A Gamified Digital Mental Health Intervention Across Six Sub-Saharan African Countries: A Cross-Sectional Evaluation of a Large-Scale Implementation

Mental health conditions affect many young people in sub-Saharan Africa (SSA), where stigma is high and access to care is limited. Digital tools accessible on basic mobile phones offer a scalable way to promote mental health, but evidence on their effectiveness in SSA is limited. This study evaluated the reach, feasibility, acceptability, and knowledge outcomes of Digital MindSKILLZ, an interactive voice response (IVR) mental health game implemented in the Democratic Republic of Congo, Ghana, Nigeria, Rwanda, Uganda, and Zambia. Over seven months, 700,138 people called the platform, and 425,395 (61%) listened to at least one message. Of these users, 63.6% were under 25 and 68.3% were from rural areas. The three content branches—mental health information, coping skills, and football quizzes—were accessed by 36.5%, 46.4%, and 50.9% of users, respectively. Among mental health users, average completion was 7.6 out of 18 messages. In a follow-up survey, 91% understood the content, 85% would recommend the game, and 38% found the mental health content most helpful. Average knowledge scores were 62%, with lower scores on common disorders and stigma. The intervention showed strong reach and acceptability. Improvements are needed to boost engagement and retention, and adapt content further by country.