Investigating the Influence of a Gamified Resource on Healthcare Students’ Attitudes, Confidence, and Knowledge Regarding Research Concepts: A Mixed-Method Study

Abstract

Many university students report anxiety and low confidence when undertaking research courses. In the field, healthcare professionals have further identified that new graduates lack basic research skills. The research aims were to (1) ascertain what research concepts were deemed challenging to inform the development of a gamified resource (named OGRE) and (2) to determine if the resource influenced students’ research attitudes, confidence, and knowledge. Adopting a mixed-method approach, four student group interviews were conducted and pre- and post-course surveys were embedded in two large research courses as measures. Additionally, the qualitative component of student evaluations from six courses served as secondary data. Descriptive statistical analysis and thematic analysis techniques were applied. Whilst students understood the relevance of research to practice, only a minority expressed enthusiasm for the topic. The game did not significantly impact on confidence to undertake research, nor could the increase in student knowledge be attributed to the game alone. Gamified resources can be helpful for visual learners and can assist students with ‘real-life’ applications to practice problems, but are not essential to achieve a course’s learning outcomes. Further multidisciplinary team scenarios could be incorporated in OGRE to enhance practice preparedness.

1. Introduction

Many students report feelings of anxiety in relation to research (Butt & Shams, 2013; Wishkoski et al., 2022). Whilst medical students generally report positive attitudes towards research (El Achi et al., 2020; Siamian et al., 2016; Sobczuk et al., 2022), their allied health counterparts appear more apprehensive. For example, a survey of 410 Australian and Swiss social work students found that both groups possessed a high level of fear of research, which directly predicted their level of interest in research courses and their openness to participate in research (Gredig et al., 2022). Similarly, Shah (2019) found that 73% of 150 physiotherapy students surveyed reported anxiety about research, perceiving the courses to be stressful.

University graduates have also been identified as lacking basic research skills or having negative attitudes towards research and evaluation (van der Linden et al., 2012). Yu and Kuo (2017) suggest that many students do not fully understand the purpose and relevance of undergraduate research courses in relation to their future work, possibly as the significance of research is not being sufficiently conveyed in tertiary courses (Wilmore & Willison, 2016), or by industry. This is concerning, as healthcare organizations may require their employees to contribute to evidence and/or demonstrate effectiveness via evaluations to justify why a service should continue. D’Arrietta et al. (2022) describe the need to build health professionals’ research skill capacity. One possible solution to improve knowledge and student confidence to conduct research is to use gamification as a teaching tool.

This paper describes the development and evaluation of a gamified resource to improve healthcare students’ attitudes towards research, confidence to engage in research, and research knowledge. The resource was developed in a collaborative partnership between academic staff and undergraduate students from five healthcare disciplines, however, an evaluation of this partnership is described elsewhere.

Gamification is defined as a process in which games or game-like elements are added to a task to encourage participation (Merriam-Webster, 2024). Gamification is not meant to replace traditional teaching, but rather assist students grappling with complex concepts, particularly if various levels of play difficulty are incorporated into the activity (Yunyongying, 2014). Combining fun and competition can allow learners to experience failure in a non-threatening way, minimise discouragement, yet sustain a learner’s interest in the content (Yunyongying, 2014). Furthermore, students can do their learning in their own time, and at their own pace.

Gamification is influencing a shift away from historical teaching structures, modifying the dynamic between educators and students (Chan & Lo, 2022). Saxena (2021) suggests that gamification provides targeted information on specific concepts in a student-centred way, increases course engagement, improves student satisfaction, and enhances concentration levels. In fact, studies have shown that millennial learners remain more engaged with class content if gamified activities are involved (Jain & Dutta, 2018). Furthermore, online games are available to all student cohorts, including those undertaking distance education (Shrivastava & Shrivastava, 2023). In university health schools, games also offer opportunities to work as part of an interprofessional team, facilitating collaborative knowledge and skills and development of desired competencies. This is particularly relevant when games simulate real-world problems, allowing students to apply knowledge and skills and formulate clinical decisions (Saxena, 2021).

