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A Comparative Analysis of Gamified and Non-gamified Interventions’ Effectiveness in Teaching Adolescent Students About Healthy Sexual Practices in Tanzania

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Abstract

Introduction

This study primarily evaluated the effectiveness of gamified learning particularly serious game and gamification platforms aimed to improve sexual health education in a resource-limited setting of Tanzania. The need for the study arose because many adolescent students have little knowledge on sexual and reproductive health, which makes them vulnerable to engaging in unhealthy and high-risk sexual practices, hence prompting global public health researchers to find innovative approaches to addressing the problem.

Methods

The study applied a participatory research design that involved active users and other key stakeholders in developing the “My Future Begins Today” digital game. A quasi-experiment-controlled study enabled the use of two gamified learning conditions—serious game and gamification platforms—with a traditional non-gamified teaching method) serving as control. In all, 108 students aged 11–15 drawn from one secondary school in Dar es Salaam, Tanzania, participated in a series of sexual health education. The age mean of participants was 13, whereby males were 61 (56.5%) and females were 47 (43.5%). Results: Overall, the gamified learning students demonstrated a significant improvement in knowledge acquisition and change of attitude on all five topics of sexual health education than the non-gamified students: F (2, 105) = 71.866, p < .001). Moreover, the gamified students perceived more positively over the whole MAKE evaluation than the non-gamified students (p < .001).

Conclusion

The study found that gamified systems can effectively reduce risky sexual behaviours and improve health outcomes by providing meaningful knowledge through activities, competitions, awards, and leaderboards, which are otherwise unavailable in non-gamified classes.

Policy Implications

Innovative teaching strategies like gamified learning can help decision-makers and policymakers create guidelines and regulations that improve services for adolescents’ sexual and reproductive health.Thus, this study has demonstrated how gamified can impact teenagers’ sexual behaviour decision-making and support cognitive development.

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References

  • Abdul, R., Gerritsen, A. A. M., Mwangome, M., & Geubbels, E. (2018). Prevalence of self-reported symptoms of sexually transmitted infections, knowledge and sexual behaviour among youth in semi-rural Tanzania in the period of adolescent friendly health services strategy implementation. BMC Infectious Diseases, 18(1). https://doi.org/10.1186/s12879-018-3138-1

  • Aboud, S., Buhalata, S. N., Onduru, O. G., Chiduo, M. G., Kwesigabo, G. P., Mshana, S. E., Manjurano, A. M., Temu, M. M., Kishamawe, C., & Changalucha, J. M. (2023). Tropical medicine and infectious disease high prevalence of sexually transmitted and reproductive tract infections (STI/RTIs) among patients attending STI/outpatient department clinics in Tanzania. Tropical Medicine and Infectious Disease, 8, 62. https://doi.org/10.3390/tropicalmed

    Article  PubMed  PubMed Central  Google Scholar 

  • Achora, S., Thupayagale-Tshweneagae, G., Akpor, O. A., & Mashalla, Y. J. S. (2018). Perceptions of adolescents and teachers on school-based sexuality education in rural primary schools in Uganda. Sexual and Reproductive Healthcare, 17(May), 12–18. https://doi.org/10.1016/j.srhc.2018.05.002

    Article  PubMed  Google Scholar 

  • Bailey, J. V., Murray, E., Rait, G., Mercer, C. H., Morris, R. W., Peacock, R., Cassell, J., & Nazareth, I. (2012). Computer-based interventions for sexual health promotion: Systematic review and meta-analyses. International Journal of STD & AIDS, 23(6), 408–413. https://doi.org/10.1258/ijsa.2011.011221

    Article  Google Scholar 

  • Bamidis, P. D., Gabarron, E., Hors-Fraile, S., Konstantinidis, E., Konstantinidis, S., & Rivera, O. (2016). Gamification and behavioral change: Techniques for health social media. In S. Syed-Abdul, E. Gabarron, & A. Y. S. Lau (Eds.), Participatory Health through Social Media. Academic Press. https://doi.org/10.1016/B978-0-12-809269-9.00007-4

    Chapter  Google Scholar 

  • Bojan, K., Christogianni, A., & Mukaetova-Ladinska, E. (2022). The Role of Serious Games in Healthcare and Its Contribution to the Healthcare Ecosystem (Oscar Bernardes & Vanessa Amorim, Eds. pp. 118–139). IGI Global. https://doi.org/10.4018/978-1-7998-9732-3.ch007

  • Bouris, A., Mancino, J., Jagoda, P., Hill, B. J., & Gilliam, M. (2016). Reinvigorating adolescent sexuality education through alternate reality games: The case of “The Source.” Sex Education, 16(4), 353–367. https://doi.org/10.1080/14681811.2015.1101373

    Article  Google Scholar 

  • Breuner, C. C., & Mattson, G. (2016). Sexuality education for children and adolescents. Pediatrics, 138(2), e20161348–e20161348. https://doi.org/10.1542/peds.2016-1348

    Article  PubMed  Google Scholar 

  • Cederbaum, J., Rodriguez, A., Sullivan, K., & Gray, K. (2017). Attitudes, norms, and the effect of social connectedness on adolescent sexual risk. Journal of School Health, 87(8), 575–583.

