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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Education on tick bite and Lyme borreliosis prevention, aimed at schoolchildren in the Netherlands: comparing the effects of an online educational video game versus a leaflet or no intervention

Authors: D. J. M. A. Beaujean, F. Gassner, A Wong, J. E. Steenbergen, R. Crutzen, D. Ruwaard

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Lyme disease or Lyme borreliosis (LB) is the most common tick-borne disease both in the United States and Europe. Children, in particular, are at high risk of contracting LB. Since child-specific educational tools on ticks, tick bites and LB are lacking, we developed an online educational video game. In this study, we compared the effectiveness of an online educational video game versus a newly developed leaflet aimed to improve prevention of tick bites and LB among Dutch schoolchildren.

Methods

A total of 887 children, aged 9–13 years and attending the two final years of primary schooling, were recruited from 25 primary schools in June and July 2012. They were assigned through cluster randomization to one of three intervention groups: ‘game’ (22.4%), ‘leaflet’ (35.6%) or ‘control’ (41.9%). Prior to and directly following intervention, the children were asked to complete a short questionnaire. The main outcome measures were knowledge, perception (perceived susceptibility and importance) and preventive behavior in relation to tick bites and LB. Generalized linear mixed models were used to analyze the data.

Results

In the game group, the leaflet group and the control group, knowledge about ticks and tick bites improved significantly. The game was also an effective tool for improving preventive behavior; the frequency of checking for ticks increased significantly. However, there were no significant differences in knowledge improvement between the interventions. The game outperformed the leaflet in terms of improving preventive behavior, whereas the frequency of tick checks increased significantly. But this frequency didn’t increase more than in the control group.

Conclusions

The positive knowledge effects observed in the control group suggests the presence of a mere measurement effect related to completion of the questionnaire. The game did not outperform the leaflet or control group on all outcome measures. Therefore, the game may be of value as a complementary role, in addition to other media, in child-specific public health education programs on ticks and LB.
This trial was retrospectively registered on October 21, 2016 (trial registration number: ISRCTN15142369).
Appendix
Available only for authorised users
Footnotes
1
This is not a ‘traditional’ DID design in the sense that individual children could not be identified. Rather, schools were identifiable, so the DID design was applicable on a grouped level (i.e., schools).
 
2
This was done for simplification purposes. The statistical software R was used in this study. We were not aware of any (non-Bayesian) package supporting the modelling of a response with three or more classes, whilst taking into account multiple random effects.
 
3
The reason why this bar was set so high was that children scored that high at the knowledge level in the study at t1 [Beaujean 2013].
 
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Metadata
Title
Education on tick bite and Lyme borreliosis prevention, aimed at schoolchildren in the Netherlands: comparing the effects of an online educational video game versus a leaflet or no intervention
Authors
D. J. M. A. Beaujean
F. Gassner
A Wong
J. E. Steenbergen
R. Crutzen
D. Ruwaard
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3811-5

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