Co-Designing Culturally Grounded Mobile Health Games for Hypertension Management in Indigenous Communities.

Hypertension, which disproportionately affects older adults, continues to pose a critical health challenge among Indigenous communities, where systemic healthcare inequities and cultural mismatches in medical interventions contribute to high rates of undiagnosed and unmanaged cases. This paper explores the co-design of culturally relevant mobile health games to support hypertension management among Indigenous Peoples in Northern Arizona. Drawing from participatory design methodologies, we conducted a workshop with 14 participants to conceptualize and prototype mobile applications focused on five key factors of hypertension care: medication adherence, nutrition, exercise, education, and blood pressure monitoring. The workshops revealed that culturally rooted play and storytelling may significantly enhance user engagement and acceptance of digital health tools. Using insights from these sessions, we developed five medium-fidelity prototypes that reflect diverse game and play strategies, from traditional gamification techniques to reappropriations of existing games infused with Indigenous cultural elements. Our findings highlight how participatory and culturally grounded design approaches can produce mobile health interventions that may resonate more deeply with Indigenous worldviews and healthcare practices. This study contributes empirical design artifacts and knowledge to the field of accessible health technologies, emphasizing the importance of Indigenous-led co-design in addressing chronic disease disparities. We conclude by outlining future directions for iterative prototyping and playtesting, with implications for broader applications in culturally responsive digital health innovation.