The Effect Of Gamification On Antibiotic Resistance Knowledge In Saudi Arabia

The term "gamification" became a trend in the past few years as its showed to be helpful in making the education process more excited and interesting to the community (Hamari, Koivisto, & Sarsa, 2014). Gamification is defined as using a game for education purpose, combined with entertainment to increase the participant motivation and engagement. (Chen, Jian, Lin, Yang, & Chang, 2014). Several studies showed the efficiency of gamification as an approach to help the students in different study fields such as courses in engineering (Barata, Gama, Jorge, & Gonçalves, 2013) and medicine (Nevin et al. , 2014).

Also, gamification was helpful in health promotional fields, as it was found to be effective in diet modification and exercise promotion (Shiyko, Hallinan, El-Nasr, Subramanian, & Castaneda-Sceppa, 2016). Few studies used gamification in health promotional field related to dentistry. In fact, there were two studies found that gamification improved oral hygiene knowledge and attitude among children in India (Kumar, Asokan, John, & Gopalan, 2015; Saraswathy, 2012). The first one was a quasi-experiment and used snake and ladder game (board game) (Saraswathy, 2012). The second one was a randomized controlled trial (RCT) that used dot-game in the study group, and found better improvement in compared to the control group that had only conventional educational method after three months follow-up (Kumar et al. , 2015). Only one study used gamification in the health field in Saudi Arabia (El Tantawi, Sadaf, & AlHumaid, 2018). This study assessed the satisfaction of dental students with gamification to improve their writing skills. The study results showed that, the writing skills of participants were significantly improved but the satisfactions of using the game as educational method was low. So, gamification seems to be a newly emerging promising venue to improve health promotion.

On the other hand, antibiotic resistance (ABR) is the modification occurred to the bacteria in response of utilizing the antibiotics for treatment purpose, which make the antibiotic (AB) not effective. World Health Organization (WHO) also stated that ABR has reached alarming levels considered to be worldwide public health problem, and that has the ability to affect anybody (WHO, 2014). In a previous systematic review, the use of (AB) without a prescription was estimated to be 58% in Asia, 47% in southern Europe, 30% in eastern Europe, 25% in South America, 39% in Middle East (al, 2011). These numbers might be due to lack of proper knowledge. This can be shown in the results of a cross sectional study that assesses AB knowledge and attitude in three countries including Saudi Arabia (Belkina et al. , 2014). The study results showed a correlation between low knowledge and AB self-medication and showed that 48% of Saudis take AB without perception. Thus, ABR awareness interventions are essential to boost knowledge and improve attitude. A recent systematic review evaluated the effectiveness of the interventions to improve targeting antimicrobial proper use and antimicrobial resistant knowledge concluded that the quality of the previous interventions were poor and there was an urge to conduct well-designed interventions (Price et al. , 2018). Gamification seems to be an innovative method to help boosting ABR awareness.

According to our knowledge, there was only one recent study that used gamification as a method to improve AMR (Hale, Young, Grand, & McNulty, 2017). This study was conducted on 153 children in United Kingdom, using three different web-based games (e-Bug) aiming to improve AMR knowledge. The results showed that all the three games improved the knowledge, However, the level of improvement in knowledge, and level of enjoyment varied according to the game type. Nevertheless, this study involved only children, while the problem might arise from adults more than children, as adult has more access to use AB. Also, developing such web-based game might be costly, in compared to other game method such as board games. Also, there is lack of enough interventional study aimed to improve ABR is Saudi Arabia. Thus, this study aims to assess the effect of gamification using (board game) on AMR knowledge and attitude in Saudi Arabia.