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.

Study Overview

• Status: Not yet recruiting
• Conditions: Nursing Education; Health Literacy; Human Papillomavirus (HPV) Infection
• Intervention / Treatment: Behavioral: Escape Room-Based Gamified Reinforcement; Behavioral: Gimkit-Based Gamified Reinforcement

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 64
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: NİHAL TAŞKIRAN; Phone Number: +905055729899; Email: nihaltaskiran@adu.edu.tr
• Study Contact Backup: Name: Abdülkadir Deniz; Phone Number: +905323019812; Email: kadirdeniz0973@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Escape Room Group; 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.	Behavioral: Escape Room-Based Gamified Reinforcement; 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.
Experimental: Gimkit Group; 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.	Behavioral: Gimkit-Based Gamified Reinforcement; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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)

Secondary Outcome Measures

Outcome Measure	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.	Day 7 (28.09.2026)

Collaborators and Investigators

• Sponsor: Aydin Adnan Menderes University

Study record dates

Study Major Dates

• Study Start (Estimated): September 21, 2026
• Primary Completion (Estimated): October 26, 2026
• Study Completion (Estimated): October 26, 2026

Study Registration Dates

• First Submitted: June 19, 2026
• First Submitted That Met QC Criteria: June 19, 2026
• First Posted (Actual): June 24, 2026

Study Record Updates

• Last Update Posted (Actual): July 2, 2026
• Last Update Submitted That Met QC Criteria: June 30, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: gamification; Human Papillomavirus; nursing education; educational intervention; escape room; game-based learning; knowledge retention; HPV literacy; gimkit
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Pathologic Processes; Disease Attributes; Virus Diseases; Communicable Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; DNA Virus Infections; Tumor Virus Infections; Pathological Conditions, Signs and Symptoms; Infections; Papillomavirus Infections
• Other Study ID Numbers: 2026-HPV Literacy

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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