JMIR Publications

ABSTRACT

Background:

The misuse and overuse of antibiotics accelerate the development of antimicrobial resistance (AMR). Serious-games, any form of games that serve a greater purpose other than entertainment, could augment public education above ongoing health promotion efforts. Hence, we developed an evidence-based educational serious game app—SteWARdS Antibiotic Defence—to educate users on good antibiotic use practices and AMR through a game quest comprising three mini games and interaction with the non-player characters.

Objective:

We aimed to evaluate the effectiveness of the SteWARdS Antibiotic Defence app in improving the knowledge of, attitude toward, and perceptions (KAP) of appropriate antibiotic use and AMR among the public in Singapore.

Methods:

We conducted a two-arm parallel randomized controlled trial, recruiting visitors 18–65 years old from two polyclinics in Singapore. Intervention group participants had to download the SteWARdS Antibiotic Defence app (only available in English and on the Android platform) on their smartphones and complete the quest in the app. Participants took half a day to two weeks to complete the quest. The control group received no intervention. Knowledge on antibiotic use and AMR (11 binary questions) was self-administered at baseline, immediately after the intervention, and 6–10 weeks post-intervention, while attitudes and perception (14 three-point Likert scale questions) were self-administered at baseline and 6–10 weeks post-intervention. We also collected participants’ feedback on app usage.

Results:

Participants (n=348; 142 Intervention, 206 Controls) had a mean age of 36.9 years. Intervention group participants showed significantly greater improvement in knowledge scores compared with controls [0.58 (95% CI: 0.28, 0.87)] after accounting for age, educational level, and exposure to advertisements on antibiotics and AMR. Intervention participants also showed significantly greater improvement in attitude-perception score [0.98 (0.44, 1.52)] after adjusting for marital status and race. More than 95% of participants agreed that the “SteWARdS Antibiotic Defence” app improved their awareness on antibiotic use and AMR. More than 70% agreed that the app is easy to use and enjoyable, and 85.2% would recommend the app to others.

Conclusions:

Our educational serious-game app improves participants’ KAP on appropriate antibiotic use and AMR. Public education apps should be engaging, educational, easy to use, and have an attractive user interface. Future research should assess the effectiveness of interventions in facilitating long-term knowledge retention and long-lasting behavioural change. Clinical Trial: ClinicalTrials.gov Identifier: NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414