PMID- 33685854 OWN - NLM STAT- MEDLINE DCOM- 20210422 LR - 20240331 IS - 1438-8871 (Electronic) IS - 1439-4456 (Print) IS - 1438-8871 (Linking) VI - 23 IP - 3 DP - 2021 Mar 25 TI - Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial. PG - e27443 LID - 10.2196/27443 [doi] LID - e27443 AB - BACKGROUND: Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called "Escape COVID-19" using Nicholson's RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change. OBJECTIVE: As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing "Escape COVID-19." METHODS: This was a web-based, triple-blind, randomized controlled trial, which took place between November 5 and December 4, 2020. The health authorities of Geneva, Switzerland, asked the managers of all LTCFs under their jurisdiction to forward information regarding the study to all their employees, regardless of professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire, which assessed their willingness to change their IPC practices and identified the reasons underlying their decision. They were then granted access to the serious game. Conversely, the serious game group played "Escape COVID-19" after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. There was no time limit. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying participants' decisions, the domains these changes would affect, changes in the use of protective equipment items, and attrition at each stage of the study. RESULTS: A total of 295 answer sets were analyzed. Willingness to change behavior was higher in the serious game group (82% [119/145] versus 56% [84/150]; P<.001), with an odds ratio of 3.86 (95% CI 2.18-6.81; P<.001) after adjusting for professional category and baseline knowledge, using a mixed effects logistic regression model with LTCF as a random effect. For more than two-thirds (142/203) of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining their willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines. CONCLUSIONS: The serious game "Escape COVID-19" was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19-safe IPC behavior. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25595. CI - (c)Melanie Suppan, Mohamed Abbas, Gaud Catho, Loric Stuby, Simon Regard, Sophia Achab, Stephan Harbarth, Laurent Suppan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.03.2021. FAU - Suppan, Melanie AU - Suppan M AUID- ORCID: 0000-0002-8807-9619 AD - Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. FAU - Abbas, Mohamed AU - Abbas M AUID- ORCID: 0000-0002-7265-1887 AD - Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. FAU - Catho, Gaud AU - Catho G AUID- ORCID: 0000-0002-4948-0944 AD - Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. FAU - Stuby, Loric AU - Stuby L AUID- ORCID: 0000-0003-1663-5249 AD - Geneve TEAM Ambulances, Geneva, Switzerland. FAU - Regard, Simon AU - Regard S AUID- ORCID: 0000-0002-3979-7593 AD - Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. AD - Division of the Surgeon General, Geneva Directorate of Health, Geneva, Switzerland. FAU - Achab, Sophia AU - Achab S AUID- ORCID: 0000-0002-3861-3297 AD - Specialized Facility in Behavioral Addictions ReConnecte, University of Geneva Hospitals, Geneva, Switzerland. AD - WHO Collaborating Center in Training and Research in Mental Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland. FAU - Harbarth, Stephan AU - Harbarth S AUID- ORCID: 0000-0002-3551-1025 AD - Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. FAU - Suppan, Laurent AU - Suppan L AUID- ORCID: 0000-0001-6989-6421 AD - Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20210325 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 SB - IM MH - COVID-19/epidemiology/*prevention & control/*transmission MH - Disease Transmission, Infectious/*prevention & control MH - Female MH - Humans MH - Infection Control/*methods/statistics & numerical data MH - Intention MH - Internet MH - Long-Term Care/*methods/standards MH - Male MH - SARS-CoV-2/isolation & purification MH - *Video Games PMC - PMC7996198 OTO - NOTNLM OT - COVID-19 OT - SARS-CoV-2 OT - control OT - elderly OT - game OT - health care worker OT - impact OT - infection prevention OT - intention OT - long-term care facilities OT - nursing homes OT - randomized controlled trial OT - serious game OT - transmission COIS- Conflicts of Interest: None declared. EDAT- 2021/03/10 06:00 MHDA- 2021/04/23 06:00 PMCR- 2021/03/25 CRDT- 2021/03/09 06:01 PHST- 2021/02/01 00:00 [received] PHST- 2021/03/07 00:00 [accepted] PHST- 2021/03/07 00:00 [revised] PHST- 2021/03/10 06:00 [pubmed] PHST- 2021/04/23 06:00 [medline] PHST- 2021/03/09 06:01 [entrez] PHST- 2021/03/25 00:00 [pmc-release] AID - v23i3e27443 [pii] AID - 10.2196/27443 [doi] PST - epublish SO - J Med Internet Res. 2021 Mar 25;23(3):e27443. doi: 10.2196/27443.