Much of the research on gamification in university health schools has been undertaken in the disciplines of medicine and nursing (Sandoval-Hernández et al., 2023). Shrivastava and Shrivastava (2023) state young medical students are exposed to video games, mobile applications, blogs, wikis, social media, and multiple gamification apps and thus readily accept new gamification activities. Components of gamified resources that contribute to student engagement and learning include the provision of feedback, setting the scene with real-world scenarios and encouraging mastery through opportunities for repeated practice (Hope et al., 2023; Malicki et al., 2020). Game-based learning also provides opportunities for collaborative awareness and increases critical thinking and problem-solving skills, all of which are highly important attributes for future medical practitioners (Sannathimmappa et al., 2022; Xu et al., 2023).

However, despite these benefits, only six studies involving game-based learning in allied health courses were identified. These comprise five in physiotherapy education (Chong, 2019; Cortés-Pérez et al., 2023; Ferrer-Sargues et al., 2021; Molina-Torres et al., 2021; Sandoval-Hernández et al., 2023) and one in occupational therapy (Dugnol-Menéndez et al., 2021). While these studies reported benefits ranging from reduced student anxiety, increased assessment marks, and student satisfaction, none of these studies examined the use of a gamified resource to influence healthcare students’ research attitudes, confidence, and knowledge. While two studies have been conducted with nursing students on using gamified resources to teach research, the results were conflicting. Davidson and Candy (2016) evaluated nursing students’ perceptions of using 3D GameLab—a platform designed to improve students’ research knowledge—and found that the overall response of students to this game was positive. Conversely, Gallegos et al. (2017) reported overall negative outcomes when evaluating the same platform with a different group of nursing students.

Research evaluating the impact of gamified resources on healthcare students’ attitudes towards research, confidence to engage with research, and research knowledge is very limited. Given this paucity, the overall aim of this project was to develop and evaluate a gamified resource to demystify research concepts and improve healthcare students’ research attitudes, confidence, and knowledge. To address this aim, the following research questions were formulated:

• What were healthcare students’ perceptions of learning about research?
• Did access to a gamified resource on research methods change healthcare students’ attitudes towards research, confidence to engage with research, and research knowledge?

2. Materials and Methods

This study used a mixed-method design. In phase 1, group interviews (2021) and course feedback comments (2020, 2021) from students enrolled in health-related university research courses were used to inform game development. In phase 2, undergraduate students partnered with academic staff to develop a gamified resource. The partnering process and impacts on student partners are described elsewhere (Johns et al., 2025).

Students were provided access to an app titled the Online Griffith Research Expedition (OGRE) (Figure 1), created using Microsoft Power Apps (Learn Microsoft, 2024) using attributes that are part of Microsoft Office 365 for Enterprise. The game was a video with animated characters—created using Character Creator 3 and animated using iClone 7 software applications—that spoke to each other and to the player. Storyboards were created using Lucidchart (lucid.co) software (Figure 2).

The game’s objective was to make research less intimidating. Students worked through scenarios, answered questions (Figure 3), and received immediate feedback.

In phase 3, the resource was evaluated with undergraduate and postgraduate healthcare students enrolled in research courses. Triangulation was undertaken by combining three sets of data (quantitative pre- and post-game surveys, group interviews, and student course/teaching evaluations) to determine if results were similar or divergent (Heale & Forbes, 2013).

Ethics approval was obtained from the relevant human research ethics committee (ref: 2021/080). For group interviews, purposive sampling techniques were used. Health school course convenors promoted the study via email to undergraduate students in the disciplines of social work/human services/child youth and family, pharmacy/medicine, nursing/midwifery, and physiotherapy, and postgraduate students in the disciplines of social work, nursing/midwifery, infection prevention and control, human services, dentistry, health services management, rehabilitation counselling, and mental health practice. An information sheet was provided and participants signed a consent form.

