JMIR Publications

ABSTRACT

Background:

Use of alternative forms of cigarettes, such as e-cigarettes, is becoming increasingly common among adolescents. Many high schools now provide smoking-prevention education in attempts to minimize the potential negative health effects and illness burdens e-cigarettes may induce in adolescents. However, it is often difficult to motivate young students to engage with traditional education regarding the harmful effects of tobacco; thus, the development of alternative approaches may be required.

Objective:

In this study, we aimed to conduct an acceptability evaluation of educational virtual-reality games designed to support smoking-prevention measures. We based the acceptability evaluation on two experience types: game-playing and content-learning. The paths by which these experience types affect intention to abstain from smoking were also examined.

Methods:

We applied a prospective observational study design. We developed educational games based on three-dimensional virtual-reality technology, in which participants operated joysticks to complete challenge tasks. To increase the possibility of the games fostering motivation to abstain from smoking, the ARCS motivational model (comprising attention, relevance, confidence, and satisfaction) was used as a framework during the games’ design. We measured the participants’ game-playing experiences by enquiring into the strength of the ARCS elements. Meanwhile, content-learning experiences were measured using overall knowledge improvement and the perceived persuasiveness of the content. A total of 130 students participated in the program. Study hypotheses for this evaluation were derived from a literature review. We used partial least squares structural equation modeling to examine the proposed hypotheses.

Results:

Based on their responses to questionnaire items concerning attention, relevance, confidence, and satisfaction in the context of the games, most students agreed or strongly agreed that the educational games were motivational, and that their game-playing experiences were positive. Regarding content-learning experience, there was a significant improvement in knowledge (t=25.67, P<.01), and most students perceived themselves as being persuaded to abstain from smoking. Attention, relevance, and satisfaction significantly influenced perceived persuasiveness (t=3.19, P<.01; t=4.28, P<.01; and t=3.49, P=.01, respectively); however, confidence did not (t=0.42, P=.67). Perceived persuasiveness significantly influenced intention to abstain from smoking (t=3.57, P<.01). Instead of directly affecting intention to abstain from smoking, indirect effects were observed from relevance and satisfaction, respectively, to intention via perceived persuasiveness (t=2.87, P<.05; t=2.11, P<.05, respectively). However, intention was not significantly influenced by knowledge improvement.

Conclusions:

Our findings revealed that the educational games were positively accepted by the participating students. This indicates that the integration of the ARCS framework and persuasive strategies is applicable for smoking-prevention education. We recommend that the games be included as teaching materials for smoking-prevention education.