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Table 2 Mapping participant experiences against the five constructs

From: Person-centred interventions for problem gaming: a stepped care approach

Construct Participant experiences Indicative quotes
Ability to perceive a need for support Health beliefs
• Perceived harm included wasted time, energy, ability to focus on more meaningful achievement, entrenched lifestyle, ignoring personal hygiene or disrupted sleep.
• Decisional balance involved the benefits of gaming (positive hobby, social connection, skill building, enjoyable, relaxing) versus negatives (health, work, social). Cons of gaming start to outweigh the benefits.
• The reasons for excessive gaming included loneliness, isolation, boredom, lack of excitement, feelings of safety, respect (player), sense of achievement, relaxation, distraction, altering mood such as to feel good, fill a void, manage stress.
• Other mental health (depression or anxiety) or substance use disorders (alcohol, cannabis) were perceived as more acute and associated with immediate harm.
Health literacy
• Understand the potential seriousness of addiction in terms of the risk for harm. This includes understanding the nature of addiction and how it relates to gaming.
• Understand the prevalence, biological and psychological characteristics, harm and risk factors associated with problematic gaming.
Gaming addictions certainly appear to be seen as “soft” addictions, especially in comparison to chemical addictions, and as such are not taken seriously until it’s too late. (#2)
Gaming has become a way of life for me recently to the point of gaming from when I wake up till when I sleep. (#6)
I think that the addiction just isn’t seen as being as serious despite the hours and money spent on it. (#10)
I think gaming addiction in particular is sometimes regarded as a bit more trivial or not as much of a problem as addictions. I’ve tried talking about it with a few people I am close with and it’s kind of been brushed off, and I haven’t really felt comfortable going to a counselor for it either. (#5)
I think it works like any other addiction. Whether physical or mental we build a reliance on things. Mine is gaming for dopamine I guess. (#18)
My addiction feels like it’s taking a big chunk of my ability to actually think of things I want to accomplish by overcoming it. I am near failing at university, I can’t get by on just been bright anymore. Actually, need to do hard work, which sadly is difficult to start. (#3)
When I am feeling a bit down, I’ll tell myself just to chill out and play something for a bit, but it kinda spirals from there. (#10)
The amount of time I spend gaming has a much bigger negative impact on my life (health, work, sleep, social) than positive. (#5)
Ability to seek support Knowledge of services
• Limited knowledge of where to seek help. Limited knowledge of how treatment works.
Appropriateness of help seeking
• A perception that services already have too much need and that gaming is not as important or harmful as other issues. Associated view that in-person services are unable or unwilling to make time for gaming issues.
• Locating gaming treatment with perceived more serious issues discourages help-seeking.
• Services do not convey a knowledge of gaming culture or specific approaches to treatment.
• Friends, partners, and family provided encouragement to game less, but limited encouragement, support or motivation to seek help or engage in behaviour change.
Stigma and shame
• A feeling of shame or embarrassment that help is needed and that the issue is beyond self-management.
• Help seeking is not typical amongst gamers and the gaming culture does not support leaving gaming networks.
Age and sex appropriate services
• Perception that treatment may not be age or sex appropriate. This includes the way information is currently provided (needs to be brief and targeted) as well as the type of information conveyed (e.g., relevant to young adults).
• Recognise that females have gaming problems too and likely experience additional stigma.
Desire for autonomy
• A desire to choose personal gaming reduction goals (stay the same, reduce, abstain) and to determine the speed of change.
• A preference to avoid treatment that does not respect individual choice. Interest in self-management and a do-it-yourself approach.
• Preference to be treated as an adult and be able to make own decisions.
I don’t know where to seek help for a potential gaming addiction. I don’t know of any available services for specifically this. (#2)
I think if it was made known that these other programs could also assist with things such as a gaming habit it would help people like me take the issue more seriously because until recently it never seemed a serious enough issue next to the other problems these programs deal with. (#7)
People I know have told me that I should “solve my problem” and that “I need to stop gaming” but they technically have never actually encouraged me to say seek a service to assist in the matter. (#5)
I would be reluctant to engage in counselling because of the strain on local services and cost of private services. (#2)
Other programs dedicated to helping people overcome personal issues tend to be focused on more serious problems such as mental health, living conditions, or family issues, and therefore these programs don’t advertise the fact that they could help with something like this. (#7)
Yeah of course there’s stigma around it. It’s quite embarrassing, especially today’s university students since my friends play the same amount as I do it isn’t embarrassing within our circle however outside of that people will always question and shame it. (#8)
I feel like people would perceive me in a strange/snowflake way if I were to get help for ‘playing too many games’. (#5)
Anyone my age probably wouldn’t want the information to be incredibly detailed and long but more key phrased and engaging. (#18)
Not being treated like a child when I’m not is a big thing though. If they don’t respect me what’s the point? The service did not understand addictive behaviour, only physical addiction, and didn’t have an understanding of the factors that relate to addiction enough to actually help and I ended up giving up seeking help. (#4)
Ability to reach for support Transport, travel and wait times
• Few service options mean travelling distances to receive help. Ideally it is available within own town or region.
