A team comprising of family physicians from SingHealth Polyclinics and mobile application developers from AI Innovation Labs Private Limited embarked on a first local study to co-create a locally designed serious game to raise community awareness of dengue vector control programme among residents in Singapore.
Serious games are games built for the purpose of learning and education instead of just for entertainment. Using serious games, participants will be able to learn from an interactive and engaging environment, which can help to promote or assist in an individual’s training or education.
The results showed that participants who played the serious game were more inclined to translate the acquired knowledge into actual practices, such as checking for any garbage or rubbish that can block the drainage system around the house, and checking for Aedes larvae in the toilet tank. In addition, the findings suggested that serious game can be equally effective compared to conventional web-based learning in promoting dengue prevention measures and vaccination intention among adults. It could be considered as a feasible alternative to digitally engage local residents’ awareness of dengue, and influence their attitude towards its prevention.
The study was conducted at SingHealth Polyclinics – Sengkang, with over 370 volunteered patients randomly allocated between an intervention and control group to receive information regarding dengue prevention. Patients in the intervention group played a serious game called “Sam’s Mozzie Adventure”, while those in the control group visited a dengue prevention website to learn more about dengue prevention. Before and after receiving information on dengue prevention, participants completed a self-administered online questionnaire within a two-week interval to assess the Knowledge, Attitude and Practice (KAP) score, and their interest to vaccinate against dengue. Participants, who played serious game, evaluated the game with the System Usability Scale (SUS).
The KAP research design is a widely utilised strategy to assess the level of awareness and practices in disease prevention programmes1. Many regional studies have used the KAP surveys to assess the literacy of residents in dengue prevention programmes. SUS is a tool for measuring the usability of the application.
The game story centred around the character Sam. As Sam travelled through four different everyday scenarios at home, the bus-stop, his school and workplace, participants take on the role of Sam, whose goal was to identify potential dengue breeding sites and learn about dengue prevention measures so as to create a ‘Mozzie-free world’. Through each scenario, the game would trigger the participant to click on potential dengue breeding sites such as vase, potted plants, and water containers without lids. When correctly selected, Sam would be activated to do an animated action to rectify the problem and a pop up containing the relevant dengue information would be presented to the participant.
Behavioural change technique using reward and threat was used in the design of ‘Sam’s Mozzie Adventure’. A correct answer or action would earn the participant more ‘stars’, while an incorrect move would result in a lower score, or require the participant to repeat the task. Participants could also view dengue posters or participate in quizzes while exploring the interactive environment to learn about dengue prevention measures. Hints were prompted at the start of each scenario to lead the participant towards identifying the triggers within the game so as to achieve the maximum desired outcome with minimum effort on the participant’s part.
The control group accessed the NEA ‘Stop Dengue’ website2, which contained dengue prevention information in the forms of online articles, posters and video.
All the participants were instructed to either complete playing the game or read the online resources within two weeks.
Participants in both groups had increased KAP score from baseline, but the mean difference in score was greater when assessing participants’ daily practice towards dengue prevention in the intervention group as compared to the control group. In addition, more than 84 per cent of the participants in both groups were keen for dengue vaccination in this study. However, as dengue vaccination is only suitable for people who have been previously infected, further adaptation of this serious game has to be done, such as fitting in-game features of identifying suitable vaccination candidates and collaborating with nearby primary care clinics to provide the vaccination.
Dr Alon Tan, Associate Consultant at SingHealth Polyclinics said, “Dengue is endemic in Singapore but each year, a significant number of residents are infected with dengue, and a small proportion of these patients faced the possibility of death from this preventable infectious disease. According to the dengue situation update by NEA, more than 32,000 dengue cases were reported as on 30 Dec 2022, despite extensive vector control measures to curb mosquito breeding.” Dr Alon Tan is also the main author of this research paper.
“The outcomes of this study exhibited the possibility of how a stimulated interactive learning environment such as a serious game, could have a positive impact in health behaviours in a general population”, added Dr Alon.
“As Singapore is one of the most wired countries and technological advanced countries, with more than 90 per cent of the population owning a smart phone, serious game can be a feasible option to deliver important health and disease preventive information to the masses. The interactive features and immersive story embedded with the relevant content knowledge and behavioural theory can enhance the user’s motivation to play the game and gradually facilitate behavior change”, said Clinical Associate Professor (Dr) Tan Ngiap Chuan, Director of Research, SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP).
“We see a lot of potential in using serious game as a tool to impart health education to our patients. However, further studies have to be done to validate it,” added Prof Tan.
‘Sam’s Mozzie Adventure’ is currently available on both Apple App Store and Google Play Store.
1 AhbiRami R and Zuharah WF. School-based health education for dengue control in Kelantan, Malaysia: impact on knowledge, attitude and practice. PLoS Negl Trop Dis 2020; 14: e0008075. 2 National Environmental Agency. Singapore. Stop Dengue Now, https://www.nea.gov.sg/dengue-zika/stop-dengue-now, (2022, accessed 15 March 2022).