Learning occupational safety through gamification: A randomized controlled field trial
Keywords:
randomized field trial, occupational health and safety, high school, studentsAbstract
Background. Traditional health and safety training often fail to engage workers effectively. Gamification has emerged as a promising strategy to enhance motivation and learning outcomes. This study aimed to assess the effectiveness of a gamified training course in improving occupational health and safety knowledge.
Methods. A randomized controlled field trial was conducted with 77 participants. Participants were divided into two groups: an experimental group (EG) and a control group (CG). The intervention, titled “Let's play to 626!” consists of a one-day course comprising a seminar and gaming session. The participants were assessed using an internally validated Q626 questionnaire at baseline (T0) and after the intervention (T1), with a knowledge score was computed ranged from to 0-15. Descriptive statistics, paired sample tests, and regression analyses were used to analyse the data.
Results: The internal reliability of the Q626 tool was moderate, with Cronbach's α of 0.723. The results indicated a significant improvement in Q626 scores for both the experimental group (EG) and the control group (CG) at T1 compared to T0 (p<0.001; meanEGT1=10.8, SD=1.9; meanCGT1=10.0, SD=2.7).
Discussion: The gamification session showed a positive effect on knowledge enhancement. Indeed, gamified training in occupational health and safety not only enhances learning retention and engagement but also represents a cost-effective solution to reduce the probability of workplace incidents. Future studies should explore the long-term impact of gamified learning on occupational health and safety training.
References
1. Lugli C, Murani F, Bellini C, Favazzi UM, Mazzaccara A, Vinceti M, Filippini T. Knowledge and perception of modern learning approaches in Continuing Medical Education: a cross-sectional study. Ann Ig. 2025 Jul-Aug;37(4):488-99. doi: 10.7416/ai.2025.2693.
2. Singer DG, Golinkoff RM, Hirsh-Pasek K, eds. Play=learning: how play motivates and enhances children's cognitive and social-emotional growth. Oxford: Oxford University Press; 2010.
3. Kolb AY, Kolb DA. Learning to play, playing to learn: a case study of a ludic learning space. J Organ Change Manag. 2010;23(1):26-50. doi:10.1108/09534811011017199
4. Diaz-Varela A, Wright LHV. Play for adults: play-based approaches in teacher training. Scott Educ Rev. 2019;51(2):132-6.
5. Barnett LA. The nature of playfulness in young adults. Pers Individ Dif. 2007;43(4):949-58. doi:10.1016/j.paid.2007.02.018
6. Proyer RT. The well-being of playful adults: adult playfulness, subjective well-being, physical well-being, and the pursuit of enjoyable activities. Eur J Humour Res. 2013;1(1):84-98. doi:10.5167/UZH-78008
7. Deterding S, Khaled R, Nacke L. Gamification: toward a definition. CHI 2011 Gamification Workshop Proceedings; 2011. [incomplete - see error log]
8. Darragh AR, Lavender S, Polivka B, Sommerich CM, Wills CE, Hittle BA, et al. Gaming simulation as health and safety training for home healthcare workers. Clin Simul Nurs. 2016;12(8):328-35. doi:10.1016/j.ecns.2016.03.006
9. Lanzotti A, Vanacore A, Tarallo A, Nathan-Roberts D, Coccorese D, Minopoli V, et al. Interactive tools for safety 4.0: virtual ergonomics and serious games in real working contexts. Ergonomics. 2020;63(3):324-33. doi:10.1080/00140139.2019.1683603
10. McCullagh MC, Valentin-Cortes MA, D'Souza C, Batterman SA, Neitzel R, Zhen H, et al. Integrating interprofessional collaborative practice into occupational and environmental health and safety education: results of a feasibility study. J Occup Environ Med. 2022;64(8):653-8. doi:10.1097/JOM.0000000000002549
11. Benoit M, Austin E, Simcox N, Rabinowitz P, Yost M. Predictors of dairy worker pre-test and post-test performance on a dairy safety knowledge test: impact of education level and native language. J Agromedicine. 2023;28(3):456-69. doi:10.1080/1059924X.2022.2140732
12. Italian Legislative Decree. Testo unico sicurezza. 2008. [incomplete - see error log]
13. Hernandez WAD, Gomez LG. Virtual learning environment and its relationship with worker characteristics and occupational accident rates. Front Public Health. 2022;10. doi:10.3389/fpubh.2022.1006918
14. Borrelli I, Rossi MF, Santoro PE, Gualano MR, Tannorella BC, Perrotta A, Moscato U. Occupational exposure to work-related stress, a proposal of a pilot study to detect psychological distress in collar-workers. Ann Ig. 2023 Sep-Oct;35(5):521-33. doi: 10.7416/ai.2023.2566.