Invitations to participate in surveys were distributed by the convenor of a postgraduate research course delivered over four teaching trimesters in 2021 and 2022 (trimester (T) 1 2021 (n = 205 enrolments), T2 2021 (n = 211), T1 2022 (n = 2022) and T2 2022 (n = 174), and an undergraduate research course (n = 208) in T2 2022. Completion of the anonymous surveys was considered consent. Data collection occurred between January 2021 and December 2022, and 2020 course evaluation data were also retrospectively collected.

Three pre-game group interviews were conducted to determine students’ experiences of learning about research to inform game development (Supplementary file S1). A post-intervention group interview captured students’ perception of the game’s usefulness. Interviews (~50 min in duration) were audio-recorded and conducted by research team members.

Using Microsoft Forms, three scales measured students’ attitudes, knowledge, and confidence in relation to research (Supplementary file S2). Two (knowledge and confidence) were developed by the team based on the course learning objectives. Each included nine items using a 5-point Likert scale that ranged from “very poor” (1) to “excellent” (5) (knowledge), and “very low” (1) to “very high” (5) (confidence). The attitudes scale was adapted from Papanastasious’s (Papanastasiou, 2014) revised 8-item Attitudes towards Research scale, with a 5-point Likert scale that ranged from “strongly disagree” (1) to “strongly agree” (5). Students could make written comments after each scale. Demographic data were collected on participants’ age, gender, and discipline. In 2022, students were also asked to comment specifically on whether the game influenced their attitudes towards, confidence to undertake, and knowledge of research. The online survey took approximately 15–20 min to complete.

Surveys were coded to allow identification of paired data for analysis and administered at the beginning and end of each trimester (pre and post). In 2021, this was in the absence of the game to provide a baseline. In 2022, the game was delivered after the pre-course survey and followed by the post-course survey at the end of the trimester.

Students’ qualitative comments on standard university-administered Student Experience of Course (SEC) and Student Experience of Teaching (SET) surveys from research courses delivered in six health schools provided further insights regarding students’ attitudes towards research, along with inhibitors of and facilitators to learning about research. Courses 1, 2, and 4 were delivered at multiple campuses per trimester, so there were multiple sets of SEC and SET data for those courses. Data were obtained from two research courses delivered in 2020 and courses delivered in 2021 (for phase 1) and in 2022 (for phase 3) at the end of trimester.

Following transcription, interview data were coded using Braun and Clarke’s (2006) six-phase method. The initial codes were deductively generated from responses to the interview questions. Subsequently, an iterative process was then undertaken to check for patterns and emerging themes within the quotes. For rigour, the four group interviews were analysed by three researchers (LJ, SW, LB) working collaboratively and by a fourth working independently (TM). Consensus was attained by discussion.

Descriptive statistics were used to analyse the quantitative survey data. Means were calculated for the attitudes, confidence, and knowledge scales. Items 3, 4, and 5 of the attitudes scale were reverse-scored as per the original scale validation (Papanastasiou, 2014). Scale reliability was determined using Cronbach’s alpha. Levene’s test was used to determine homogeneity of variances between pre and post samples (Pallant, 2020).

Given the small number of paired samples, independent t tests were first used to examine differences in pre- and post-survey means. Subsequently, paired sample t tests were used to examine differences in means between time 1 and time 2. Chi-squared tests were used to examine differences in proportions of gender and age between pre- and post-course participants. Separate analyses were conducted for the undergraduate and postgraduate courses by year (2021, 2022). Qualitative survey responses were analysed using content analysis techniques (Graneheim & Lundman, 2004), where specific content was quantified in terms of changes in students’ perceptions of research after using the game.

Qualitative data from the student evaluations were extracted by four team members (LB, LJ, JW, TM) to identify concepts students deemed both difficult and comprehensive and what facilitated or inhibited their learning about research. Subsequently, two team members (SG, SB), deductively coded the data against keywords to identify emerging patterns. One team member (LJ) then checked the analyses.

