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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:
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:
Data Collection Time Points
Data will be collected at four time points:
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Escape Room Group | Experimental | Participants will receive standardized theoretical education on Human Papillomavirus (HPV), followed by participants will engage in a collaborative Escape Room activity involving HPV-related problem-solving tasks, crossword puzzles, matching exercises, and educational challenges completed in small groups. |
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| Gimkit Group | Experimental | Participants will receive standardized theoretical education on Human Papillomavirus (HPV), followed by a digital quiz-based educational reinforcement activity (Gimkit) designed according to retrieval practice and test-enhanced learning principles to improve HPV literacy and knowledge retention. Participants will complete an individual digital gamification activity using the Gimkit platform. The intervention includes multiple-choice and true/false questions focusing on HPV transmission, vaccination, screening, prevention, and nursing responsibilities. Immediate feedback will be provided throughout the activity. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Escape Room-Based Gamified Reinforcement | Behavioral | A collaborative educational reinforcement activity designed according to constructivist and experiential learning principles to improve HPV literacy and knowledge retention. Participants will receive standardized theoretical education on Human Papillomavirus (HPV), followed by participation in structured escape room intervention will design as a collaborative, problem-solving-based learning activity conducted in groups of 7 students. Participants will randomly assigned to 4 groups and placed in separate classrooms to prevent interaction between groups. The escape room will consist of 4 stations involving HPV-related crossword puzzles, word-search activities, matching exercises, and problem-solving tasks developed according to the study learning objectives. Students will attempt to complete all activities within 20 minutes under moderator supervision. Groups can request hints from the moderator when needed; however, each hint resulted in a 1-minute time penalty. |
| Measure | Description | Time Frame |
|---|---|---|
| Human Papillomavirus Literacy | HPV literacy will be measured using the Human Papillomavirus Literacy Scale (HPV-LS). Scores range from 24 to 120; higher scores indicate higher literacy. Higher scores indicate higher levels of HPV literacy. | Baseline (Day 0, 21.09.2026), immediately after theoretical education (Day 0), immediately after the intervention (Day 7, 28.09.2026), and follow-up (Day 28, 26.10.2026) |
| Measure | Description | Time Frame |
|---|---|---|
| Gamified Learning Experience | The Gameful Experience Scale (GAMEX) was developed by Eppmann et al. to evaluate students' perceptions of gamified learning experiences and was adapted into Turkish by Hatipoğlu and Türker (Eppmann et al., 2018; Hatipoğlu & Türker, 2022). The scale consists of 27 items rated on a 5-point Likert scale and assesses six dimensions: enjoyment, engagement, creative thinking, activation, absence of negative affect, and dominance. Total scores range from 27 to 135, with higher scores indicating a more positive game-based learning experience. The Turkish version demonstrated excellent internal consistency, with a Cronbach's α coefficient of 0.93 in the validation study. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| NÄ°HAL TAÅžKIRAN | Contact | +905055729899 | nihaltaskiran@adu.edu.tr | |
| Abdülkadir Deniz | Contact | +905323019812 | kadirdeniz0973@gmail.com |
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Participants will be randomly assigned to one of two educational reinforcement interventions following standardized HPV theoretical instruction. One group will receive a digital quiz-based gamification intervention using Gimkit, whereas the second group will participate in a collaborative Escape Room activity. Outcome measures will be assessed longitudinally across four measurement points.
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| Gimkit-Based Gamified Reinforcement | Behavioral | Participants will receive standardized theoretical education on Human Papillomavirus (HPV), followed by participation in a Gimkit-based digital quiz game consisting of multiple-choice and true/false questions designed to reinforce HPV-related knowledge.The Gimkit intervention will consist of a digitally structured, quiz-based gamification activity including multiple-choice and true/false questions related to HPV infection, vaccination, screening, and prevention. The activity will design to support retrieval practice and immediate feedback processes. Students individually will access the game using smartphones and personal login codes in the classroom environment. All participants will start the activity simultaneously and completed the questions within 20 minutes while using headphones to minimize distraction and interaction among students. |
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| Day 7 (28.09.2026) |
| ID | Term |
|---|---|
| D030361 | Papillomavirus Infections |
| D007239 | Infections |
| ID | Term |
|---|---|
| D015229 | Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D003141 | Communicable Diseases |
| D004266 | DNA Virus Infections |
| D014777 | Virus Diseases |
| D014412 | Tumor Virus Infections |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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