15. Dartigues JF, Foubert-Samier A, Le Goff M, Viltard M, Amieva H, Orgogozo JM, et al. Playing board games, cognitive decline and dementia: a French population-based cohort study. BMJ Open. 2013;3(8):e002998. doi:10.1136/bmjopen-2013-002998
16. La Torre G, Sinopoli A, Sestili C, D'Egidio V, Di Bella O, Cocchiara RA, et al. "GiochiAMO": a school-based smoking and alcohol prevention program for children - a pilot randomized field trial. Part 2. Ann Ig. 2018;30(4):273-84. doi:10.7416/ai.2018.2219
17. Bettini A, Amore E, Vagnoli L, Maffei F, Martin R. Acceptability and feasibility of a therapeutic board game for children and adolescents with cancer: the Italian version of Shop Talk. Support Care Cancer. 2019;27(12):4479-85. doi:10.1007/s00520-019-04755-8
18. Tesi B, Donia P, Covelli A, Aloise I, Renzi E, Massimi A, et al. "Health is a serious game": gamification as a tool for primary prevention in public health. Eur J Public Health. 2023;33(Suppl 2):ckad160.032. doi:10.1093/eurpub/ckad160.032
19. Altman DG. Better reporting of randomised controlled trials: the CONSORT statement. BMJ. 1996;313(7057):570-1.
20. La Torre G, Capece G, Shaholli D, Nicoli F, Mannocci A. How can you learn general issues on occupational safety and health? A randomized controlled field trial research protocol for innovative training with gamification: let's play 626! J Public Health. 2025. doi:10.1007/s10389-024-02397-7
21. La Torre G, D'Egidio V, Sestili C, Cocchiara RA, Cianfanelli S, Di Bella O, et al. ImmunizziAMO: a school-based field trial to teach new generations the importance of vaccination through games and to fight vaccine hesitancy in Italy. Vaccines (Basel). 2020;8(2):280. doi:10.3390/vaccines8020280
22. Cocchiara RA, Sestili C, Di Bella O, Backhaus I, Sinopoli A, D'Egidio V, et al. "GiochiAMO," a gaming intervention to prevent smoking and alcohol habits among children: a single-arm field trial. Games Health J. 2020;9(2):113-20. doi:10.1089/g4h.2019.0125
23. D'Egidio V, Lia L, Sinopoli A, Backhaus I, Mannocci A, Saulle R, et al. Results of the Italian project 'GiochiAMO' to improve nutrition and PA among children. J Public Health (Oxf). 2021;43(2):405-12. doi:10.1093/pubmed/fdz129
