Young People's Knowledge of Antibiotics and Vaccinations and Increasing This Knowledge Through Gaming: Mixed-Methods Study Using e-Bug

"Science pedagogy Web-based games, including the e-Bug games, have the potential to engage and excite children and young people about important public health topics and aid in the learning of knowledge."

E-Bug, led by Public Health England (PHE), is an international health education resource that teaches children and young people about hygiene, the spread of infections, antibiotic use, and resistance. E-Bug includes web-based lesson plans and activities for educators and educational games for students hosted on the e-Bug website. The aim of this study was to evaluate 2 e-Bug educational games: Body Busters, previously evaluated and then modified with new content, and Stop the Spread, which was launched in 2016.

As reported here, internet-based health interventions have been shown to change health behaviours. Gamification, where features of gaming are used in other disciplines, has become increasingly popular in recent years, aiming to make science and health education more available and exciting to the general public. "Serious games" are those games where the primary focus is not entertainment but education and learning. Both e-Bug games are responsive on all devices including computers and tablets.

The study recruited 473 students (123 junior (7-11 years of age) and 350 senior (11-16 years of age) students) from 5 educational providers across 3 local authorities in the United Kingdom (UK). The study was a mixed-method evaluation. Quantitative methods included before and after students' knowledge questionnaires; qualitative methods included students' focus groups and open-ended questions and responses from the students' postgaming evaluation questionnaire. Data collection took place between August 2016 and July 2017.

Quantitative results showed significant improvements in knowledge (P<.05) about antibiotic use, appropriate sneezing behaviours, and vaccinations for both age groups. Positive knowledge change for juniors was greater in 9 out of the 12 questions compared with senior students, suggesting that the e-Bug games had a greater impact on junior student knowledge. The researchers therefore recommend that the e-Bug games should be designed to reach junior-school-aged children and should be further promoted to this age group. Baseline knowledge was very high in senior students, especially about vaccinations and sneezing behaviours, so there is little need for improvements; however, modifications, including adding more levels to the games or adding extra learning outcomes, are recommended.

Qualitative results from focus groups and open questionnaire responses for Body Busters were overall very positive, with a few suggestions for improvement. Many students of both age groups reported positive perceptions of user experience; at least 1 participant in each focus group reported positive levels of enjoyment, and nearly all other participants agreed. Many students wanted to play for longer, as the game was very engaging, similar to Pac-Man, at the correct level of difficulty, and students reported they had learned through the gaming experience.

With regard to Stop the Spread, some students in both age groups reported positive perceptions of user experience, including reporting an increase in knowledge about the spread of infection and the importance of vaccinations. In some focus groups, students reported intent to change health behaviours. Some students, junior and senior, enjoyed the fast pace of the game and different levels of difficulty, especially the vaccination levels.

The researchers suggest that further research could investigate whether the knowledge gained from the e-Bug games is maintained or has changed future behaviour. Additional qualitative research with teachers is needed to explore and understand how e-Bug can be used in a lesson to support learning.

The researchers suggest that future national infection-related public health campaigns could link to e-Bug to encourage schools to use the games in their teaching and reinforce the campaigns. E-Bug plans to continue to follow National Institute for Health and Care Excellence (NICE) guidance and work with educators and students to develop and promote resources for teaching children and young people about microbes, infection, and antibiotics in a fun and interactive way.