(PS3-45) Acceptability Outcomes of a Novel, Tablet-based Cognitive Rehabilitation Program for Pediatric Cerebral Malaria in Sub-saharan Africa

Cerebral Malaria disproportionately affects children in sub-Saharan Africa and is associated with neurodevelopmental sequelae such as poorer attention, executive functions, and memory. Currently, no adequate cognitive treatment is available post-hospital discharge for this population. This feasibility trial explored the implementation of the cognitive rehabilitation program, Dino Island (DI) for children (n=10) recovering in Malawi, Africa. Specifically, acceptability outcomes were evaluated to determine if DI was culturally appropriate and sufficiently engaging for this population. DI combines a tablet-based, neuroscientifically developed ‘serious’ game with metacognitive coaching and can be delivered by a ‘non-professional’ adult in the child’s life. Developed to be accessible in remote communities, DI is administered 100% remotely and does not require internet access making it a promising treatment option for resource-scarce and/or rural communities. As Dino Island was designed for North American use, community involvement and an implementation science approach informed culturally appropriate adaptations to ensure the program fit the needs of the Malawian population. Program administration using a within-hospital train-the-trainer model required a parent willing to be trained by critical care nurses to implement the Dino Island game and metacognitive strategies while supervising 100% of a child’s gameplay (~1-3 hours per week). Participants were given a tablet and power source to facilitate the home-based program in their remote communities. To evaluate the acceptability of the program semi-structured interviews were collected at 1-, 3- and 6-month follow-ups. Using NVivo a line-by-line deductive thematic analysis was conducted. 100% of children and caregivers reported enjoying the intervention. Caregivers and pediatric nurses perceived the program as successfully benefiting the children (100%). Measured on a 5-point Likert scale, acceptability was rated 5.0 which shows that participants would recommend the program to others and repeat it themselves, suggesting a high level of acceptability. Although families were able to complete the program, the appropriateness of the program was limited by reported language barriers. Acceptability data drawn from different data sources will be presented, along with recommendations for maximizing uptake.