The Effects of Combining Electronic Picture Books With RPG-Based Gamified Learning on Nursing Students' Motivation and Learning Outcomes in Breastfeeding Education

This study aimed to explore the impact of electronic picture books combined with RPG on breastfeeding learning outcomes among nursing students. The study participants were third-year nursing students from a university in central Taiwan. A randomized controlled design was used, with the experimental group receiving electronic picture books combined with RPG, while the control group received traditional face-to-face instruction. Changes in students' breastfeeding knowledge, learning motivation, self-efficacy, and cognitive load were assessed. The expected results can provide a reference for innovative teaching models in nursing education and promote the future clinical application of breastfeeding.

Study Overview

• Status: Not yet recruiting
• Conditions: Nursing Students; Breastfeeding Education; Nursing Education Research
• Intervention / Treatment: Behavioral: face-to-face teaching; Behavioral: Electronic picture books and Online RPG interactive adventure game

Detailed Description

Breastfeeding is widely considered to be the best source of nutrition for infants, helping to reduce infant morbidity and mortality, reduce the risk of infection and chronic diseases, and promote intellectual development. However, in current nursing education, how to effectively improve students' knowledge and skills of breastfeeding has yet to be developed. Common traditional face-to-face courses are limited by time and venue, which requires students to re-adapt and learn when entering the clinical internship stage, affecting learning efficiency and clinical application.

This study adopts a randomized controlled experimental design and is expected to recruit 100 third-year nursing students from a university in central Taiwan, divided into an experimental group and a control group. The experimental group studied with electronic picture books combined with RPG on breastfeeding learning, and the control group took a traditional face-to-face course. Data were collected through a structured questionnaire, and changes in breastfeeding knowledge, learning motivation, self-efficacy, and cognitive load were assessed analyzed using descriptive and inferential statistics. The expected results showed that the interactive e-book not only significantly improved students' learning outcomes, but also helped overcome gender restrictions, enhance learning motivation, promote future clinical promotion of breastfeeding, and serve as an important reference for innovative nursing education models.

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ting-Shan Chang; Phone Number: 7116 +886422053366; Email: tingshan@mail.cmu.edu.tw
• Study Contact Backup: Name: Ya-Ling Tzeng; Phone Number: 7112 +886422053366; Email: tyaling@mail.cmu.edu.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. It is expected to include 100 people.
2. A third-year nursing student.
3. Studying obstetrics and gynecology nursing this semester.
4. Agree to participate in this study and sign the research consent form.

Exclusion Criteria:

1. Students who are planning to take a leave of absence at the time of data collection.
2. Students who have not taken obstetrics and gynecology nursing this semester or have taken it in the past.
3. Students who are unable to use 3C products.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: face-to-face teaching; face-to-face teaching of breastfeeding	Behavioral: face-to-face teaching; face-to-face teaching of breastfeeding
Experimental: Electronic picture books and Online RPG interactive adventure game; Integration of online RPG interactive adventure games with an electronic picture books learning mode for the instruction of breastfeeding.	Behavioral: Electronic picture books and Online RPG interactive adventure game; Integration of online RPG interactive adventure games with an electronic picture books learning mode for the instruction of breastfeeding.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ARCS-Based Learning Motivation Scale	The scale assesses learners' motivation toward the educational materials across four dimensions: Attention (12 items), Relevance (9 items), Confidence (9 items), and Satisfaction (6 items), for a total of 36 items. Responses are rated on a 5-point Likert scale, ranging from 5 ("Strongly Agree") to 1 ("Strongly Disagree"). The total score ranges from 36 to 180 points, with higher scores indicating stronger learning motivation.	The experimental group and the control group will Baseline (prior to intervention), immediately after intervention, and 4 weeks after intervention
Breastfeeding Knowledge Questionnaire	This questionnaire consists of 10 multiple-choice questions. Each correct answer is scored 10 points, and each incorrect answer is scored 0 points, yielding a total score range of 0-100. The questions were self-developed in the form of clinical scenario-based multiple-choice items, focusing on the benefits of breastfeeding, breastfeeding positions, breast milk storage methods, breast milk expression (hand expression), and nursing interventions to maintain milk supply.	The experimental group and the control group will Baseline (prior to intervention), immediately after intervention, and 4 weeks after intervention
Breastfeeding Self-Efficacy Scale	Breastfeeding self-efficacy was evaluated using a 10-item Breastfeeding Self-Efficacy Scale. Each item is rated on a 4-point Likert scale, where 1 = not at all capable and 4 = expert level. The total score ranges from 10 to 40, with higher scores indicating greater self-efficacy in performing breastfeeding self-efficacy .	The experimental group and the control group will Baseline (prior to intervention), immediately after intervention, and 4 weeks after intervention
Cognitive Load Scale	The cognitive load of learners taking electronic picture books and RPGs or face-to-face courses was assessed using an 8-item cognitive load scale. All items were rated on a 1-point Likert scale, ranging from 5 ("strongly agree") to 1 ("strongly disagree"). The total score ranged from 8 to 40, with higher scores indicating stronger cognitive load.	The experimental group and the control group will Baseline (prior to intervention), immediately after intervention, and 4 weeks after intervention

Collaborators and Investigators

• Sponsor: China Medical University Hospital
• Collaborators: China Medical University, Taiwan

Study record dates

Study Major Dates

• Study Start (Estimated): September 30, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: April 7, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: nursing education; Nursing Students; Breastfeeding Education; learning motivation; electronic picture books; RPG
• Other Study ID Numbers: CMUH115-REC1-069

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No