Effectiveness of Digital Serious Games on Knowledge and Attitudes in Public Health Education: Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials

Clinical Snapshot

Key Findings

• P Value: Statistically significant for both outcomes (CIs exclude null)

• Effect Size: Knowledge: SMD 0.66 (moderate effect); Attitudes: SMD 0.50 (moderate effect)

• Primary Outcome: Standardized mean difference for public health knowledge and attitudes

• Nnt Or Sensitivity: Mobile app-based games ranked highest for knowledge improvement; computer-offline games ranked highest for attitudes

• Confidence Interval: Knowledge: 95% CI 0.32-0.99; Attitudes: 95% CI 0.27-0.76

Clinical Application

High feasibility given widespread digital device access, though requires consideration of digital literacy and infrastructure Relevant to Australian Digital Health Strategy and preventive health initiatives. Could support RACGP health promotion activities and complement existing health education programs through Medicare Benefits Schedule health assessments Broad applicability to nonprofessional populations seeking health education, particularly adolescents and community groups

Abstract

BACKGROUND: Inadequate health literacy and low engagement challenge public health education. Digital serious games show potential to enhance health knowledge and attitudes. However, the comparative effectiveness of different game formats is unclear. OBJECTIVE: This study aimed to evaluate and compare the effectiveness of different digital serious game formats in improving public health knowledge and attitudes. METHODS: This systematic review and Bayesian network meta-analysis followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Seven databases (PubMed, CINAHL, Embase, PsycINFO, Cochrane Library, Scopus, and Web of Science) were searched from January 2000 to October 2025. An updated search in February 2026 identified no additional studies. Eligible studies were randomized controlled trials (RCTs) involving nonprofessional participants comparing digital serious games with traditional or noninteractive education. Standardized mean differences and 95% credible intervals were pooled using Bayesian network models with random effects. Subgroup analyses examined population characteristics, intervention duration, health topic, and delivery format. Risk of bias was assessed using the Cochrane risk-of-bias tool, and evidence certainty was rated using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Forty randomized controlled trials from 19 countries (N=8764 participants) were included. Digital serious games significantly improved knowledge (standardized mean difference 0.66, 95% CI 0.32-0.99; I²=89.1%) and attitudes (standardized mean difference 0.50, 95% CI 0.27-0.76; I²=80.7%) compared with traditional education. Multisession interventions showed larger effects than single-session interventions for knowledge (0.76 vs 0.43) and attitudes (0.53 vs 0.30), with greater improvements among adolescents, nonpatient populations, and Asian studies. Network meta-analysis showed low heterogeneity (I²=8% for knowledge; 3% for attitudes). Mobile app-based, computer-offline, and web-based games ranked highest for knowledge; computer-offline, web-based, and virtual reality games ranked highest for attitudes. Evidence certainty was moderate for knowledge and low-to-moderate for attitudes. CONCLUSIONS: Digital serious games improve public health knowledge and attitudes across diverse contexts. Using a Bayesian network meta-analysis of randomized controlled trials, this review compares the relative effectiveness of different game formats. Mobile app-based, computer-offline, and web-based games most improved knowledge; computer-offline, web-based, and virtual reality formats most improved attitudes. Multisession interventions were more effective than single-session ones, particularly for adolescents and nonpatient populations. These findings guide scalable digital health education strategies. Future research requires adequately powered trials, longer follow-up, and standardized frameworks.

References

1. 1.Huang, D., Wu, D., Hexel, R., Brown-Wilson, C., Zhou, J., & Moyle, W. (2026). Effectiveness of Digital Serious Games on Knowledge and Attitudes in Public Health Education: Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. Journal of Medical Internet Research, 28(4), e89281. https://doi.org/10.2196/89281