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An Evidence-Based Serious Game App for Public Education on Antibiotic Use and Antimicrobial Resistance: Protocol of a
Zhilian Huang1,2, Wern Ee Tang3, Huiling Guo2
1Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore.
Background:
The misuse and overuse of antibiotics contribute to the acceleration of antimicrobial resistance (AMR), but public knowledge on appropriate antibiotic use and AMR remained low despite ongoing health promotion efforts. App gamification has gained traction in recent years for health promotion and to affect change in health behaviors. Hence, we developed an evidence-based serious game app "SteWARdS Antibiotic Defence" to educate the public on appropriate antibiotic use and AMR and address knowledge gaps.
Objective:
We aim to evaluate the effectiveness of the "SteWARdS Antibiotic Defence" app in improving the knowledge of, attitude toward, and perception (KAP) of appropriate antibiotic use and AMR among the public. The primary objective is to assess the changes in KAP of antibiotic use and AMR in our participants, while the secondary objectives are to assess the extent of user engagement with the app and the level of user satisfaction in using the app.
Methods:
Our study is a parallel 2-armed randomized controlled trial with a 1:1 allocation. We plan to recruit 400 participants (patients or their caregivers) aged 18-65 years from government-funded primary care clinics in Singapore. Participants are randomized in blocks of 4 and into the intervention or control group. Participants in the intervention group are required to download the "SteWARdS Antibiotic Defence" app on their smartphones and complete a game quest within 2 weeks. Users will learn about appropriate antibiotic use and effective methods to recover from uncomplicated upper respiratory tract infections by interacting with the nonplayer characters and playing 3 minigames in the app. The control group will not receive any intervention.
Results:
The primary study outcome is the change in participants' KAP toward antibiotic use and AMR 6-10 weeks post intervention or 6-10 weeks from baseline for the control group (web-based survey). We will also assess the knowledge level of participants immediately after the participant completes the game quest (in the app). The secondary study outcomes are the user engagement level (tracked by the app) and satisfaction level of playing the game (via the immediate postgame survey). The satisfaction survey will also collect participants' feedback on the game app.
Conclusions:
Our proposed study provides a unique opportunity to assess the effectiveness of a serious game app in public health education. We anticipate possible ceiling effects and selection bias in our study and have planned to perform subgroup analyses to adjust for confounding factors. The app intervention will benefit a larger population if it is proven to be effective and acceptable to users.
Trial Registration:
ClinicalTrials.gov NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414.
International Registered Report Identifier (Irrid):
DERR1-10.2196/45833.
Insights
This study evaluated a serious game app, "SteWARdS Antibiotic Defence," to improve public knowledge on antibiotic use and antimicrobial resistance (AMR). Results will inform the app's effectiveness in public health education.
Area of Science:
- Public Health
- Health Informatics
- Gamification in Health
Background:
- Antibiotic misuse accelerates antimicrobial resistance (AMR).
- Public knowledge on appropriate antibiotic use and AMR remains low.
- Serious game apps offer a novel approach for health promotion.
Purpose of the Study:
- Evaluate the
- SteWARdS Antibiotic Defence
- app's effectiveness in improving public knowledge, attitude, and perception (KAP) of antibiotic use and AMR.
- Assess user engagement and satisfaction with the app.
Main Methods:
- Parallel 2-armed randomized controlled trial with 400 participants (18-65 years) from Singaporean primary care clinics.
- Intervention group uses the
- SteWARdS Antibiotic Defence
- app; control group receives no intervention.
- Primary outcome: change in KAP 6-10 weeks post-intervention. Secondary outcomes: app engagement and user satisfaction.
Main Results:
- Primary outcome: Change in participants' knowledge, attitude, and perception (KAP) toward antibiotic use and AMR.
- Secondary outcomes: User engagement levels tracked via the app.
- User satisfaction assessed through an immediate post-game survey, including feedback.
Conclusions:
- The study assesses a serious game app for public health education on antibiotic use and AMR.
- Potential for subgroup analyses to address ceiling effects and selection bias.
- App effectiveness and user acceptability are key for broader public health benefits.
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