Effectiveness of game-based learning in mental health nursing education on self-directed learning and academic self-efficacy among nursing students.

Authors

Alireza Rafi, Maryam Heidari, Seyed Mohammad Salehi Behbahani, Hassan Bostan, Ali Tamimi, Mehrnaz Ahmadi, Samaneh Naeimi

Published in

BMC medical education. Jul 14, 2026. Epub Jul 14, 2026.

Abstract

Traditional lecture-based teaching in nursing education often leads to limited student engagement, poor knowledge retention, and low self-confidence, particularly in complex fields such as mental health nursing, where students must navigate abstract clinical presentations and develop interpersonal skills that cannot be reduced to algorithmic protocols. Game-based learning (GBL) has emerged as an interactive strategy to enhance motivation, critical thinking, self-directed learning (SDL), and academic self-efficacy. This study aimed to evaluate the effectiveness of GBL integrated into a mental health nursing internship on SDL and academic self-efficacy among undergraduate nursing students.
A quasi-experimental, two-group, pretest-posttest design with a one-month follow-up was employed. Forty-six sixth-semester nursing students from Abadan University of Medical Sciences (Iran) were enrolled and allocated to an intervention group (n = 23) or a control group (n = 23) based on the pre-existing scheduling of their clinical internship rotations. After accounting for attrition, the final analytical sample comprised 40 participants (intervention: n = 20; control: n = 20). The intervention group received GBL integrated with standard instruction, while the control group received conventional internship training only. The intervention involved a custom-designed board game with scenario-based challenges delivered over 10 sessions (40 h total). Outcomes were measured using the Self-Directed Learning Readiness Scale (SDLRS) and the College Academic Self-Efficacy Scale (CASES) at pretest, posttest, and one-month follow-up. Data were analyzed using repeated measures ANOVA with Bonferroni-corrected pairwise comparisons for within-group changes, independent t-tests for between-group comparisons, and Cohen's d for effect sizes. A sensitivity analysis for attrition bias was conducted using a pattern-mixture model under best-case, worst-case, and intermediate imputation scenarios.
Groups were homogeneous at baseline (P > 0.05 for all demographic and outcome variables). In the intervention group, repeated measures ANOVA revealed significant main effects of time for both SDL (F(2,38) = 38.74, P < 0.001, partial η²=0.67) and academic self-efficacy (F(2,38) = 42.51, P < 0.001, partial η²=0.69). Post-intervention, the GBL group showed significant improvements in SDL (mean difference: 16.25 ± 8.03, P < 0.001) and academic self-efficacy (mean difference: 12.50 ± 7.14, P < 0.001), with large effect sizes (Cohen's d = 1.25 and 1.56, respectively). These gains were maintained at the one-month follow-up, with no significant decline from posttest to follow-up (SDL: P = 0.784; self-efficacy: P = 0.821). The control group exhibited no significant changes across any time points (P > 0.05). Between-group differences were significant at posttest (SDL: P = 0.037, d = 0.68; self-efficacy: P = 0.029, d = 0.72) and at follow-up (SDL: P = 0.043, d = 0.66; self-efficacy: P = 0.034, d = 0.70). Sensitivity analyses confirmed that the findings were robust to plausible patterns of missing data due to attrition, with the treatment effect remaining significant even under worst-case imputation scenarios.
GBL integrated into a mental health nursing internship significantly enhanced SDL and academic self-efficacy, with effects sustained at one-month follow-up. These findings support the integration of game-based strategies into nursing curricula as a student-centered approach to bridge theory-practice gaps and foster durable self-regulatory capacities. Further research with larger samples, multi-site designs, and extended follow-up periods of six to twelve months is recommended to confirm the generalizability and long-term durability of these effects.

PMID:
42449387
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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