JMIR Publications

ABSTRACT

Background:

The metaverse provides an immersive, interactive medium for health education, but most studies evaluate immersion and gamification together. Randomized evidence disentangling their separate effects on immediate learning and short-term retention in breast health education is lacking.

Objective:

To isolate the effects of gamification, over and above an identical immersive metaverse environment, on immediate gains and 4-week retention of women’s breast health knowledge.

Methods:

This study conducted a parallel two-arm individually randomized controlled trial in Hangzhou, China. 72 women were recruited and randomly allocated (1:1) using a computer-generated sequence with concealed allocation to a Gamified Metaverse group (GM) or a Non-Gamified Metaverse group (NGM). Both groups used the Mammoverse platform with identical educational content and exposure time. Breast health knowledge was assessed at baseline (T1), immediately post-intervention (T2), and 4-week follow-up (T3) using the same questionnaire, the primary outcome was change in knowledge score. Analyses followed the intention-to-treat principle using linear mixed-effects models, with age, education, family history of breast cancer, prior training, and baseline knowledge as covariates. Participants and investigators were not blinded.

Results:

Seventy-two women were randomized and all were analysed (GM n=36; NGM n=36), recruitment and follow-up were completed. Knowledge scores improved in both groups, but gains from T1 to T2 were larger in GM than NGM (Hedges g=0.65, 95% CI 0.18–1.12, p=.007). From T2 to T3, there was no between-group difference in change scores (p=.91). However, at 4 weeks GM retained higher absolute knowledge than NGM (estimated marginal means 15.7 vs 13.0). No intervention-related adverse events were reported.

Conclusions:

This study marks the first application of gamification in BSE education for ordinary Chinese women within a 3D desktop metaverse. By comparing gamified and non-gamified versions under identical metaverse platform conditions, it expands the application boundaries of gamified metaverses in breast health education. Gamification significantly enhanced immediate acquisition of breast health knowledge but did not provide additional advantages for short-term retention. However, the gamified group maintained higher absolute knowledge levels at the 4-week follow-up. Overall, in the 3D desktop metaverse, immersive experiences provide foundational effects, while gamification delivers immediate gains. To further optimize long-term retention, memory consolidation strategies must be integrated into the gamified framework. Clinical Trial: This trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06930898, URL: https://clinicaltrials.gov/study/NCT06930898, registered on 8 April 2025).