3. Results

3.1. Participants

Sixteen participants consented to the interviews. Twelve engaged in three pre-intervention group interviews, and four participated in the post-intervention interview (

Table 1. Group interview participant characteristics.

Discipline	No. of Participants	Total
Bachelor of Social Work	2—2021 pre-game 4—2022 pre-game 1—2022 post-game	7
Bachelor of Physiotherapy	2—2021 pre-game	2
Bachelor of Nursing	1—2021 pre-game 1—2022 post-game	2
Bachelor of Midwifery	2—2021 pre-game	2
Bachelor of Child, Youth and Families	1—2022 post-game	1
Master of Advanced Nursing Practice	1—2022 post-game	1
Master of Social Work	1—2022 pre-game	1
Total:		16 participants

). Within the three pre-intervention groups, the majority were social work students (n = 7) and undergraduates (n = 11). The number of interviewees per group ranged from three to five participants.

A total of 143 students completed a pre-course survey and 74 completed a post-course survey across both courses over the two-year period: 108 of these in 2021 and 108 in 2022. The majority were female (83.3%), with 41 enrolled in the undergraduate course and 175 in the postgraduate course. Sample demographics (

Table 2. Survey sample demographics.

Variable	Total	2021 Postgraduate n (%)	2022 Postgraduate n (%)	2022 Undergraduate n (%)
Time
Time 1 Time 2 Paired	142 74 30	72 37 10	45 22 8	26 15 12
Gender
Female Male Other	119 (83.8) 22 (15.5) 1 (0.7)	58 (80.6) 13 (18) 1 (1.4)	37 (82.2) 8 (17.8)	25 (96.2) 1 (3.8)
Age
18–24 25–29 30–34 35–39 40–44 45–49 50+	21 (14.8) 22 (15.5) 28 (19.7) 23 (16.2) 18 (12.7) 13 (9.2) 17 (12.0)	16 (22.2) 9 (12.5) 14 (19.4) 11 (15.3) 10 (13.9) 4 (11.1) 8 (5.6)	4 (8.9) 8 (17.8) 8 (17.8) 8 (17.8) 3 (6.67) 7 (15.6) 7 (15.6)	1 (3.8) 5 (19.2) 6 (23.1) 4 (15.4) 5 (19.2) 2 (7.7) 3 (11.5)

) are reported for pre-course samples only, as chi-squared analysis showed no significant difference in proportions between pre and post samples. Cronbach’s alpha for the attitudes, confidence, and knowledge scales was 0.823, 0.944, and 0.951, respectively.

In sum, 424 students completed SEC (n = 352) and SET (n = 72) surveys across five undergraduate and one postgraduate research course over a two-year period. Qualitative SEC and SET data were obtained from six courses prior to game delivery, and from two of the six courses post-delivery.

3.2. Question 1: What Were Healthcare Students’ Perceptions of Learning About Research?

The overarching theme—Research is challenging—had five subthemes: Research is difficult to understand; Research is difficult to apply; Research is a dry and boring subject; Discomfort with statistics; and Relevance of research to practice.

3.2.1. Research Is Difficult to Understand

All pre-game group interview students (n = 12) indicated that they had attained a basic understanding of the two main methodologies, quantitative and qualitative research, while most identified an individual preference for either one or the other. However, despite achieving introductory knowledge, some still struggled to attain full comprehension of the concepts. Elaborating on this, one student stated they “found [both] research designs, qualitative and quantitative, very difficult to understand” (Isla, Social Work [SW]). Isla found “the terminology is quite hard to digest” and added that understanding “probability and non-probability” in relation to a particular methodology was confusing. She provided an example, “I can’t, like use, probability sampling, because it has to be non-probability, because of my research design”. Edward (Master of Social Work [MSW]), noted that “rigorousness of research” was “a bit technical” for him, adding “validity and reliability” were particularly complicated to understand. He further mentioned having “difficulty with what is ethical research”, indicating a fear of doing something wrong or harmful.