    Article  PubMed  Google Scholar 

  • Chib, A. (2011). Promoting sexual health education via gaming: Evidence from the Barrios of Lima, Peru. In F. Patrick (Ed.), Handbook of Research on Improving Learning and Motivation through Educational Games: Multidisciplinary, (Vol. I, p. 1462). IGI Global. https://books.google.com/books?id=G9oJ8KpDbM4C&pgis=1

  • Chu, S. K. W., Kwan, A. C. M., Reynolds, R., Mellecker, R. R., Tam, F., Lee, G., Hong, A., & Leung, C. Y. (2015). Promoting sex education among teenagers through an interactive game: Reasons for success and implications. Games for Health Journal, 4(3), 168–174. https://doi.org/10.1089/g4h.2014.0059

    Article  PubMed  Google Scholar 

  • Cózar-Gutiérrez, R., & Sáez-López, J. M. (2016). Game-based learning and gamification in initial teacher training in the social sciences: An experiment with MinecraftEdu. International Journal of Educational Technology in Higher Education, 13(2). https://doi.org/10.1186/s41239-016-0003-4

  • D’Cruz, J., Santa Maria, D., Dube, S., Markham, C., McLaughlin, J., Wilkerson, J. M., Peskin, M. F., Tortolero, S., & Shegog, R. (2015). Promoting parent–Child sexual health dialogue with an intergenerational game: Parent and youth perspectives. Games for Health Journal, 4(2), 113–122. https://doi.org/10.1089/g4h.2014.0080

    Article  PubMed  PubMed Central  Google Scholar 

  • DeSmet, A., Shegog, R., Ryckeghem, D. V., Crombez, G., & Bourdeaudhuij, I. D. (2015). A systematic review and meta-analysis involving serious digital games. Games for Health, 4(1), 1–13. https://doi.org/10.1089/g4h.2014.0110

    Article  Google Scholar 

  • DeSmet, A., Thompson, D., Baranowski, T., Palmeira, A., Verloigne, M., & De Bourdeaudhuij, I. (2016). Is participatory design associated with the effectiveness of serious digital games for healthy lifestyle promotion? A meta-analysis. Journal of Medical Internet Research, 18(4), e94. https://doi.org/10.2196/jmir.4444

    Article  PubMed  PubMed Central  Google Scholar 

  • Eisenberg, M. E., Madsen, N., Oliphant, J. A., & Sieving, R. E. (2013). Barriers to providing the sexuality education that teachers believe students need. Journal of School Health, 83(5), 335–342. https://doi.org/10.1111/josh.12036

    Article  PubMed  Google Scholar 

  • Engeström, Y. (1987). Learning by expanding: An Activity-Theoretical approach to developmental research. Orienta-Konsultit Oy. https://doi.org/10.1016/j.intcom.2007.07.003

    Article  Google Scholar 

  • Fiellin, L. E., Hieftje, K. D., Pendergrass, T. M., Kyriakides, T. C., Duncan, L. R., Dziura, J. D., Sawyer, B. G., Mayes, L., Crusto, C. A., Forsyth, B. W. C., & Fiellin, D. A. (2017). Video game intervention for sexual risk reduction in minority adolescents: Randomized controlled trial. Journal of Medical Internet Research, 19(9), 1–13. https://doi.org/10.2196/jmir.8148

    Article  Google Scholar 

  • Francis, S. C., Holm Hansen, C., Irani, J., Andreasen, A., Baisley, K., Jespers, V., Crucitti, T., Changalucha, J., Hayes, R. J., Nnko, S., Watson-Jones, D., & Buvé, A. (2019). Results from a cross-sectional sexual and reproductive health study among school girls in Tanzania: High prevalence of bacterial vaginosis. Sexually Transmitted Infections, 95(3), 219–227. https://doi.org/10.1136/sextrans-2018-053680

    Article  PubMed  Google Scholar 

  • Gabarron, E., Schopf, T., Serrano, J. A., Fernandez-Luque, L., & Dorronzoro, E. (2013). Gamification strategy on prevention of STDs for youth. Studies in Health Technology and Informatics, 192(1–2), 1066. https://doi.org/10.3233/978-1-61499-289-9-1066

