechanics, and interface. Each module of the game was systematically mapped to evidence-based domains of T1D self-management, transforming complex health tasks into interactive and child-friendly experiences. A four-week mixed-method empirical study was conducted with 54 children (aged 4–9) from four hospitals, including quantitative assessments and qualitative interviews. RESULTS Quantitative analysis showed statistically significant improvements in self-management knowledge, practical skills, and psychological readiness after the intervention, with the largest gains observed in intrinsic motivation and self-efficacy (all p < 0.001). Usability and engagement ratings were consistently high. Qualitative interviews revealed increased confidence, greater willingness to practice self-care, and strong appreciation for the game’s narrative-driven design. CONCLUSIONS A narrative-driven VR serious game, developed using rigorous HCI frameworks and active user participation, can effectively promote multi-dimensional improvements in pediatric T1D self-management. This work advances both the theoretical and practical landscape of digital health interventions for children and provides actionable guidance for future large-scale adoption and research in health technology design.