Work

Gamified Versus Nongamified Metaverse Learning for Breast Health Knowledge in Women: Randomized Controlled Trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: BACKGROUND: The metaverse provides an immersive, interactive medium for health education, but most studies evaluate immersion and gamification together. Randomized evidence disentangling their separate effects on immediate learning and short-term retention in breast health education is lacking. OBJECTIVE: To isolate the effects of gamification, over and above an identical immersive metaverse environment, on immediate gains and 4-week retention of women's breast health knowledge. METHODS: This two-arm parallel individually randomized controlled trial was conducted in Hangzhou, China. Eligible participants were women aged ≥18 years who were interested in breast health and able to use a personal computer with internet access. A total of 80 women were recruited via the Xiaohongshu social media platform; 8 withdrew before randomization or did not complete the baseline assessment, and the remaining 72 women were randomized to a Gamified Metaverse (GM) or a Non-Gamified Metaverse (NGM) group using a computer-generated 1:1 sequence. Both groups used the Mammoverse platform with identical educational content and exposure time. Breast health knowledge was assessed at baseline (T1), immediately post-intervention (T2), and 4-week follow-up (T3) using the same questionnaire, the primary outcome was change in knowledge score. Using linear mixed-effects models, with age, education, family history of breast cancer, prior training, and baseline knowledge as covariates. Participants and investigators were not blinded. RESULTS: All randomized participants completed follow-up and were included in the analysis (GM group n=36; NGM group n=36), with no loss to follow-up. Knowledge scores improved in both groups, but gains from T1 to T2 were larger in GM than NGM (Hedges g=0.65, 95% CI 0.18-1.12, p=.007). From T2 to T3, there was no between-group difference in change scores (p=.91). However, at 4 weeks GM retained higher absolute knowledge than NGM (estimated marginal means 15.7 vs 13.0). No intervention-related adverse events were reported. CONCLUSIONS: This study marks the first application of gamification in BSE education for ordinary Chinese women within a 3D desktop metaverse. By comparing gamified and non-gamified versions under identical metaverse platform conditions, it expands the application boundaries of gamified metaverses in breast health education. Gamification significantly enhanced immediate acquisition of breast health knowledge but did not provide additional advantages for short-term retention. However, the gamified group maintained higher absolute knowledge levels at the 4-week follow-up. Overall, in the 3D desktop metaverse, immersive experiences provide foundational effects, while gamification delivers immediate gains. To further optimize long-term retention, memory consolidation strategies must be integrated into the gamified framework. CLINICALTRIAL: This trial was retrospectively registered at ClinicalTrials.gov (Identifier: NCT06930898, URL: https://clinicaltrials.gov/study/NCT06930898, registered on 8 April 2025).

Source: JMIR Serious Games

DOI: 10.2196/75318

Authors: Rui Li, Sabzali Musa Kahn, Bingyu Duan, Seng Yue Wong

Institution: University of Malaya

Language: English

Topic: Educational Games and Gamification

Subfield: Developmental and Educational Psychology

Field: Psychology

Domain: Social Sciences

SDGs: Good health and well-being, Quality education

Open Access status: gold

Estimated APC paid: $2,500