A nurse-facilitated gamified health literacy intervention for substance use prevention among borderland ethnic school children in Northern Thailand: a preliminary quasi-experimental study
Year: 2026
Type: article
Study design: Clinical Trial
Abstract: Background Primary school children residing in borderland regions face heightened vulnerabilities to early substance exposure due to socio-economic disparities and linguistic barriers. Gamified health literacy interventions offer a promising approach to engage young learners, yet empirical evidence regarding nurse-facilitated digital interventions in borderland ethnic contexts remains limited. This study evaluated the short-term effectiveness of a novel nurse-facilitated computer-based gamified health literacy intervention targeting substance use prevention among ethnic primary school students in borderland Northern Thailand. Methods A two-arm quasi-experimental study with a non-randomized control group design was conducted across two primary schools in Chiang Khong District, Chiang Rai Province, Thailand. Primary school students ( $$\:N=54$$ ; Grades 4–6) were allocated to either a 6-week nurse-facilitated computer-based gamified intervention group ( $$\:n=27$$ ) or a standard school health curriculum control group ( $$\:n=27$$ ). Outcomes were evaluated at baseline ( $$\:{T}_{0}$$ ) and 1-month post-intervention ( $$\:{T}_{1}$$ ). The primary outcome was Total Health Literacy score. Secondary outcomes included six health literacy subdomains and self-reported substance exposure risk scores assessed via an adapted ASSIST-Y scale. Between-group post-intervention comparisons for health literacy outcomes were analyzed using Analysis of Covariance (ANCOVA), adjusting for baseline scores ( $$\:{T}_{0}$$ ) and baseline age differences as continuous covariates. Substance exposure risk scores were analyzed using Independent Samples $$\:t$$ -tests and verified via non-parametric Mann-Whitney $$\:U$$ tests. The study adhered to the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) reporting guidelines. Results All 54 enrolled participants completed the study with zero dropouts (100% retention). At 1-month post-intervention ( $$\:{T}_{1}$$ ), after controlling for baseline scores and age, ANCOVA demonstrated a statistically significant higher Total Health Literacy score in the intervention group compared to the control group ( $$\:192.26\pm\:44.16$$ vs. $$\:166.67\pm\:28.38$$ ; adjusted mean difference $$\:=22.89$$ , $$\:95\%\text{\:CI\:}\left[\text{1.83,43.94}\right]$$ , $$\:F\left(\text{1,50}\right)=4.765$$ , $$\:p=.034$$ , Partial Eta Squared $$\:=.087$$ ). Among health literacy subdomains, the intervention group exhibited significant improvement in Understanding of Health Information ( $$\:F\left(\text{1,50}\right)=4.518$$ , $$\:p=.038$$ , Partial Eta Squared $$\:=.083$$ , $$\:95\%\text{\:CI\:}\left[\text{0.27,9.37}\right]$$ ). For secondary substance risk outcomes, all participants scored within the low-risk threshold (0–3 score range) at baseline and follow-up. At $$\:{T}_{1}$$ , the intervention group reported a statistically significant lower alcohol risk score compared to the control group ( $$\:1.00\pm\:1.44$$ vs. $$\:3.00\pm\:2.65$$ ; mean difference $$\:=-2.000$$ , $$\:t=-3.449$$ , $$\:p=.001$$ ; Mann-Whitney $$\:U=202.50$$ , $$\:p=.002$$ ). No significant between-group differences were detected for illicit drugs or volatile substances ( $$\:p>.05$$ ). Conclusion Participation in a 6-week nurse-facilitated computer-based gamified intervention was associated with short-term improvements in total health literacy, enhanced health understanding, and lower self-reported alcohol risk scores among ethnic primary school students in a borderland setting. Given the non-randomized design, baseline age imbalance, and brief 1-month follow-up window, these findings should be considered preliminary evidence. Future multi-center randomized controlled trials incorporating longer follow-up timepoints are warranted to establish sustained outcome retention and broader adaptability. Clinical trial registration Not applicable. This study was an educational, schoolbased health literacy evaluation conducted within regular academic hours among a nonclinical student population and did not involve clinical patients, pharmacological agents, or healthcare interventions. Because this nonrandomized quasiexperimental study evaluated educational curriculum outcomes rather than clinical healthcare processes, it was conducted and reported in strict compliance with the TREND (Transparent Reporting of Evaluations with Nonrandom
Source: BMC Nursing
Institutions: Mae Fah Luang University, Chiang Mai University, Chiangrai College
Language: English
Subfield: Developmental and Educational Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7223235417