Effects of a Serious Game on Knowledge, Attitude and Practice in Vector Control and Dengue Prevention Among Adults in Primary Care
Condition: Dengue
MeSH terms: Dengue
Study type: Interventional

Summary: 
      Dengue can be mitigated by both vector control and vaccination. Serious games in healthcare
      can be used to raise the community awareness of vector control in dengue prevention in a
      simulated interactive learning environment, by motivating serious game participants to
      optimise their own performance and influence their behaviour. The results show a specially
      designed serious game can better engage local residents by raising their awareness in vector
      control and proactiveness in dengue prevention. At least 8 out of 10 participants were
      willing to be vaccinated against dengue if they knew of the availability of a safe and
      effective vaccine.
    

Detailed description: 
      Study design: From March to August 2021, a single-centre randomised controlled trial was
      conducted to determine the effectiveness of playing a serious game (intervention) in
      improving the KAP of participants in vector control and dengue prevention compared to those
      who viewed a dengue prevention website (control).

      Study site: This study was conducted at a regional public primary care clinic (Polyclinic) in
      Sengkang. Sengkang Polyclinic is located in Sengkang Community Hub, which is an amenity
      centre in Sengkang, within the North-East region of Singapore. Sengkang is also a residential
      town, which is the second most populous in the region, being home to 244,600 residents in
      2019.

      Sample size calculation: To determine the effect of serious game in the literacy level of
      adults in preventing dengue in Singapore, the sample size was computed based on the study by
      Nurul Akmar Ghani et al, in which the significant difference in mean and standard deviation
      of knowledge scores were 14.55 (3.09) and 15.41 (2.75) respectively between the compared
      groups. To obtain a sample size with 95% confidence level and 80% power for this study, a
      minimum of 182 participants per group was required. With a possible drop out of 10%, the
      sample size was increased to 200 per group.

      Recruitment and consent process: Recruitment posters, containing registration details of the
      study, were placed within the clinic's premises from March to August 2021. Adults who were
      interested to join the study voluntarily could approach the clinical research coordinators
      (CRCs), who would screen them for eligibility, explained the study intent and procedure to
      them in a designated room within the study site. The CRCs were trained by the principal
      investigator to provide adequate information and address relevant concerns or queries from
      the participants prior to the start of this study. The latter were informed about the purpose
      and content of the study based on the approved participant information sheet. After
      clarifying their doubts and queries, every eligible participant endorsed their written
      informed consent before randomization.

      Randomization: The randomization sequence was created by the biostatistician using computer
      generated random numbers in a 1:1 ratio. Random permuted blocks were used to ensure equal
      number in each group. The randomization sequence was concealed in sequentially numbered,
      opaque, sealed envelopes by the principal investigator (PI) at the study site, and stored in
      a secured location that was accessible only by the research assistants. Blinding was not
      possible for the participants and the CRCs, as the intervention group would be required to
      download an application into the mobile phone. Both the biostatistician and PI were not
      involved in the enrolment or randomization process of participants in this study.

      Study procedure: The KAP assessment instrument was adapted from a previous study conducted by
      Nurul Akmar Ghani et al.

      Participants in both groups completed the first (baseline) questionnaire via a secured online
      platform, Form.sg. Form.sg was used to create online questionnaires that capture classified
      data for this study. The platform does not store participants' response data in its servers
      and all responses are sent directly to the study team's dedicated email address.

      Participants in the intervention group installed a mobile application, 'Sam's Mozzie
      Adventure' and were instructed to complete the game within 2 weeks.

      Participants in the control group accessed the National Environmental Agency 'Stop Dengue'
      website and were instructed to complete reading the dengue prevention information within 2
      weeks.

      Both groups completed the second questionnaire, containing the KAP assessment and a question
      pertaining to individual's interest to vaccinate against dengue, within 2 weeks after the
      intervention. In addition, participants in the serious game group evaluated the game with the
      adapted Systems Usability Score.

      Analysis: The knowledge, attitude and practice scores varied from 0-16, 0-15, 0-15
      respectively, with a maximum score of 46 points. The highest achievement attained by the
      participants in serious game group were measured by the number of stars awarded in-game,
      which varied from 0-48 stars. The data were audited and errors were rectified before
      analyses. Descriptive statistics in terms of frequency (n), percentage (%), mean and standard
      deviations (SD) were used to express the data. The socio-demographic variables between the
      two groups were compared using Chi-Square test for categorical variables and independent
      t-test for continuous variables. Independent t-test was used to compare the baseline, follow
      up and change in KAP scores between the control and intervention group. Paired t-test was
      used to determine the difference in scores from baseline and follow up. The Spearman's
      correlation was used to determine the association between change scores and maximum game
      stars awarded in the intervention group. SUS score was presented in frequency and
      percentages. A p-value of less than 0.05 is considered statistically significant. All
      analyses were performed using IBM SPSS 27.0.
    

Intervention name(s): Serious game; Dengue prevention website
Intervention type(s): Other; Other
Intervention description(s): This is a serious game in the form of a mobile application, designed to educate adults on dengue prevention.; This is a website containing information regarding dengue prevention.
Other intervention name(s): Sam's Mozzie Adventure; National Environmental Agency 'Stop Dengue' website
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A randomized controlled trial was conducted among volunteer adults who were visiting a regional primary care clinic in Sengkang, Singapore. 400 participants were randomly allocated to receive information regarding dengue prevention from either playing a serious game (intervention) or visiting a dengue prevention website (control). Before and after receiving information on dengue prevention, participants completed a self-administered questionnaire within a 2-week interval to assess the knowledge, attitude and practice (KAP) score and their interest to vaccinate against dengue. Participants, who played serious game, evaluated the game with the Systems Usability Score (SUS).
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Serious game; Dengue prevention; Primary care