3.2.2. Research Is Difficult to Apply

One interview student indicated how difficult it was to choose what methodology suits their topic, lamenting, “it’s like going round in circles” (Jasmin, Social Work [SW]), while another stated, “the nuances around the theories, and all the ways to apply different things got kind of confusing” (Christopher, SW). Maddy, a postgraduate nursing student, added, “If you identify a world problem, then how do you relate to a theory? It was a bit hard to link the two”. Alice (SW) indicated her challenge was “to search for associations between variables, but then this has to suit your topic, but you also have to kind of do the literature review before you can figure out if that’s the best way to address. I found that quite difficult to get my head around”. Three social work students (Jasmin, Alice, and Isla) mentioned choosing the right research design for the research question was difficult.

3.2.3. Discomfort with Statistics

Isla (SW) indicated, “Week 11 was really heavy because it was statistics. I’m so glad I’m doing social work and not psychology”. Similarly, two midwifery (MW) group interview students stated they could relate to qualitative studies more because “there wasn’t a great deal of statistics or data analysis involved” (Sally-Ann, MW).

3.2.4. Research Is a Dry and Boring Subject

In the course evaluation surveys, while there were multiple positive statements, many students from social work, midwifery, nursing, and physiotherapy, made negative references to learning about research. For example, the terms ‘dry’ and ‘boring’ were used nine times, and students requested more innovative teaching strategies, more effective use of technology by teachers, more lecturer contact, and additional mini-videos explaining concepts.

3.2.5. Relevance of Research to Practice

For the midwifery and nursing group interview students, the relevance of the research course content to their future practice was unclear. Sally-Anne (MW) stated, “there were certain aspects of the course that I could relate to, but it definitely wasn’t all super relevant; and it was hard too. I understand that the concepts weren’t 100% applicable to us; that’s my experience”. She then provided an example to illustrate her point: “you can’t do a trial when you’re going to have an effect on a pregnancy, it’s not ethical, so that’s why it was not applicable to us”. A second midwifery student agreed “control[led] trials not being relevant due to ethics” (Karly, MW). Jenna (Nursing) also added that whilst “it is important to be evidence-based”, she “didn’t feel the content was relevant to nursing”, adding “research nursing is a specialization” and that as an emergency department nurse or renal nurse, “it wasn’t as relevant”. Jenna concluded research in practice was more relevant for “lab assistants” or “a research nurse”. However, the remaining participants from social work and physiotherapy (n = 9) all identified the relevance of research to their future practice.

Similarly, seven comments (from 106 responses) in the nursing student course evaluation data questioned the relevance of research to practice, for example, “that the content is not relevant, unless you plan to be a research nurse”. Three physiotherapy students (from 34 responses) could not determine the relevance of research content to future practice either, with one student reporting, “There is no value in this course for those who do not care for or have a desire to conduct research at a future date”. Three students added that the course should be an elective for students who wish to pursue research in the future and should not be compulsory for students to complete.

3.3. Question 2: Does Access to a Gamified Resource on Research Methods Change Healthcare Students’ Attitudes Towards Research, Confidence to Engage with Research, and Research Knowledge?

Over 2021 and 2022 pre-course and post-course surveys were embedded into four deliveries of a large postgraduate course and one undergraduate course over one delivery. The students in 2021 did not have access to the game, while the 2022 students did.

3.3.1. Quantitative Survey Data

On the unpaired data from the 2021 sample who did not have access to the game, scores on the attitudes, confidence, and knowledge scales improved significantly at time 2 compared to time 1 (

Table 3. Mean scale scores by course, year, and time.

