Life and Death in the Age of Malaria: A risk-reduction game for study abroad students

Laurie Hartjes

Abstract

In this presentation, I will describe the development and evaluation of a game designed to educate study abroad students about malaria risk-reduction. Lessons learned will be offered along with study results. Three prototypes were created and rejected based on iterative user testing before arriving at a version that was engaging and intuitive enough to play-to-completion without incentive. Game evaluation focused on best practices for the delivery of explanatory feedback within the context of an educational game. Player engagement was critical as it was the only incentive to complete the study protocol. Students at seven campuses in the Midwestern U.S. were recruited to participate, and 482 students completed the study protocol. Three versions of the game were used to compare feedback strategies: no pop-up explanatory feedback, player-controlled (discretionary) explanatory feedback, and automated (every time) explanatory feedback. One third of the students who clicked on the link to access the study protocol completed it. Of these students 32% reported prior travel to a malaria endemic region, 5% didn't know if they'd visited an endemic region, and 64% plan to travel to an endemic region in the future. The overall mean time duration to complete game activities was 18.0 minutes, although mean completion time was significantly longer (20.3 minutes) in the automated group (F=6.1, p<0.002). Primary outcome measures were pre/post knowledge gain and satisfaction with the gaming experience. Only the automated explanatory feedback condition produced a significantly higher mean score for knowledge gain as compared to the other conditions (F=6.5, p<0.01). Differences in knowledge gain between game conditions was small (partial eta squared=0.026); however, there was a large effect size (0.767) for the pre to post increase in knowledge scores across all conditions, demonstrating a strong overall learning effect (m=7 pre and m=14 post; t=39, p<0.001). Malaria risk perception ratings increased significantly following the game intervention regardless of assigned condition (likelihood t=3.1, p<0.01; worry t=3.5, p<0.001). Open-text comments were generally positive for 60% (informative, fun, engaging); negative for 33% (too long, repetitive, technical problems), and 7% were valence neutral. There were no differences in player satisfaction between conditions. Game satisfaction was rated as 'very' to 'extremely' satisfying by 65% of participants. In the context of this genre of educational game, learning can be supported by providing explanatory feedback with each decision without diminishing player satisfaction. Research is needed to examine the association between knowledge gain and risk-reduction behavior during actual exposure to health threats.