A Mobile App Serious Game to Increase Awareness of Antibiotic Use in the Community
Condition: Antimicrobial Resistance
Study type: Interventional

Summary: 
      The widespread and unnecessary use of antibiotics has encouraged the growth of
      antibiotic-resistant bacteria which can cause hard-to-treat and deadly infections. These
      infections are due to antimicrobial resistance (AMR). The public's lack of knowledge on the
      indication for and proper use of antibiotics often leads to unnecessary patient demands and
      subsequent misuse of antibiotics. Traditional mass public educational efforts through the use
      of brochures, posters and advertisements are extensive in outreach but questionable in
      effectiveness in improving the general public's knowledge on appropriate antibiotics use and
      AMR.

      Serious games app provides an additional venue for public education outreach to the
      population since a substantial amount of time is spent using smartphones. The use of serious
      games is expected to increase user engagement in learning, which will lead to short- and
      long-term improvements in knowledge, attitudes and perceptions on the appropriate use of
      antibiotics.

      The study team has co-developed an evidence-based serious game app- "SteWARdS Antibiotic
      Defense" -with Temasek Polytechnic. Users will be brought on a quest to learn about
      antibiotic use and AMR through mini-games and the bite-sized information released throughout
      the game quest. We intend to clinically validate our evidence-based app and improve its
      application with actual participants' feedback on its usage. Hence, this study aims to
      evaluate the effectiveness of an evidence-based serious game mobile application (SteWARdS
      Antibiotic Defense) in improving the knowledge on, attitude towards, and perception (KAP) of
      appropriate antibiotic use and AMR among Singaporeans.

      The primary objective is to assess the change in knowledge on antibiotic use and AMR among
      the app users compared with the control group. The secondary objectives are to:1) Assess the
      extent of user engagement of the app by evaluating the users' average screen time per day;
      and 2) Assess the level of user satisfaction in using the app for learning through a user
      satisfaction survey.
    

Detailed description: 
      The widespread and unnecessary use of antibiotics has accelerated the development of
      antimicrobial resistance (AMR) which can cause infections that are fatal and resistant to
      treatment. One pertinent factor contributing to the misuse of antibiotics is the public's
      knowledge deficit of the indication for and proper use of antibiotics. This knowledge deficit
      often leads to unnecessary patient demand for antibiotics and subsequent misuse of them. The
      public has low awareness of the gravity of AMR as it appears to be a non-imminent
      life-threatening problem. Traditional mass public educational efforts through the use of
      brochures, posters and advertisements are extensive in outreach but questionable in
      effectiveness in improving the general public's knowledge on appropriate antibiotics use and
      AMR.

      Serious games app provides an additional venue for public education outreach to the
      population since a substantial amount of time is spent using smartphones. Leveraging digital
      technology to increase the awareness of antimicrobial resistance and the knowledge of
      appropriate antibiotic use is timely as Singapore develops into a smart nation. The use of
      serious games is postulated to increase user engagement in learning, which will lead to
      short- and long-term improvements in knowledge, attitudes and perceptions on the appropriate
      use of antibiotics.

      The study team has co-developed an evidence-based serious game app- "SteWARdS Antibiotic
      Defense" -with Temasek Polytechnic. Users will be brought on a quest to learn about
      antibiotic use and AMR through mini-games and the bite-sized information released throughout
      the game quest. We intend to clinically validate our evidence-based app and improve its
      application with actual participants' feedback on its usage. Hence, this study aims to
      evaluate the effectiveness of an evidence-based serious game mobile application (SteWARdS
      Antibiotic Defense) in improving the knowledge on, attitude towards, and perception (KAP) of
      appropriate antibiotic use and AMR among Singaporeans.

      The primary objective is to assess the change in knowledge on antibiotic use and AMR among
      the app users compared with the control group. The secondary objectives are to:1) Assess the
      extent of user engagement of the app by evaluating the users' average screen time per day;
      and 2) Assess the level of user satisfaction in using the app for learning through a user
      satisfaction survey.
    

Intervention name(s): "SteWARdS Antibiotic Defense" app
Intervention type(s): Device
Intervention description(s): The "SteWARdS Antibiotic Defense" app is an evidence-based serious game app developed by the study team. The app uses gamification theories to increase user engagement and to deliver bite-sized information to participants. For example, players will learn about the uses of antibiotics through the messages delivered through the game and the cost of tackling antibiotic-resistant infections through purchasing an expensive antibiotic with the virtual currency earned from the games.
Intervention MeSH terms: Anti-Bacterial Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A two-arm randomised controlled trial with the intervention group receiving an educational app and the control group not receiving any app intervention
Masking: None (Open Label)
Primary purpose: Prevention