The goal of this observational study is to investigate if VR game-based educational intervention can enhance primary schoolchildren's compliance with hygiene practices to prevent the transmission of SARS-CoV-2 and other upper respiratory pathogens in the community.

The main questions the study aims to answer are, after receiving the VR game-based education intervention:

• Does VR game-based educational intervention improve hygiene-practice compliance in primary schoolchildren?
• What are the bacterial loads on primary schoolchildren's hands?
• What are the rates of infections caused by SARS-CoV-2 and other respiratory viruses in primary schoolchildren?

Researchers will compare the interventional group to the control group to see if VR game-based educational intervention can enhance primary schoolchildren's hygiene practices.

Participants will

• Receive in a training programme on hygiene practices through playing VR games for two weeks, 1 hour per week.
• Do a questionnaire on hygiene knowledge before and after receiving the education programme
• Provide hand swabs and saliva samples before and after receiving the education programme

This study aims to evaluate the effectiveness of a VR game (VRG)-based educational program on hygiene practices among primary schoolchildren in Hong Kong. The research design employs a randomized controlled trial with repeated measures.

Participants will be primary schoolchildren aged 6 to 12 who can communicate and read in Chinese. To minimize selection bias, children will remain unaware of their group assignments. The sample size calculation aims for a statistical power of at least 0.8, targeting 2160 participants across 18 school clusters. Thirty-six local primary schools will be randomly assign to the intervention group or the control group in a ratio of 1:1.

The pilot phase will refine the VRG educational program based on feedback from a previous intervention. Two schools will be selected for this pilot, where trained teachers will assist in student recruitment. The main intervention will involve an VRG-based educational program delivered over two to three weeks. Children in the intervention group will engage with VRGs that cover topics such as SARS-CoV-2 and influenza virus transmission, hygiene practices, importance of rapid testing and vaccination in the prevention of upper respiratory tract infections. The control group will receive standard community health education and will be invited to participate in the VRG program after the intervention period.

Each child's involvement will last six months, with assessments occurring at baseline (T1) and at two subsequent intervals: immediately-post (T2), 1-month post (T3). Data collection will include demographic data, questionnaire to assesses hygiene knowledge, videos to record handwashing practices, hand swabs to measures bacterial loads on hands and saliva samples to tests for respiratory viruses.

Inclusion Criteria:

• Primary schoolchildren aged 6-12 years.
• Able to communicate in Chinese and to read Chinese.

Exclusion Criteria:

• Reported mental or physical health disorders.
• Participated in other health educational programs related to hygiene practices 2 months or less before recruitment.