Scale	2021 PG Mean ± SD	Test Statistics 2-Sided	2022-PG Mean ± SD	Test Statistics 2-Sided	2022-UG Mean ± SD	Test Statistics 2-Sided
Attitudes All
T1	3.30 ± 0.58	t = −2.9113; df = 107	3.45 ± 0.65	t = −0.825; df = 65;	3.25 ± 0.72	t = −1.213; df = 39
T2	3.63 ± 0.51	p = 0.004	3.60 ± 0.75	p > 0.05	3.52 ± 0.67	p > 0.05
Paired only
T1	3.34 ± 0.56	t = −2.209; df = 9	3.89 ± 0.68	t = −0.540; df = 7	3.60 ± 0.59	t = −0.133; df = 11
T2	3.66 ± 0.48	p > 0.05	3.72 ± 0.82	p > 0.05	3.57 ± 0.73	p > 0.05
Confidence All
T1	2.61 ± 0.75	t = −6.124; df = 107	2.69 ± 0.78	t = −5.112; df = 65	3.04 ± 0.65	t = −1.470; df = 39
T2	3.49 ± 0.62	p < 0.001	3.64 ± 0.55	p < 0.001	3.36 ± 0.64	p > 0.05
Paired only
T1	2.81 ± 0.65	t = −2.113; df = 9	2.85 ± 1.01	t = −4.161; df = 7	3.13 ± 0.42	t = −1.547; df = 11
T2	3.41 ± 0.57	p > 0.05	3.68 ± 0.75	p = 0.004	3.36 ± 0.72	p > 0.05
Knowledge All
T1	2.55 ± 0.78	t = −7.571; df = 107	2.77 ± 0.80	t = −4.629; df = 65	3.16 ± 0.62	t = −2.148; df = 39
T2	3.69 ± 0.68	p < 0.001	3.65 ± 0.59	p < 0.001	3.62 ± 0.73	p = 0.038
Paired only
T1	2.76 ± 0.75	t = −2.772; df = 9	3.08 ± 0.88	t = −3.842; df = 7	3.32 ± 0.32	t = −1.834; df = 11
T2	3.65 ± 0.60	p = 0.022	3.76 ± 0.77	p = 0.006	3.65 ± 0.78	p > 0.05

PG = postgraduate; UG = undergraduate; T1 = time 1; T2 = time 2.

). On the paired sample, while mean scores were higher on all three scales at time 2, this was only statistically significant for knowledge (Table 3).

For the 2022 postgraduate sample that had access to the game, post-course scores increased on all three scales, but these increases were only statistically significant for the confidence and knowledge scales (Table 3). When paired data were examined, there were statistically significant increases in mean scores for confidence and knowledge, but not attitudes.

When examining the unpaired data from the 2022 undergraduate sample that had access to the game, the scores increased for all three scales, but were only statistically significant for knowledge (Table 3). None of the changes to mean scores for the paired data were statistically significant.

3.3.2. Qualitative Survey Data

In relation to research attitudes, an analysis of the open-ended questions in the paired survey data revealed several aspects. Only three of 12 undergraduate students (T2 2022) explicitly stated they found research “interesting” and “enjoyable” in their pre-game responses, expressing enthusiasm to learn more, despite feeling “nervous to begin with” (AE89ON). The same three students (AE89ON; AE92PE; ID88ON) continued to express positive views in their post-game surveys. One undergraduate participant expressed a negative attitude towards research in both their pre- and post-game responses, stating “it [research] is confusing” (pre) and “research is overwhelming and confusing” (post) (DA71SH), indicating no change. A second participant signalled similarly, with no substantial change noted, reporting, “I understand the necessity, but don’t enjoy it” (pre), then “I dislike it, but I understand the need for it” (ED28DY).

However, aside from these five examples of ‘no attitude change’, the remaining 15 undergraduate and postgraduate participants indicated some level of change. For example, one undergraduate student stated in their pre-game survey that “it [research] is not something exciting”. However, in their post-game response, they stated, “I love the idea of learning and partaking in research during my degree. I feel that with the guidance of distinguished staff … [research] could return a great deal of worthwhile data and conclusions for the betterment of humanity” (JI74CH T2 2022).

