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Randomized Controlled Trial
. 2025 Jul 1;25(1):876.
doi: 10.1186/s12909-025-07541-9.

The effect of an interactive game-based e-book with simulative clinical scenarios on the health literacy competency among medical students in Taiwan

Pei-Ling Tseng  1 , Hui-Fang Yang  2 , Chia-Chen Chang  1 , Tai-Yuan Chiu  3 , Jaw-Shiun Tsai  4 , Hsiang-Ru Lai  1 , Chen-Yin Tung  5
Affiliations
Randomized Controlled Trial

The effect of an interactive game-based e-book with simulative clinical scenarios on the health literacy competency among medical students in Taiwan

Pei-Ling Tseng et al. BMC Med Educ. .

Abstract

Background: Health literacy plays a vital role in effective patient-physician communication. Over the past decades, health literacy efforts have strengthened public empowerment by improving access to health information and its effective use. Despite this progress, there are still insufficient digitalized teaching materials in medical schools, especially in the post-pandemic era. To address this gap, this study developed an interactive e-book as a supplementary e-learning tool for fifth-year medical students during their family medicine clerkship. The e-book integrates game-based learning, multimedia content, and scenario-based simulations to enhance students' knowledge, attitudes, and skills in health literacy.

Methods: A true experimental design was employed, involving 216 medical students randomly assigned to experimental (n = 110) and control (n = 106) groups. Students in the experimental group utilized the e-book alongside standard clerkship training, while the control group participated in standard training alone. Pre- and post-intervention assessments measured health literacy knowledge, attitudes, and skills using a validated questionnaire.

Results: Results showed the experiment group (n = 110) who read the e-book demonstrated greater improvements in health literacy knowledge, attitude, and skills than the control group (n = 106). Knowledge scores increased by 0.117 points, attitudes by 0.175 points, and skills by 0.162 points (p < 0.05). Students reported high satisfaction with the e-book's engaging and interactive format, highlighting its potential for enhancing learning outcomes.

Conclusions: This study demonstrates the effectiveness of incorporating interactive digital tools into medical education to foster health literacy competencies, which should be expected in medical education and clinical pratical settings.

Keywords: Clinical scenarios; Health literacy; Interactive E-book; Medical students; Simulation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of National Taiwan Normal University (Approval Number: 202105HM045). All participants provided informed consent prior to participation. The study was conducted in accordance with the Declaration of Helsinki. Competing interests: The authors declare no competing interests. Institutional review board: The study was approved by the NTNU Institutional Review Board in June 2021. The tracking number is 202105HM045. Declaration of conflicting interests: The authors declared no potential conflicts of interest concerning to the research, authorship, and publication of this article. Consent for publication-: not applicable. Author constributions: P-L T. led the conceptualization of the study alongside C-C C., J-S T., H-R L., and C-Y T. Additionally, P-L T., H-F Y., and C-Y T. collaborated on curriculum development, ensuring the course met the necessary standards. Data curation was managed by P-L T., H-F Y., and C-C C., who organized and prepared the data for analysis. P-L T. and H-F Y. conducted the formal analysis, ensuring the integrity of the findings. The administration of the project was overseen by P-L T. and T-Y C., ensuring smooth project execution. Finally, the original draft of the manuscript was primarily written by P-L T. and C-Y T., who synthesized the research into a cohesive document. All authors reviewed the manuscript.

Figures

Fig. 1
Fig. 1
Flowchart of students’ enrollment and assessment
Fig. 2
Fig. 2
The difference in the average scores of three variables between two groups
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