This study evaluates the effectiveness of a robot-assisted immersive escape room intervention for tobacco harm prevention among upper-grade elementary school students. A total of 200 fifth- and sixth-grade students from elementary schools in New Taipei City, Taiwan, will participate in this quasi-experimental, parallel-group design. Participants will be allocated non-randomly to either the experimental group, which receives the robot-assisted immersive escape room intervention, or the active comparator group, which receives standard classroom-based tobacco harm prevention education. In the experimental arm, an educational robot named "Anti-Smoking Kebbi" serves as a non-player character (NPC) to facilitate human-robot interaction through puzzle-solving and scenario-based learning focused on e-cigarette and tobacco hazards. Both groups will be assessed using validated questionnaires at three time points: baseline (pre-intervention), immediately post-intervention, and 1-month follow-up. Primary and secondary outcome measures will include changes in tobacco harm knowledge, health beliefs, smoking refusal self-efficacy, extended expectation confirmation, learning engagement, behavioral intention, and advocacy intention.
This study investigates the effectiveness of a robot-assisted immersive escape room game for tobacco harm prevention among elementary school students. The intervention integrates human-robot interaction and gamified learning to enhance students' understanding of e-cigarette and tobacco-related health risks. A quasi-experimental parallel-group design will be used. Approximately 200 fifth- and sixth-grade students from elementary schools in New Taipei City, Taiwan will participate. Schools will be assigned to either the experimental group or the control group based on matched characteristics such as school size and location. Students in the experimental group will participate in a 60-minute robot-assisted immersive escape room activity. The educational robot "Anti-Smoking Kebbi" acts as a non-player character (NPC) guiding students through puzzle-solving tasks related to tobacco harm prevention. The control group will receive a standard classroom-based tobacco harm prevention lesson delivered by trained teachers. Data will be collected using structured questionnaires administered at baseline, immediately after the intervention, and at one-month follow-up. Outcomes include tobacco harm knowledge, health beliefs, smoking refusal self-efficacy, , extended expectation confirmation, learning engagement, behavioral Intention, and advocacy Intention will be assessed using structured questionnaires at baseline, immediately after the intervention, and at one-month follow-up.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
200
Students participate in a 60-minute robot-assisted immersive escape room designed to prevent e-cigarette use. The session is facilitated by the educational robot "Anti-Smoking Kebbi," which acts as a non-player character (NPC) guiding students through interactive puzzles and scenario-based challenges. The activity integrates human-robot interaction and gamified learning strategies to teach the health risks of e-cigarette use and tobacco prevention concepts. The intervention is delivered once in a classroom setting.
Students receive a 60-minute standard classroom-based health education session on tobacco and e-cigarette harms delivered by trained teachers. The session uses lectures, presentation slides, and guided discussion to introduce the health risks of tobacco and e-cigarette use and strategies for prevention. The intervention is delivered once in a classroom setting.
Shuangfeng Elementary School, New Taipei City
New Taipei City, Xindian District, Taiwan
Change in Tobacco Harm Knowledge
This study adapted the Tobacco Harm Knowledge Scale from the Youth Smoking Behavior Survey Questionnaire (Health Promotion Administration, 2021). The scale covers e-cigarette components, legal regulations, and health impacts to assess students' understanding of basic tobacco knowledge gained from the curriculum. The 10-item scale uses objective scoring (1 point for correct answers, 0 points for incorrect or "don't know" responses) and demonstrates acceptable internal consistency (Cronbach's Alpha = 0.66).
Time frame: Baseline (pre-intervention), immediately post-intervention, and 1-month follow-up
Change in Health Beliefs About Tobacco Use
This study adapted the scale from Kueh, M. T. W., Rahim, F. F., \& Rashid, A. (2022). The questionnaire uses a 5-point Likert scale ranging from "Strongly Disagree" to "Strongly Agree." It begins with students' recognition of tobacco harm risks, such as "Smoking increases the risk of lung cancer" or "Smoking causes changes in appearance," to measure the strength of students' health beliefs and their awareness of smoking-related harms. The 12-item scale employs a 5-point scoring system, with higher scores indicating stronger health beliefs. The scale demonstrates good internal consistency (Cronbach's Alpha = 0.87).
Time frame: Baseline, immediately post-intervention, and 1-month follow-up.
Change in Smoking Refusal Self-Efficacy
This study adapted the Chinese version of the General Self-Efficacy Scale (GSES) from Zhang JX, Schwarzer R, Jerusalem M (1995), consisting of 7 items. It uses a 5-point Likert scale, with higher scores indicating greater self-efficacy. The scale demonstrates excellent internal consistency (Cronbach's Alpha = 0.94).
Time frame: Baseline, immediately post-intervention, and 1-month follow-up.
Extended Expectation Confirmation
This study was adapted from scale items by Gupta et al. (2021), Moon \& Kim (2001), and Venkatesh et al. (2012) to measure expectation confirmation regarding the e-cigarette prevention escape room game. It consists of 20 items using a 5-point Likert scale, with higher scores indicating greater expectation confirmation. The scale demonstrates excellent internal consistency (Cronbach's Alpha = 0.94).
Time frame: Baseline, immediately post-intervention, and 1-month follow-up.
Learning Engagement
This study was adapted from Zaichkowsky (1994) to assess participants' engagement level with the e-cigarette prevention escape room game. It includes two dimensions-"cognitive engagement" and "emotional engagement"-comprising 10 items total. The scale uses a 7-point Likert format, with higher scores indicating greater agreement. The scale demonstrates good internal consistency (Cronbach's Alpha = 0.83).
Time frame: Immediately post-intervention.
Behavioral Intention
This study's behavioral intention measurement tool aims to assess specific behaviors for actual e-cigarette prevention. It was revised after expert review and pilot testing to ensure applicability, validity, and reliability. The scale was evaluated by three experts for semantic clarity and contextual appropriateness, with wording refined post-pilot. It demonstrates good internal consistency reliability (Cronbach's α = 0.77), consists of 3 items using a 5-point Likert scale, with higher scores indicating greater likelihood of taking action.
Time frame: Immediately post-intervention.
Advocacy Intention
This study's advocacy intention measurement tool aims to assess participants' willingness to promote e-cigarette prevention policies. It was revised after expert review and pilot testing to ensure applicability, validity, and reliability. The scale was evaluated by three experts for semantic clarity and contextual appropriateness, with wording refined post-pilot. It demonstrates good internal consistency reliability (Cronbach's α = 0.75), consists of 2 items using a 5-point Likert scale, with higher scores indicating greater likelihood of advocacy action.
Time frame: Immediately post-intervention and 1-month follow-up.
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