In their pre-game responses, 11 of the 12 undergraduate students believed research was relevant to their future practice, while one participant initially stated (pre), “I understand why I need to learn about research, but I don’t feel it will be of great use to me in my practice” but in their post-game response stated, “I feel it is important to know how research is conducted and why it’s conducted. Without research, evidence-based-practice would not be possible” (ME82H T2 2022). Two of the 12 participants realised learning about research would help them in other areas of practice, such as “writing a good work report” (JA81FG T2 2022) and “how to look beyond the surface of articles” (DA71SH T2 2022) (post-game data). All 20 undergraduate and postgraduate participants agreed post-game that learning about research at university was important.

In terms of research confidence, 11 of the 12 undergraduate students for which there were paired pre–post-game survey data, reported some change (albeit slight) in their confidence to undertake research in their post-game responses. Named areas of enhanced confidence included conducting a literature review or developing a research question or research proposal, albeit at a basic level. One undergraduate student overtly mentioned in their pre-game data having confidence to undertake “basic research on a given topic”, then stated post-game that their confidence had particularly increased regarding “literature reviews” (JA81FG T2 2022). Another reported similarly, “I am not overly confident but would be able to design a basic research project with some assistance” (pre), then named key areas in which their confidence had further increased post-game: “quant research, data collection, sample selection, designs” (ME82H T2 2022). However, one undergraduate student expressed no confidence to undertake “quantitative and qualitative as it stands” (pre), but still had no confidence “in all of it” (DA71SH T2 2022) (post).

In comparison, seven of eight postgraduate students indicated increased confidence to engage in methodologies most utilised by their profession (e.g., qualitative research for social work, quantitative research for medical students) in their post-game responses, however, almost all expressed less confidence in methodologies not commonly adopted by their profession. Regarding independent research, one postgraduate participant stated in their post-game response, “I would not feel confident doing it by myself at this stage, I feel like I would need more guidance” (KI85RN T1 2022), indicating a similar view to the undergraduate students, who would be willing to engage in research if working as “part of a multidisciplinary team” (JI74CH T2 2022) (post-game data).

Seven postgraduate students made qualitative comments about their experience of playing the game. When asked whether the game increased their confidence, one student answered “yes” (ME87CE T2 2022) to this question, whilst another answered “slightly” (KI85RN T1 2022).

Regarding research knowledge, both undergraduate and postgraduate students indicated an increase in research knowledge by the end of the course. Fourteen participants made comments about specific learnings, such as, “It [the course] has provided me with a basic understanding of research practices” (TE88PR T2 2022 undergraduate) (post-game). Another undergraduate participant stated, “It helped in learning about frameworks” (ED28DY T2 2022). A postgraduate student indicated, “It [research knowledge] will assist in implementing quality innovative ideas into a healthcare service” (JH64SH T2 2022).

One postgraduate student stated, “I feel more knowledgeable about population sampling”, further adding that the game helped with “understanding research concepts” (ME87CE T2 2022) A further three postgraduate students specifically indicated that the “real-life” scenario improved their knowledge, as it was relatable, for instance, “The real-life example was very good and see research benefits for” (RA74EY T1 2022). However, one participant mentioned the game only influenced their knowledge “slightly” (KI85RN T1 2022).

3.3.3. Group Interview Data

One theme emerged from the post-game interview, which was that playing the game influenced confidence slightly. Only four students undertaking group interviews had played the game from beginning to end. Regarding confidence, Suzanne (SW) stated, “I don’t know whether it increased my confidence to undertake research, but it definitely increased my confidence in the terminology, and like, how it’s linked to the real world”. However, she also said, “Before seeing how it’s applied to real life, I was like, no, I don’t want to do research; I want this course to be over. But playing the game made me go from ‘dead set not wanting to do it’, to ‘yeah, I could do that. The game did that for me” (Suzanne SW). Isla (SW) indicated, “my confidence to undertake research did not increase by 50% or 100%, but by maybe 20%”. Alice (SW) also reflected on the impact on her confidence, stating, “It kind of did and it didn’t. I did find it really interesting, because, like I said, I’m a visual learner, so using a game is extremely helpful”. Isla (SW) also indicated she learnt about grounded theory, which she had not known about before the game.