    Article  PubMed  Google Scholar 

  • Gold, J., & Pedrana, A. (2011). A systematic examination of the use of online social networking sites for sexual health promotion. Health, 3–5. https://doi.org/10.1186/1471-2458-11-583

  • Granic, I., Lobel, A., & Engels, R. C. M. E. (2014). The benefits of playing video games. American Psychologist, 69(1), 66–78. https://doi.org/10.1037/a0034857

    Article  PubMed  Google Scholar 

  • Gutierrez, B., Kaatz, A., Chu, S., Ramirez, D., Samson-Samuel, C., & Carnes, M. (2014). “Fair Play”: A videogame designed to address implicit race bias through active perspective taking. Games for Health Journal, 3(6), 371–378. https://doi.org/10.1089/g4h.2013.0071

    Article  PubMed  PubMed Central  Google Scholar 

  • Haruna, H., Hu, X., & Chu, S. K. W. (2018a). Adolescent school-based sexual health education and training: A literature review on teaching and learning strategies. Global Journal of Health Science, 10(3), 172–183. https://doi.org/10.5539/gjhs.v10n3p172

    Article  Google Scholar 

  • Haruna, H., Hu, X., Chu, S. K. W., & Mellecker, R. R. (2019a). Initial validation of the MAKE framework: A comprehensive instrument for evaluating the efficacy of game-based learning and gamification in adolescent sexual health literacy. Annals of Global Health, 85(1), 19. https://doi.org/10.5334/aogh.1110

    Article  PubMed  PubMed Central  Google Scholar 

  • Haruna, H., Hu, X., Chu, S., Mellecker, R., Gabriel, G., & Ndekao, P. (2018b). Improving sexual health education programs for adolescent students through game-based learning and gamification. International Journal of Environmental Research and Public Health, 15(9), 2027. https://doi.org/10.3390/IJERPH15092027

    Article  PubMed  PubMed Central  Google Scholar 

  • Haruna, H., Zainuddin, Z., Mellecker, R. R., Kong, H., Kong, H., Chu, S. K. W., & Hu, X. (2019b). An iterative process for developing digital gamified sexual health education for adolescent students in low-tech settings. Information and Learning Sciences, 120(11), 723–742. https://doi.org/10.1108/ILS-07-2019-0066

    Article  Google Scholar 

  • Hirose, N., Sanmei, C., Okamoto, M., Madeni, F. E., Madeni, N., Teshima, A., Ando, Y., Takahama, K., Yoshikawa, M., Kunimoto, Y., & Shimpuku, Y. (2023). Associated factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy among early and late adolescents in Tanzania: A cross-sectional study. Reproductive Health, 20(1). https://doi.org/10.1186/s12978-023-01583-2

  • Huang, B., Hew, K. F., & Lo, C. K. (2018). Investigating the effects of gamification-enhanced flipped learning on undergraduate students’ behavioral and cognitive engagement. Interactive Learning Environments, 0(0), 1–21. https://doi.org/10.1080/10494820.2018.1495653

    Article  Google Scholar 

  • Ippoliti, N. B., & L’Engle, K. (2017). Meet us on the phone: Mobile phone programs for adolescent sexual and reproductive health in low-to-middle income countries. Reproductive Health, 14(1), 1–8. https://doi.org/10.1186/s12978-016-0276-z

    Article  Google Scholar 

  • Jiang, R., McKanna, J., Calabrese, S., & Seif El-Nasr, M. (2017). Iterative design and testing for the development of a game-based chlamydia awareness intervention: A pilot study. Games for Health Journal, 6(4), 205–216. https://doi.org/10.1089/g4h.2016.0112

    Article  PubMed  PubMed Central  Google Scholar 

  • Kaale, G., & Muhanga, M. (2017). Sexual health knowledge among secondary school students in Morogoro, Tanzania: Half full or full empty? International Journal of Health, 5(2), 120. https://doi.org/10.14419/ijh.v5i2.8190

    Article  Google Scholar 

  • Kraiger, K., Ford, J. K., & Salas, E. (1993). Application of cognitive, skill-based, and affective theories of learning outcomes to new methods of training evaluation. Journal of Applied Psychology, 78(2), 311–328. https://doi.org/10.1037/0021-9010.78.2.311

    Article  Google Scholar 

  • Landers, R. N., & Landers, A. K. (2014). An empirical test of the theory of gamified learning: The effect of leaderboards on time-on-task and academic performance. Simulation and Gaming, 45(6), 769–785. https://doi.org/10.1177/1046878114563662