24. Livingstone C. Role play in language learning. Harlow: Longman; 1985.
25. Beard RL, Salas E, Prince C. Enhancing transfer of training: using role-play to foster teamwork in the cockpit. Int J Aviat Psychol. 1995;5(2):131-43. doi:10.1207/s15327108ijap0502_1
26. Aspegren K. BEME guide no. 2: teaching and learning communication skills in medicine - a review with quality grading of articles. Med Teach. 1999;21(6):563-70. doi:10.1080/01421599978979
27. Bobbitt LM, Inks SA, Kemp KJ, Mayo DT. Integrating marketing courses to enhance team-based experiential learning. J Mark Educ. 2000;22(1):15-24. doi:10.1177/0273475300221003
28. Burgoyne AP, Sala G, Gobet F, Macnamara BN, Campitelli G, Hambrick DZ. The relationship between cognitive ability and chess skill: a comprehensive meta-analysis. Intelligence. 2016;59:72-83. doi:10.1016/j.intell.2016.08.002
29. Whitton N. Playful learning: tools, techniques, and tactics. Res Learn Technol. 2018;26. doi:10.25304/rlt.v26.2035
30. Pallavicini F, Ferrari A, Mantovani F. Video games for well-being: a systematic review on the application of computer games for cognitive and emotional training in the adult population. Front Psychol. 2018;9:2127. doi:10.3389/fpsyg.2018.02127
31. Noda S, Shirotsuki K, Nakao M. The effectiveness of intervention with board games: a systematic review. BioPsychoSoc Med. 2019;13(1):22. doi:10.1186/s13030-019-0164-1
32. Smiderle R, Rigo SJ, Marques LB, Pecanha De Miranda Coelho JA, Jaques PA. The impact of gamification on students' learning, engagement and behavior based on their personality traits. Smart Learn Environ. 2020;7(1):3. doi:10.1186/s40561-019-0098-x
33. Vita-Barrull N, Estrada-Plana V, March-Llanes J, Sotoca-Orgaz P, Guzman N, Ayesa R, et al. Do you play in class? Board games to promote cognitive and educational development in primary school: a cluster randomized controlled trial. Learn Instr. 2024;93:101946. doi:10.1016/j.learninstruc.2024.101946
34. Karpicke JD, Blunt JR. Retrieval practice produces more learning than elaborative studying with concept mapping. Science. 2011;331(6018):772-5. doi:10.1126/science.1199327
35. Baniqued PL, Lee H, Voss MW, Basak C, Cosman JD, Desouza S, et al. Selling points: what cognitive abilities are tapped by casual video games? Acta Psychol (Amst). 2013;142(1):74-86. doi:10.1016/j.actpsy.2012.11.009
36. Nunnally JC. Psychometric theory. New York: McGraw-Hill; 1967.
37. Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 4th ed. Oxford: Oxford University Press; 2008.
38. Bujang MA, Baharum N. Guidelines of the minimum sample size requirements for Kappa agreement test. Epidemiol Biostat Public Health. 2022;14(2). doi:10.2427/12267
39. Tan S. Misuses of KR-20 and Cronbach's alpha reliability coefficients. Egitim Bilim. 2009;34:101-12.
40. The World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. 2008. [incomplete - see error log]
41. Cellek S, Ozdemir M, Erarslan K. A serious game for occupational health and safety training in a construction site. 2023:1-15. [incomplete - see error log]
42. Gurer S, Surer E, Erkayaoglu M. MINING-VIRTUAL: a comprehensive virtual reality-based serious game for occupational health and safety training in underground mines. Saf Sci. 2023;166:106226. doi:10.1016/j.ssci.2023.106226
43. Tsukada K, Yasui Y, Miyata S, Fuyumuro J, Kikuchi T, Mizuno T, et al. Effectiveness of virtual reality training in teaching personal protective equipment skills: a randomized clinical trial. JAMA Netw Open. 2024;7(2):e2355358. doi:10.1001/jamanetworkopen.2023.55358
44. Landers RN. Developing a theory of gamified learning: linking serious games and gamification of learning. Simul Gaming. 2014;45(6):752-68. doi:10.1177/1046878114563660
45. Koivisto J, Hamari J. The rise of motivational information systems: a review of gamification research. Int J Inf Manag. 2019;45:191-210. doi:10.1016/j.ijinfomgt.2018.10.013
46. Singh P, Niranjan I. Using groupwork in the designing and playing of board games in occupational health and safety. Groupwork. 2012;22(3):65-82. doi:10.1921/gpwk.v22i3.753
47. Wu JH, Su PH, Wu HY, Hsin YM, Lin CH, Lee CY. Educational board game for training dental and dental hygiene students in patient safety issues. BMC Med Educ. 2025 Apr 11;25(1):518. doi: 10.1186/s12909-025-07115-9. Erratum in: BMC Med Educ. 2025 May 14;25(1):708. doi: 10.1186/s12909-025-07284-7.
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Copyright (c) 2026 Giuseppe La Torre, Guendalina Capece, David Shaholli, Francesca Nicolì, Alice Mannocci (Author)
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