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.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands. Desiree.beaujean@rivm.nl.
authors.forename: D J M A
authors.initials: DJ
authors.lastname: Beaujean
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Gassner
authors.affiliation: Department of Statistics, Informatics and Mathematical Modeling, National Institute for Public Health and the Environment, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Wong
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Control, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.|Department of Infectious Diseases, Leiden University Medical Center, P.O. Box 9600, 2300, Leiden, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Steenbergen
authors.affiliation: Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200, Maastricht, MD, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Crutzen
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200, Maastricht, MD, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Ruwaard
mesh_terms: D000818:Animals; D002648:Child; D002675:Child, Preschool; D054626:Consumer Health Information / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008193:Lyme Disease / Q000517:prevention & control / Q000523:psychology*; D008297:Male; D009426:Netherlands; D010174:Pamphlets; D012189:Retrospective Studies; D012572:School Health Services; D011795:Surveys and Questionnaires; D064927:Tick Bites / Q000517:prevention & control / Q000523:psychology*; D018910:Video Games
keywords: Educational video game; Knowledge; Leaflet; Lyme borreliosis; Lyme disease; Perception; Prevention; Schoolchildren; Tick bites; Tick check; Ticks