Huang Zhilian, Ow Jing Teng, Tang Wern Ee, Chow Angela
Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore.
JMIR Serious Games. 2024 Sep 5;12:e59848. doi: 10.2196/59848.
The misuse and overuse of antibiotics accelerate the development of antimicrobial resistance (AMR). Serious games, any form of games that serve a greater purpose other than entertainment, could augment public education above ongoing health promotion efforts. Hence, we developed an evidence-based educational serious game app-SteWARdS Antibiotic Defence-to educate players on good antibiotic use practices and AMR through a game quest comprising 3 minigames and interaction with the nonplayer characters.
We aimed to evaluate the effectiveness of the SteWARdS Antibiotic Defence app in improving the knowledge of, attitude toward, and perceptions (KAP) of appropriate antibiotic use and AMR among the public in Singapore.
We conducted a 2-arm parallel randomized controlled trial, recruiting visitors aged 18-65 years from 2 polyclinics in Singapore. Intervention group participants had to download the SteWARdS Antibiotic Defence app (available only in English and on the Android platform) on their smartphones and complete the quest in the app. Participants took half a day to 2 weeks to complete the quest. The control group received no intervention. Knowledge questions on antibiotic use and AMR (11 binary questions) were self-administered at baseline, immediately after the intervention, and 6-10 weeks post intervention, while attitudes and perception questions (14 three-point Likert-scale questions) were self-administered at baseline and 6-10 weeks post intervention. We also collected participants' feedback on app usage.
Participants (n=348; intervention: n=142, control: n=206) had a mean age of 36.9 years. Intervention group participants showed a statistically significant improvement in mean knowledge score (effect size: 0.58 [95% CI 0.28-0.87]) compared with controls after accounting for age, educational level, and exposure to advertisements on antibiotics and AMR. Intervention participants also showed a statistically significant improvement in mean attitude-perception scores (effect size: 0.98 (95% CI 0.44-1.52)) after adjusting for marital status and race. A majority of participants agreed that the "SteWARdS Antibiotic Defence" app improved their awareness on antibiotic use (135/142, 95.1%) and AMR (136/142, 95.8%). About 73.9% (105/142) of the participants agreed that the app is easy to use, 70.4% (100/142) agreed that the app was enjoyable, and 85.2% (121/142) would recommend the app to others.
Our educational serious game app improves participants' KAP on appropriate antibiotic use and AMR. Public education apps should be engaging, educational, easy to use, and have an attractive user interface. Future research should assess the effectiveness of interventions in facilitating long-term knowledge retention and long-lasting behavioral change.
ClinicalTrials.gov NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/45833.
抗生素的滥用和过度使用加速了抗菌药物耐药性（AMR）的发展。严肃游戏是指任何形式的、除娱乐之外还有更大目的的游戏，它可以在现有的健康促进工作基础上加强公众教育。因此，我们开发了一款基于证据的教育类严肃游戏应用程序——“SteWARdS抗生素防御”，通过一个包含3个小游戏以及与非玩家角色互动的游戏任务，向玩家传授正确使用抗生素的方法和抗菌药物耐药性相关知识。
我们旨在评估“SteWARdS抗生素防御”应用程序在提高新加坡公众对抗生素合理使用及抗菌药物耐药性的知识、态度和认知（KAP）方面的有效性。
我们进行了一项双臂平行随机对照试验，从新加坡的2家综合诊疗所招募年龄在18至65岁之间的访客。干预组参与者必须在其智能手机上下载“SteWARdS抗生素防御”应用程序（仅提供英文版本且仅适用于安卓平台），并完成应用程序中的任务。参与者需要半天到2周的时间来完成任务。对照组不接受任何干预。关于抗生素使用和抗菌药物耐药性的知识问题（11个二元问题）在基线、干预结束后立即以及干预后6至10周进行自我填写，而态度和认知问题（14个三点李克特量表问题）在基线以及干预后6至10周进行自我填写。我们还收集了参与者对应用程序使用情况的反馈。
参与者（n = 348；干预组：n = 142，对照组：n = 206）的平均年龄为36.9岁。在考虑年龄、教育水平以及接触抗生素和抗菌药物耐药性相关广告等因素后，干预组参与者的平均知识得分显示出与对照组相比具有统计学意义的提高（效应量：0.58 [95%置信区间0.28 - 0.87]）。在调整婚姻状况和种族因素后，干预组参与者的平均态度 - 认知得分也显示出具有统计学意义的提高（效应量：0.98（95%置信区间0.44 - 1.52））。大多数参与者同意“SteWARdS抗生素防御”应用程序提高了他们对抗生素使用（135/142，95.1%）和抗菌药物耐药性（136/142，95.8%）的认识。约73.9%（105/142）的参与者同意该应用程序易于使用，70.4%（100/142）同意该应用程序有趣，85.2%（121/142）会向他人推荐该应用程序。
我们的教育类严肃游戏应用程序提高了参与者对抗生素合理使用及抗菌药物耐药性的KAP。公众教育应用程序应该具有吸引力、有教育意义、易于使用且拥有吸引人的用户界面。未来的研究应该评估干预措施在促进长期知识保留和持久行为改变方面的有效性。
ClinicalTrials.gov NCT05445414；https://clinicaltrials.gov/ct2/show/NCT05445414。
国际注册报告识别码（IRRID）：RR2 - 10.2196/45833。
