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Randomized Controlled Trial
. 2021 Mar 25;23(3):e27443.
doi: 10.2196/27443.

Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial

Mélanie Suppan  1 , Mohamed Abbas #  2 , Gaud Catho #  2 , Loric Stuby #  3 , Simon Regard  4   5 , Sophia Achab  6   7 , Stephan Harbarth  2 , Laurent Suppan  4
Affiliations
Randomized Controlled Trial

Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial

Mélanie Suppan et al. J Med Internet Res. .

Abstract

Background: Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called "Escape COVID-19" using Nicholson's RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change.

Objective: As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing "Escape COVID-19."

Methods: This was a web-based, triple-blind, randomized controlled trial, which took place between November 5 and December 4, 2020. The health authorities of Geneva, Switzerland, asked the managers of all LTCFs under their jurisdiction to forward information regarding the study to all their employees, regardless of professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire, which assessed their willingness to change their IPC practices and identified the reasons underlying their decision. They were then granted access to the serious game. Conversely, the serious game group played "Escape COVID-19" after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. There was no time limit. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying participants' decisions, the domains these changes would affect, changes in the use of protective equipment items, and attrition at each stage of the study.

Results: A total of 295 answer sets were analyzed. Willingness to change behavior was higher in the serious game group (82% [119/145] versus 56% [84/150]; P<.001), with an odds ratio of 3.86 (95% CI 2.18-6.81; P<.001) after adjusting for professional category and baseline knowledge, using a mixed effects logistic regression model with LTCF as a random effect. For more than two-thirds (142/203) of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining their willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines.

Conclusions: The serious game "Escape COVID-19" was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19-safe IPC behavior.

International registered report identifier (irrid): RR2-10.2196/25595.

Keywords: COVID-19; SARS-CoV-2; control; elderly; game; health care worker; impact; infection prevention; intention; long-term care facilities; nursing homes; randomized controlled trial; serious game; transmission.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Front page of the study website (in French). Only the first three long-term care facilities are displayed.
Figure 3
Figure 3
General information displayed (in French) before accessing the registration form.
Figure 4
Figure 4
Registration form (in French).
Figure 5
Figure 5
Control material (in French). The model was displayed for 10 seconds before providing links to infection prevention and control guidelines.
Figure 6
Figure 6
Welcome screen of the Escape COVID-19 serious game.
Figure 7
Figure 7
"Game over" screen of the Escape COVID-19 serious game.
Figure 8
Figure 8
The only way participants could access the second questionnaire was by clicking on the “Exit the game” button.
Figure 9
Figure 9
Study flowchart.
Figure 10
Figure 10
Magnitude of the willingness to change workplace disinfection behavior.
Figure 11
Figure 11
Magnitude of the willingness to change face mask handling behavior.
Figure 12
Figure 12
Magnitude of the willingness to protect oneself from asymptomatic people.
See this image and copyright information in PMC

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