Efficacy of a Gamified Training Program for Improving Occupational Health and Safety Knowledge Among Italian Secondary School Students: A Randomized Controlled Field Trial

This study evaluated the short-term effectiveness of an innovative gamified educational program based on the principles of the Italian Legislative Decree 81/2008 in improving occupational health and safety (OHS) knowledge among Italian secondary school students. A cluster-randomized controlled field trial was conducted in Italy from September 2024 to June 2025. Classes were randomized into experimental (EG) and control groups (CG). The intervention combined a seminar with three structured games (role-playing, board, and card games). Knowledge was assessed using a 15-item questionnaire (Q81) at baseline (T0) and post-intervention (T1). The primary endpoint was the between-group difference in Q81 score at post-intervention (T1). Of 930 eligible students, 927 participated (99.7%), 694 completed the study (74.6%), including 187 middle school and 507 high school students (N_EG = 356; N_CG = 338). Baseline Q81 scores were comparable between groups (EG: 5.6 ± 3.3 vs CG: 5.4 ± 2.9), whereas at T1, mean Q81 scores were significantly higher in the EG compared to the CG (9.0 ± 3.1 vs. 5.2 ± 2.9, P < 0.001; Cohen's d = 1.26). Within-group analysis showed a significant improvement in the EG (P < 0.001), but not in the CG. Reliability analysis yielded alpha = 0.804, indicating good internal consistency. Gamification training improved OHS knowledge among secondary school students and may represent an effective educational strategy for early safety education. These findings support the integration of gamified OHS training into secondary school curricula to strengthen early safety education in line with the principles of Legislative Decree 81/2008. . Future studies should include larger samples, address item-level weaknesses and explore long-term behavioural outcomes.