JMIR Publications

ABSTRACT

Background:

Early bystander cardiopulmonary resuscitation (CPR) and prompt defibrillation are key determinants of survival after out-of-hospital cardiac arrest. School-based adult basic life support (BLS) education is a high-impact public health strategy, yet scalability and standardized assessment remain challenging. Gamified digital environments may support engagement while enabling comparable, rubric-based evaluation of learning artefacts.

Objective:

To evaluate a fully online, school-oriented, gamified adult BLS initiative delivered through Minecraft Education Edition by quantifying participation and rubric-based performance, and describing program costs from a provider perspective.

Methods:

Cross-sectional program evaluation of the 2025 “Build & Save: CPR Museum Challenge” (21-day participation window). Teachers facilitated student participation using a self-directed adult BLS online course and a structured in-game building task requiring dedicated rooms representing key adult BLS actions (check responsiveness, call emergency number 112, compress, defibrillate). Each class submitted one project (project diary and exported world file), with an optional ≤2-minute explanatory video (+1 point). A four-member jury assessed projects using a predefined five-domain rubric (1–4 per domain; base score range 0–20; total score 0–21 capped at 20 in reporting). Descriptive statistics, non-parametric group comparisons, internal consistency (Cronbach’s alpha), and Spearman correlations were computed. A cost–consequence analysis reported direct implementation costs and awards.

Results:

Thirty projects were submitted; 27 were formally evaluated. The initiative reached 23 teachers and 850 students across 11 regions (Spain, United States, Colombia, Malaysia). The median base score was 7 (IQR 2–10; range 0–19) and the median total score was 7 (IQR 2–10; range 0–20). The proportion of high domain scores (3–4) ranged from 7.4% to 22.2%. Rubric internal consistency was high (Cronbach’s alpha 0.95). Projects including an explanatory video scored higher (Mann–Whitney U=134.5, p=0.0062; Cliff’s delta=0.66), and secondary-level projects outperformed primary-level submissions (H=7.457, p=0.0063). Domain correlations were high (all p<0.001), strongest between content integration and in-world explanation (ρ=0.94). Direct implementation costs were €4,500, rising to €6,000 including awards; cost per student was €5.29–€7.06.

Conclusions:

A teacher-facilitated, fully online Minecraft-based challenge can achieve wide reach at low provider cost while generating standardized learning artefacts for scalable assessment. However, modest median performance and strong inter-domain correlations suggest that future editions should strengthen instructional scaffolding, particularly to ensure accurate integration and explanation of adult BLS content in primary education. Digital gamified activities should complement, not replace, hands-on CPR training; controlled studies should evaluate knowledge/skills acquisition, retention, and transfer to real-world bystander behaviour.