This randomized comparative study aims to evaluate the effectiveness of two gamified reinforcement strategies, Gimkit and Escape Room, on human papillomavirus (HPV) literacy, short-term retention, and gameful learning experiences among undergraduate nursing students. Following standardized theoretical instruction on HPV infection, participants will be randomly assigned to either a digital quiz-based gamification intervention (Gimkit) or a collaborative Escape Room activity. Outcomes will be assessed using the Human Papillomavirus Literacy Scale (HPV-LS) and the Gameful Experience Scale (GAMEX) at multiple time points, including baseline, post-theoretical instruction, post-intervention, and one-month follow-up.
Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide and is associated with several cancers, including cervical, anal, penile, and oropharyngeal cancers. Nurses play a critical role in HPV prevention through health education, vaccination advocacy, and screening promotion. Therefore, enhancing HPV literacy among nursing students is an important educational objective. Gamification has emerged as an innovative educational approach that can increase learner engagement, motivation, and knowledge retention. However, evidence comparing different gamification modalities within the same educational context remains limited. Digital quiz-based platforms and collaborative escape room activities represent two distinct gamification strategies that may facilitate learning through different cognitive and social mechanisms. This study will compare the effects of a Gimkit-based digital reinforcement activity and a collaborative Escape Room intervention following standardized HPV education. The primary outcome will be HPV literacy. Secondary outcomes will include HPV literacy subdimension scores and gameful learning experiences. The findings are expected to provide evidence regarding the comparative effectiveness of different gamification approaches in nursing education and contribute to the design of evidence-based educational interventions. The study will be conducted among third-year nursing students enrolled in the Obstetrics and Gynecology Nursing course. Participants will be randomly assigned into two groups: 1. Gimkit-based gamification combined with theoretical education 2. Escape room-based gamification combined with theoretical education All participants will receive standardized theoretical instruction on Human Papillomavirus (HPV). Subsequently, participants in the intervention groups will engage in gamified learning activities (Gimkit or escape room). Data Collection Instruments Data will be collected using the following instruments: * Student Information Form The form will develop by the researchers based on the literature and included questions related to participants' age, gender, prior awareness of HPV, sources of HPV-related information, mobile gaming habits, and family history of cervical cancer * Human Papillomavirus Literacy Scale (HPV-LS) The Human Papillomavirus Literacy Scale (HPV-LS), developed by Türkoğlu and Akpınar Ay (2025), evaluates individuals' knowledge, comprehension, and decision-making abilities related to HPV. * Gameful Experience Scale (GAMEX) The Gameful Experience Scale (GAMEX), developed by Eppmann et al. (2018), is used to assess participants' game-based learning experiences. Data Collection Time Points Data will be collected at four time points: 1. Pretest (before theoretical education) 2. Posttest 1 (immediately after theoretical education) 3. Posttest 2 (immediately after the intervention) 4. Follow-up test (one month after Posttest 2) Statistical Analysis Changes in HPV literacy over time will be analyzed using linear mixed-effects models. Time, group, and group-by-time interaction will be entered as fixed effects, and participant identification number will be included as a random effect. Sensitivity analyses will be performed to adjust for baseline differences in prior HPV knowledge. Statistical significance will be set at p \< .05.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
64
A collaborative educational reinforcement activity designed according to constructivist and experiential learning principles to improve HPV literacy and knowledge retention. Participants will receive standardized theoretical education on Human Papillomavirus (HPV), followed by participation in structured escape room intervention will design as a collaborative, problem-solving-based learning activity conducted in groups of 7 students. Participants will randomly assigned to 4 groups and placed in separate classrooms to prevent interaction between groups. The escape room will consist of 4 stations involving HPV-related crossword puzzles, word-search activities, matching exercises, and problem-solving tasks developed according to the study learning objectives. Students will attempt to complete all activities within 20 minutes under moderator supervision. Groups can request hints from the moderator when needed; however, each hint resulted in a 1-minute time penalty.
Participants will receive standardized theoretical education on Human Papillomavirus (HPV), followed by participation in a Gimkit-based digital quiz game consisting of multiple-choice and true/false questions designed to reinforce HPV-related knowledge.The Gimkit intervention will consist of a digitally structured, quiz-based gamification activity including multiple-choice and true/false questions related to HPV infection, vaccination, screening, and prevention. The activity will design to support retrieval practice and immediate feedback processes. Students individually will access the game using smartphones and personal login codes in the classroom environment. All participants will start the activity simultaneously and completed the questions within 20 minutes while using headphones to minimize distraction and interaction among students.
Human Papillomavirus Literacy
HPV literacy will be measured using the Human Papillomavirus Literacy Scale (HPV-LS). Scores range from 24 to 120; higher scores indicate higher literacy. Higher scores indicate higher levels of HPV literacy.
Time frame: Baseline (Day 0, 21.09.2026), immediately after theoretical education (Day 0), immediately after the intervention (Day 7, 28.09.2026), and follow-up (Day 28, 26.10.2026)
Gamified Learning Experience
The Gameful Experience Scale (GAMEX) was developed by Eppmann et al. to evaluate students' perceptions of gamified learning experiences and was adapted into Turkish by Hatipoğlu and Türker (Eppmann et al., 2018; Hatipoğlu \& Türker, 2022). The scale consists of 27 items rated on a 5-point Likert scale and assesses six dimensions: enjoyment, engagement, creative thinking, activation, absence of negative affect, and dominance. Total scores range from 27 to 135, with higher scores indicating a more positive game-based learning experience. The Turkish version demonstrated excellent internal consistency, with a Cronbach's α coefficient of 0.93 in the validation study.
Time frame: Day 7 (28.09.2026)
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