Design and rationale of an interactive serious game to teach Basic Life Support among schoolchildren in Brazil. (Preprint)
Authors: Flato Uri Adrian Prync , Beffa dos Santos Emilio José , Bispo Diaz Toledo Martini Isabella , Rossignoli Vinicius , Dias Midega Thais , Kallas-Silva Lucas , Ferreira Mendes de Oliveira Ricardo , do Socorro Lima Figueiredo Adriana , Vicente Guimarães Mario , Penna Guimarães Hélio 
Published: December 2023

BACKGROUND

Cardiovascular diseases are among the leading causes of death and morbidity in the world including in Brazil. Cardiopulmonary resuscitation (CPR) and early defibrillation increase the chances of survival. Serious Games (SG) are defined as learning and training tools that can be used to enhance the learning processes. It can be presented in several ways, using the game's characteristics as an entertainment factor to achieve educational objectives and specific skills. Current strategies focus on teaching people in the community and schoolchildren how to conduct CPR. The SG Children Save Hearts was developed to teach the five steps of resuscitation according to the guidelines of the International Liaison Committee on Resuscitation on Basic Life Support. Before being applied to schoolchildren for efficacy evaluation, it should go through a formative (Qualitative Usability Testing) assessment by game developers and health professionals. This parameter refers to the ease with which users can consume, learn, and interact with the system. Therefore, usability validation is a critical step in ensuring the effectiveness of the educational resources before introducing them to a specific population.

OBJECTIVE

This study aims to discover and fix usability issues using a System Usability Scale (SUS).

METHODS

The Serious game Children Save Hearts was developed on the Smile Game Builder platform (open source) and implemented on Windows 7 to 11 operating systems, targeting schoolchildren from 7 to 17 years old. The script and storytelling are based on the ILCOR 2020 guidelines. The game includes using a joystick and simple commands to simplify the user experience, allowing greater focus on the content. After finishing the SG, participants were invited to answer a survey of 10 questions regarding its usability on a Likert-type scale. A grade higher than 70 is considered acceptable to proceed to a minimum viable product. A sample size of 17 users was needed based on an estimated probability of encountering an error in the interface expressed as 10% to find 85% of the problems.

RESULTS

The SG Children Save Hearts was applied to 17 volunteers, with a mean age of 22 years, and 47% were male. Regarding professional training, 8 (47%) were bachelor's in information technology, and 9 (53%) were nurses and doctors (health professionals). All participants played the game and answered the questionnaire at the end. The mean SUS score was 75 (Table 1). The mean score was 3.0. Questions 2 and 4 had the lowest score (2.0), and questions 7 and 9 had the highest. The game performed better on efficiency and error minimization criteria with healthcare professionals (p<0,05), with worse performance on memorization criteria. The average time spent in the game was 3.2 minutes, which was approximately 2 minutes to complete the questionnaire.

CONCLUSIONS

The SUS is a validated tool for usability tests and was selected for its practicality, ease of realization, and having been cross-culturally validated into Portuguese, that is, with discriminatory power of acceptability of implementation in Brazil. Active teaching methods were required to improve the chance of survival and translate accessible knowledge into practice. Several cardiac awareness programs, such as Kids Save Lives and World Restart a Heart Day (WRAH), are currently underway to teach schoolchildren that CPR is vital to our future. Although the game has points to improve in its usability, it is considered adequate to be used in the teaching process of schoolchildren in cardiopulmonary resuscitation in Brazil.