Nationwide Deployment of a Serious Game Designed to Improve COVID-19 Infection Prevention Practices in Switzerland: Prospective Web-Based Study.

BACKGROUND Lassitude and a rather high degree of mistrust towards the authorities can make regular or overly constraining COVID-19 infection prevention and control (IPC) campaigns inefficient and even counterproductive. Serious games provide an original, engaging, and potentially effective way of disseminating COVID-19 IPC guidelines. Escape COVID-19, a serious game designed to teach COVID-19 IPC practices, was previously validated in nursing home personnel. OBJECTIVE The objective of this study was to identify the factors facilitating or impeding the intention of changing IPC behavior after playing the Escape COVID-19 serious game in a larger and more heterogeneous population after national rollout. METHODS This fully-automated prospective web-based study, compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was conducted in all 3 main language regions of Switzerland. After creating an account on a specific web platform, participants were asked to fill in a short demographic questionnaire before accessing the serious game. A second questionnaire was then displayed and had to be completed to obtain a course completion certificate, which was the only incentive given to the potential participants. The primary outcome was the proportion of participants reporting they were willing to change their IPC behavior. Secondary outcomes were the IPC areas affected by this willingness and the presumed evolution in the use of specific personal protective equipment items. The elements associated with the intention of changing IPC behavior, or lack thereof, were also assessed. Other secondary outcomes were the subjective perceptions regarding length, difficulty, meaningfulness and usefulness of the serious game, impression of engagement and of boredom while playing it, and willingness to recommend its use to friends or colleagues. RESULTS From March 9th to June 9th 2021, a total of 3227 accounts were created on the platform and 1104 participants (34.2%) completed the post-game questionnaire. A total of 509 participants (46.1%) answered that they intended to change their IPC behavior after playing the game. Among the others, most (86%, 512/595) answered that they were already applying these guidelines. Participants who followed the German version were less likely to intend to change their IPC behavior (OR 0.48 [95%CI 0.24 to 0.96], P=.038) and found the game less engaging (P<.001). Conversely, participants aged 53 years or older had a stronger intention of changing IPC behavior (OR 2.07 [95%CI 1.44 to 2.97], P<.001). CONCLUSIONS "Escape COVID-19" is a useful tool to enhance correct IPC measures on a national scale, even after 2 COVID-19 pandemic waves. However, its impact was affected by language, age category, and previous educational training, and adaptations should be performed to enhance its impact on specific populations. CLINICALTRIAL