• Willing to travel around 30 min to receive treatment. Must have access with public transport.
• Willing to wait for an appointment because it is not generally acute or life threatening. Acceptable wait times ranged from a few days to a few months.
Location
• Co-location with addiction services or problem gambling. Could be co-located with a university counselling service.
• Access to advice and screening from primary care providers. Facilitate opportunistic interventions.
• Available weekends and in the evenings.
• If online there was a preference that the person had some local context.
Modality
• Multiple modalities including in-person and online. Need for flexible, convenient and discrete access as required. Online or face-to-face individual or group treatment.
• Smartphone access for tracking behaviour and getting help as needed, and a website for screening and information.
It should be accessible. Have multi-platform ideally, with in-person and online communication pathways. (#2)
I reckon confidentiality is very important. And I prefer talking over messaging services rather than face-to-face. (#4)
A face-to-face group will probably be my optimal one as you can also share the issue with others which I think helps the success of dealing with an issue. (#14)
I’d much rather email or text someone to set up a meeting or begin a program than have to call or come in to somewhere to do this. (#7)
I like online services more than text/phone because I’m more used to typing online, it allows me to think through my words as I’m speaking for clear communication and reading replies is easier than listening to them. Online communication is great when you can’t make it into town easily. (#2)
I think maybe an online session chat is the best. Most people who are addicted to video games are shy, introverted etc. it is hard for them to actually come out and seek help. (#16)
If it was closer to exam time, I’d be a bit more desperate and therefore want help as quickly as possible, but other times through more relaxed parts of the year I’d be willing to wait a week or two. (#7)
Ability to pay for support Direct fees
• Expectation that there would be a cost to attend in-person treatment. The recommended tiered approach based on income. For students the reasonable amount per session was around $20 and for those who were employed around $100.
• Expectation that there could be private and public options and that health insurance would cover the fees.
Factors impacting ability to pay
• Expected value for money. Willing to pay more for better and more effective treatment. Likely only want to pay if there were serious harm or impact.
• Difficulty getting time to attend appointments due to inflexible work or study.
• Transition away from family home to university or community living put pressure on finances. Money was spent on gaming which decreased the ability to spend money on treatment.
I am a student and currently not working, so I cannot afford the service if it’s over $20. The cheaper the better. (#1)
Given that general counselling sessions normally range to about $100 I could probably accept say 150–200 given expertise, specialisation and success rates. (#3)
Depending on how long the sessions are, I would say $20 an hour, because if I can take the advice from the counsellor and use it, it would be worth it and it’s a reasonable price. (#14)
People most advantaged would be people with high incomes that could be more flexible with taking time off as well as affording the service itself. (#10)
Ability to engage with support Service delivery characteristics
• Confidential, private and capacity for anonymity. Culturally appropriate.
• Pre-treatment screening so as to not waste time.
• Multiple modalities (face-to-face, group, online) and blended treatment (different types of service options such as peer and one-to-one). Single session or ongoing treatment.
• Peer support forums moderated by a professional.
• Able to be tailored to need (varying intensity from screening and drop-in to residential care).
• Resources include online and written materials.
Treatment needs
• Skills development for relationships and social situations, emotional intelligence, time and stress management and sleep hygiene.
• Treat underlying comorbidities such as impulsivity, substance use (alcohol, cannabis), depression and anxiety.
• Enhance self-efficacy and belief in capacity to change. Support increased accountability, commitment, goal setting, urge management and self-monitoring.
Quality of providers
• Professional but not formal with demonstrated unconditional positive regard. Facilitate empathic and approachable partnerships.
• The provider should understand gaming culture and technology and be an expert in treatment of gaming.
Adequacy of service
• Participants should be satisfied with the quality of service and experience the treatment as effective.
Some pre-involvement lead-up (such as questions like the ones we talked about earlier) so that the professional I was seeing could jump straight into tackling the problem from the first time I met them. (#3)
For me I feel like confidentiality is the most important when getting help with mental disorder. I want to keep it as secret as possible and sometimes you don’t even want the professional to know you  because sometimes you feel insecure about yourself. (#16)
Definitely confidentiality, nobody likes the idea of others thinking they have a problem. But by this I don’t just mean private counseling but actually setting up appointments and things like that. (#7)
I think building the skills and confidence myself, with the help of your tools, will help me go further with gaming reduction. (#10)
Accountability and some form of consultation would be good. Booklets or handouts containing tips would be good, maybe something regarding logging time online, or time spent doing other stuff, and some form of online based community with others. (#2)
I’ve been trying to tackle other elements around addiction such as alcohol and marijuana but the truth is I have an addictive personality that extends to many areas of my life. (#4)
Someone who understands game culture. I feel like having to explain concepts and things like that all the time would make me feel like I couldn’t relate to the person on this topic. (#7)