Comparing Digital and Collaborative Gamified Reinforcement Strategies for HPV Literacy and Retention Among Nursing Students

Comparing Digital and Collaborative Gamified Reinforcement Strategies for HPV Literacy and Retention Among Nursing Students: A Randomized Comparative Study

This randomized comparative study aims to evaluate the effectiveness of two gamified reinforcement strategies, Gimkit and Escape Room, on human papillomavirus (HPV) literacy, short-term retention, and gameful learning experiences among undergraduate nursing students. Following standardized theoretical instruction on HPV infection, participants will be randomly assigned to either a digital quiz-based gamification intervention (Gimkit) or a collaborative Escape Room activity. Outcomes will be assessed using the Human Papillomavirus Literacy Scale (HPV-LS) and the Gameful Experience Scale (GAMEX) at multiple time points, including baseline, post-theoretical instruction, post-intervention, and one-month follow-up.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide and is associated with several cancers, including cervical, anal, penile, and oropharyngeal cancers. Nurses play a critical role in HPV prevention through health education, vaccination advocacy, and screening promotion. Therefore, enhancing HPV literacy among nursing students is an important educational objective.

Gamification has emerged as an innovative educational approach that can increase learner engagement, motivation, and knowledge retention. However, evidence comparing different gamification modalities within the same educational context remains limited. Digital quiz-based platforms and collaborative escape room activities represent two distinct gamification strategies that may facilitate learning through different cognitive and social mechanisms.

This study will compare the effects of a Gimkit-based digital reinforcement activity and a collaborative Escape Room intervention following standardized HPV education. The primary outcome will be HPV literacy. Secondary outcomes will include HPV literacy subdimension scores and gameful learning experiences. The findings are expected to provide evidence regarding the comparative effectiveness of different gamification approaches in nursing education and contribute to the design of evidence-based educational interventions.

The study will be conducted among third-year nursing students enrolled in the Obstetrics and Gynecology Nursing course.

Participants will be randomly assigned into two groups:

1. Gimkit-based gamification combined with theoretical education
2. Escape room-based gamification combined with theoretical education

All participants will receive standardized theoretical instruction on Human Papillomavirus (HPV). Subsequently, participants in the intervention groups will engage in gamified learning activities (Gimkit or escape room).

Data Collection Instruments

Data will be collected using the following instruments:

• Student Information Form The form will develop by the researchers based on the literature and included questions related to participants' age, gender, prior awareness of HPV, sources of HPV-related information, mobile gaming habits, and family history of cervical cancer
• Human Papillomavirus Literacy Scale (HPV-LS) The Human Papillomavirus Literacy Scale (HPV-LS), developed by Türkoğlu and Akpınar Ay (2025), evaluates individuals' knowledge, comprehension, and decision-making abilities related to HPV.
• Gameful Experience Scale (GAMEX) The Gameful Experience Scale (GAMEX), developed by Eppmann et al. (2018), is used to assess participants' game-based learning experiences.

Data Collection Time Points

Data will be collected at four time points:

1. Pretest (before theoretical education)
2. Posttest 1 (immediately after theoretical education)
3. Posttest 2 (immediately after the intervention)
4. Follow-up test (one month after Posttest 2)

Statistical Analysis Changes in HPV literacy over time will be analyzed using linear mixed-effects models. Time, group, and group-by-time interaction will be entered as fixed effects, and participant identification number will be included as a random effect. Sensitivity analyses will be performed to adjust for baseline differences in prior HPV knowledge. Statistical significance will be set at p < .05.

Inclusion Criteria:

• Being a nursing student
• Voluntary participation
• Aged 18 years or older
• Participation in all measurement points
• Ownership of a smartphone
• Internet access
• Having headphones

Exclusion Criteria:

• Incomplete data forms
• Not participating in intervention sessions
• Absence in posttest or follow-up