    Article  Google Scholar 

  • L’Engle, K. L., Vahdat, H. L., Ndakidemi, E., Lasway, C., & Zan, T. (2013). Evaluating feasibility, reach and potential impact of a text message family planning information service in Tanzania. Contraception, 87(2), 251–256. https://doi.org/10.1016/j.contraception.2012.07.009

    Article  PubMed  Google Scholar 

  • Lim, M. S. C., Hocking, J. S., Aitken, C. K., Fairley, C. K., Jordan, L., Lewis, J. A., & Hellard, M. E. (2012). Impact of text and email messaging on the sexual health of young people: A randomised controlled trial. Journal of Epidemiology and Community Health, 66(1), 69–74. https://doi.org/10.1136/jech.2009.100396

    Article  PubMed  Google Scholar 

  • Lowry, R., Robin, L., & Kann, L. (2017). Effect of forced sexual intercourse on associations between early sexual debut and other health risk behaviors among US high school students. Journal of School Health, 87(6), 435–447.

    Article  PubMed  Google Scholar 

  • Lukumay, G. G., Mgopa, L. R., Mushy, S. E., Simon Rosser, B. R., Massae, A. F., Mkonyi, E., Mohammed, I., Mwakawanga, D. L., Trent, M., Wadley, J., Ross, M. W., Bonilla, Z., & Leshabari, S. (2023). Community myths and misconceptions about sexual health in Tanzania: Stakeholders’ views from a qualitative study in Dar es Salaam, Tanzania. PLoS One, 18(2 February). https://doi.org/10.1371/journal.pone.0264706

  • Mbachu, C. O., Agu, I. C., Eze, I., Agu, C., Ezenwaka, U., Ezumah, N., & Onwujekwe, O. (2020). Exploring issues in caregivers and parent communication of sexual and reproductive health matters with adolescents in Ebonyi State, Nigeria. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-019-8058-5

  • Mbeba, R. M., Mkuye, M. S., Magembe, G. E., Yotham, W. L., Mellah, A. O., & Mkuwa, S. B. (2012). Barriers to sexual reproductive health services and rights among young people in Mtwara district, Tanzania: A qualitative study. The Pan African Medical Journal, 13(Suppl), 1.

    Google Scholar 

  • Mcharo, R. D., Mayaud, P., & Msuya, S. E. (2021). Where and how do young people like to get their sexual and reproductive health (SRH) information? Experiences from students in higher learning institutions in Mbeya, Tanzania: A cross-sectional study. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11728-2

  • Millanzi, W. C., Osaki, K. M., & Kibusi, S. M. (2023). Parent-adolescent communication about sexual and reproductive health and its determinants among adolescents: Baseline findings from a randomized controlled trial in Tanzania. SAGE Open, 13(4). https://doi.org/10.1177/21582440231216281

  • Mitchell, K. J., Ybarra, M. L., Korchmaros, J. D., & Kosciw, J. G. (2014). Accessing sexual health information online: Use, motivations and consequences for youth with different sexual orientations. Health Education Research, 29(1), 147–157. https://doi.org/10.1093/her/cyt071

  • Mullinax, M., Mathur, S., & Santelli, J. (2017). Adolescent sexual health and sexuality education. In D. M. Cherry A., Baltag V. (Ed.), International Handbook on Adolescent Health and Development (pp. 143–167). Springer International Publishing. https://doi.org/10.1007/978-3-319-40743-2_8

    Chapter  Google Scholar 

  • Nkata, H., Teixeira, R., & Barros, H. (2019). A scoping review on sexual and reproductive health behaviors among Tanzanian adolescents. In Public Health Reviews (Vol. 40, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s40985-019-0114-2

  • Nöstlinger, C., Borms, R., Dec-Pietrowska, J., Dias, S., Rojas, D., Platteau, T., Berghe, W. V., & Kok, G. (2016). Development of a theory-guided Pan-European computer-assisted safer sex intervention. Health Promotion International, 31(4), 782–792. https://doi.org/10.1093/heapro/dav061

    Article  PubMed  Google Scholar 

  • Pokharel, S., Kulczycki, A., & Shakya, S. (2006). School-based sex education in Western Nepal: Uncomfortable for both teachers and students. Reproductive Health Matters, 14(28), 156–161. https://doi.org/10.1016/S0968-8080(06)28255-7

    Article  PubMed  Google Scholar 

  • Pfeiffer, C., Kleeb, M., Mbelwa, A., & Ahorlu, C. (2014). The use of social media among adolescents in Dar es Salaam and Mtwara, Tanzania. Reproductive Health Matters, 22(43), 178–186. https://doi.org/10.1016/S0968-8080(14)43756-X

  • Reeves, T. (2006). Design research from a technology perspective. In J. Van Den Akker, K. Gravemeijer, S. McKenney, & N. Nieveen (Eds.), Educational design research (pp. 52–66). Routledge.

