JMIR Publications

ABSTRACT

Background:

Most residents of long-term care facilities (LTCFs) are at high risk of complication and death after SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called “Escape COVID-19” using Nicholson’s RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change.

Objective:

As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing “Escape COVID-19”.

Methods:

This was a web-based, triple-blind, randomized controlled trial, which took place between November 5th and December 4th, 2020. The health authorities of Geneva (Switzerland) asked the managers of all LTCFs under their jurisdiction to forward information regarding the study and the connection procedure to all their employees, regardless of their professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire which assessed their willingness to change their IPC practices and identify the reasons underlying their decision. They were finally granted access to the serious game. Conversely, the serious game group played "Escape COVID-19" after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying the participants' decisions, the domains these changes would affect, the changes in the use of protective equipment items, and attrition at each stage of the study.

Results:

A total of 295 answer sets were analyzed. The willingness to change behavior was higher in the serious game group (82% [119/145] vs 56% [84/150], P < .001), with an odds ratio of 3.9 (95%CI 2.2 – 6.9, P < .001) after adjustment for LTCF site, professional status and baseline knowledge. For more than two thirds of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining the willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines.

Conclusions:

The serious game “Escape COVID-19” was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19 safe IPC behavior.