| The purpose of this study was to develop and evaluate a pedagogically rigorous web-based game designed to increase malaria knowledge and risk-reduction skills among youthful travelers. Three prototypes were created and rejected based on iterative user testing before arriving at one that was engaging and intuitive enough to ensure online completion of the study protocol without incentive. The self-regulation model of health behavior and the cognitive theory of multimedia learning guided design of the game and evaluation instruments.;U.S. outbound study abroad students (N=482) from seven midwestern universities participated by playing the game and completing pre/post surveys. An experimental design was used to compare three feedback strategies: no explanatory feedback, player-controlled explanatory feedback (pop-up text boxes give rationale for decision consequence when player chooses), and automated explanatory feedback (pop-up text boxes give rationale after every decision). Primary outcome measures were knowledge gain, risk perception, and player satisfaction.;One-third of participants had already traveled to a malaria-risk destination, while two-thirds planned to do so. The partial eta squared effect size for pre/post knowledge scores across conditions was large (0.767), showing a strong overall learning effect. Malaria risk perception ratings also increased significantly following the game intervention. Automatically providing a rationale for why each game decision has a positive or negative impact on game consequences (automated condition) produced a significantly higher score for knowledge gain. Player satisfaction with the game did not vary by feedback condition. Satisfaction was rated as very to extremely satisfying by 65% of participants. Even those participants who had already traveled to a malaria-risk destination demonstrated a knowledge gap (50% correct on the pre-game knowledge test) and showed significant gains in knowledge post-game, indicating that both malaria-experienced and malaria-naive students would benefit from this novel approach to travel health education.;The threat of cognitive overload when designing feedback strategies makes this work highly relevant to health educators designing web-based interventions. The rising number of students traveling to higher-risk destinations demands attention. Next steps include testing the effectiveness of this intervention on behavior before, during, and after travel. |