    Google Scholar 

  • Sadiq Sani, A., Abraham, C., Denford, S., & Mathews, C. (2018). Design, implementation and evaluation of school-based sexual health education in sub-Saharan Africa: A qualitative study of researchers’ perspectives. Sex Education, 18(2), 172–190. https://doi.org/10.1080/14681811.2017.1414040

    Article  Google Scholar 

  • Schoech, D., Boyas, J. F., Black, B. M., & Elias-Lambert, N. (2013). Gamification for behavior change: Lessons from developing a social, multiuser, web-tablet based prevention game for youths. Journal of Technology in Human Services, 31(3), 197–217. https://doi.org/10.1080/15228835.2013.812512

    Article  Google Scholar 

  • Shayo, F. K., & Kalomo, M. H. (2019). Prevalence and correlates of sexual intercourse among sexually active in-school adolescents: An analysis of five sub-Sahara African countries for the adolescent’s sexual health policy implications. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-7632-1

  • Sun, W. H., Wong, C. K. H., & Wong, W. C. W. (2017). A peer-led, social media-delivered, safer sex intervention for Chinese college students: Randomized controlled trial. Journal of Medical Internet Research, 19(8). https://doi.org/10.2196/jmir.7403

  • Taggart, T., Grewe, M. E., Conserve, D. F., Gliwa, C., & Isler, M. R. (2015). Social media and HIV: A systematic review of uses of social media in HIV communication. Journal of Medical Internet Research, 17(11), 13. https://doi.org/10.2196/jmir.4387

    Article  Google Scholar 

  • Tarimo, R., & Kavishe, G. (2017). Internet access and usage by secondary school students in Morogoro Municipality, Tanzania. In International Journal of Education and Development Using Information and Communication Technology (Vol. 13, Issue 2).

  • TCRA. (2023). Communication Statistics: Quarter ending December 2022. https://www.tcra.go.tz/uploads/text-editor/files/Quarter%202%20Communications%20Statistics%20-%20Revised%20Final%20(1)_1677145396.pdf

  • The United Republic of Tanzania. (2022). The 2022 population and housing census: Age and sex distribution report Tanzania. https://sensa.nbs.go.tz/

  • UNICEF. (2017). The state of the world’s children 2017: Children in a digital world. In UNICEF Publications. https://www.unicef.org/publications/files/SOWC_2017_ENG_WEB.pdf

  • UNICEF. (2020). HIV and AIDS fact sheet. https://www.unicef.org/tanzania/media/2436/file/HIV%20Programme%20Fact%20Sheet.pdf

  • Vahdat, H. L., L’Engle, K. L., Plourde, K. F., Magaria, L., & Olawo, A. (2013). There are some questions you may not ask in a clinic: Providing contraception information to young people in Kenya using SMS. International Journal of Gynecology and Obstetrics, 123(SUPPL. 1), e2–e6. https://doi.org/10.1016/j.ijgo.2013.07.009

    Article  PubMed  Google Scholar 

  • Velayutham, S., Aldridge, J., & Fraser, B. (2011). Development and validation of an instrument to measure students’ motivation and self-regulation in science learning. International Journal of Science Education, 33(15), 2159–2179. https://doi.org/10.1080/09500693.2010.541529

    Article  Google Scholar 

  • Wang, D., Shinde, S., Drysdale, R., Vandormael, A., Tadesse, A. W., Sherfi, H., Tinkasimile, A., Mwanyika-Sando, M., Moshabela, M., Bärnighausen, T., Sharma, D., & Fawzi, W. W. (2023). Access to digital media and devices among adolescents in sub-Saharan Africa: A multicountry, school-based survey. Maternal & Child Nutrition. https://doi.org/10.1111/mcn.13462

    Article  PubMed  Google Scholar 

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Acknowledgements

The author would like to acknowledge the technical support of Writing Lab, Institute for the Future of Education, Tecnologico de Monterrey, Mexico, in the production of this work.

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Correspondence to Hussein Haruna.

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Haruna, H. A Comparative Analysis of Gamified and Non-gamified Interventions’ Effectiveness in Teaching Adolescent Students About Healthy Sexual Practices in Tanzania. Sex Res Soc Policy (2024). https://doi.org/10.1007/s13178-024-00961-0

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