Narrative-driven virtual reality serious game to support type 1 diabetes self-management in children

Supporting type 1 diabetes (T1D) self-management in young children remains a major challenge. Traditional education often fails to sustain attention or meet developmental needs. This study introduces Tangbao Superman Transformation, a narrative-driven virtual reality (VR) serious game developed through participatory Human-Computer Interaction (HCI) methods, to enhance pediatric T1D self-management. A four-week single-group pre-post feasibility study was conducted with 54 children aged 4-9 years recruited from four pediatric hospitals in eastern China. The intervention translated the Chinese Diabetes Society's seven-domain (CDS-7) framework into VR modules co-designed with children, parents, and clinicians. Quantitative measures included the Self-Management Scale for T1D Children (SMS-T1DC), the System Usability Scale for Children (SUS-C), and an Engagement and Motivation Questionnaire (EMQ). Attendance logs and field notes documented adherence and safety, while semi-structured interviews with children, parents, and providers provided qualitative insights. Children showed significant improvements across all seven self-management domains (p < 0.001; Cohen's d = 0.78-1.27). Usability was rated as excellent (SUS-C = 86/100), engagement was high (95% session completion), and qualitative findings highlighted reduced resistance, increased confidence, and application of strategies in daily routines. This feasibility study provides preliminary evidence that participatory, narrative-driven VR interventions can enhance pediatric T1D self-management. However, the absence of a control group, short intervention duration, lack of biomedical endpoints, and sample homogeneity limit generalizability. Future trials should incorporate active comparators (traditional teaching or mobile apps), biomedical outcomes, multi-center recruitment, and long-term validation to establish incremental efficacy and scalability.