4. Discussion

The project’s aim was to ascertain students’ perceptions of learning about research to inform the development of a gamified resource (OGRE), then determine if the resource influenced students’ attitudes towards, confidence to engage in, and knowledge of research. In phase 1, students identified that studying research was ‘dry’ and ‘boring’, and few expressed any excitement for research content in their pre-course surveys. Students identified concepts such as reliability and validity, theoretical frameworks, working with statistics, and sampling methods as difficult to digest. They also indicated that they found it difficult to know how to apply some of the concepts. Thus, OGRE was designed to address these issues. Scenarios were used to illustrate the application concepts, and terminology was explained throughout the game. Having the information presented as a game was intended to make the content more engaging. By course completion, students did report a baseline level of confidence to participate in research in the future, on the proviso guidance was provided. Regarding relevance, our findings differed from those of previous studies, which indicated tertiary students did not connect research course content to their future practice very well (Wilmore & Willison, 2016; Yu & Kuo, 2017). Most participants in this study indicated that they believed research to be highly relevant to practice.

Furthermore, an analysis of the pre and post qualitative data did reveal some shifts in attitude for some students. As knowledge on research increased during the course delivery, more positive attitudes were noted in the post-course survey data. However, there was not any substantial evidence to reveal that this shift could be attributed to the game, but was more likely related to the course itself. These findings closely align with those of Wishkoski et al. (2022), who also found student attitudes to research became more positive as research knowledge increased.

A strength of our study was that we had a control group and objective measures that could be statistically analysed. For example, while Davidson and Candy (2016) reported that the use of a game to teach research to nursing students resulted in high levels of engagement, course satisfaction, and good grades, there was no control group, so it is not possible to separate the effects of the course, teacher, and student cohort from the effects of the game. Gallegos et al. (2017), using the same game platform with nursing students, reported negative attitudes of students towards the game, but the evaluation did not include objective measures on which performance of students could be contrasted with and without the game.

Where our study findings did not align with other empirical research was in relation to reported feelings of anxiety (Butt & Shams, 2013; Shah, 2019; Wishkoski et al., 2022). Only one student stated that they felt ‘nervous’ about studying research in their pre-course survey, and expressions relating to ‘fear’ or ‘anxiety’ were not identified in our data. In essence, our results revealed the course tended to be approached as ‘necessary’, ‘relevant’, but ‘uninteresting’.

Finally, and importantly, the addition of the game (OGRE) did not increase confidence or knowledge to any great degree beyond the course alone. Whilst the game assisted students to see how research methods can be applied to a real-life practice problem and did help demystify key concepts in a small way, there were minimal significant effects on student research attitudes, confidence, and knowledge overall. That said, it is also important to note that the implementation of a game can help visual learners engage more with research content and has the potential to increase understanding of how to work as an interprofessional team to address a practice gap.

This study was not without limitations. We acknowledge the potential for ‘groupthink’ bias when utilising focus groups as a data source. Additionally, the potential for social desirability response bias (van de Mortel, 2008) in both interviews and surveys should be noted. A further limitation is the small sample of post-intervention group interviews and for the paired survey data. Additionally, student evaluation data were also drawn upon as a secondary data source, meaning responses were collected for another purpose, rather than to answer this specific research question (Vartanian, 2011). This impacted on the amount of data deemed relevant for this project’s aim. Therefore, despite 424 responses being reviewed, the amount of data available for analysis was limited.

5. Conclusions

Whist our results did not reveal statistically significant changes in students’ attitudes, confidence, or knowledge, participants indicated that the real-life practice scenario was helpful. Unlike other studies that have reported on the use of game-based learning in improving healthcare students’ research knowledge and/or course satisfaction, the strength of our study was that it had control groups, which made the findings more robust. A direction for future research is to develop and add further multidisciplinary scenarios to the game and evaluate whether these improve the effectiveness of the game in healthcare student practice.