An effective innovative pedagogy for sexual health education is required to meet the demands of technology savvy digital natives. This study investigates the extent to which game-based learning (GBL) and gamification could improve the sexual health education of adolescent students. We conducted a randomized control trial of GBL and gamification experimental conditions. We made a comparison with traditional teaching as a control condition in order to establish differences between the three teaching conditions. The sexual health education topics were delivered in a masked fashion, 40-min a week for five weeks. A mixed-method research approach was uses to assess and analyze the results for 120 students from a secondary school in Dar Es Salaam, Tanzania. Students were divided into groups of 40 for each of the three teaching methods: GBL, gamification, and the control group (the traditional teaching method). The average post-test scores for GBL (Mean = 79.94, SD = 11.169) and gamification (Mean = 79.23, SD = 9.186) were significantly higher than the control group Mean = 51.93, SD = 18.705 (F (2, 117) = 54.75, p = 0.001). Overall, statistically significant differences (p ≤ 0.05) were found for the constructs of Motivation, Attitude, Knowledge, and Engagement (MAKE). This study suggests that the two innovative teaching approaches can be used to improve the sexual health education of adolescent students. The methods can potentially contribute socially, particularly in improving sexual health behaviour and adolescents’ knowledge in regions plagued by years of sexual health problems, including HIV/AIDS.

Purpose: Despite the enhanced popularity of flipped classroom research, there is a lack of empirical evidence reported about the different impacts revealed by the implementation of this concept. Therefore, to respond to this issue, this study aims to review and analyze the trends and contents of flipped classroom research based on 48 studies recently published in 2017 and 2018. The analysis was based on flipped classroom impacts from various fields. Design/methodology/approach: A systematic literature review and content analysis were used as a methodology to investigate positive impacts and challenges of flipped classroom implementation. Findings: The results of the analysis were interpreted using descriptive analysis. Analysis of the impact revealed that the flipped classroom yielded positive impacts on students’ learning activities such as academic performance, learning motivation and/or engagement, social interaction and self-directed learning skills. Meanwhile, the most significant challenges encountered by the instructors is a lack of students’ motivation to watch the pre-recorded video lectures or to study the contents outside of the class time. Practical implications: Several issues in this discussion become implications that can be taken into consideration for future research. The findings suggest that the flipped classroom concept might be effective in promoting the twenty-first century learning skills. Originality/value: While highlighting the limitations of an ineffective flipped classroom implementation, this study proposes further recommendations for future research.

Purpose: Digital technology has great potential for educating today’s digitally oriented adolescents on health. In particular, digital health gamified learning can make the promotion of the sexual well-being of adolescents more effective. Although venereal diseases such as HIV/AIDS have become a greater problem in Sub-Saharan African (SSA) countries than in any country outside of Africa, little is publicly known about the development of gamified learning for use in counter-measures. This paper aims to address that deficit by presenting the process of developing one such game. The paper highlights how the “My Future Begins Today” game for sexual health education was developed, evaluated and refined in the real-world of low-tech settings and made improvements based on the response of users. Design/methodology/approach: Design-based research (DBR) was used to guide the design, develop, test and refine the digital game in iterative cycles. The evaluation of the effectiveness of iterations of the game was done using adolescent sexual health literacy tests and the validated Motivation, Attitude, Knowledge and Engagement framework, the authors developed based on existing approaches. That framework combines the elements of motivation, attitude, knowledge and engagement, effectiveness was evaluated based on the game’s ability to motivate students, improve their attitudes, increase their acquisition of knowledge and engage them in learning self-rating surveys and interviews. The whole process of game design, testing, evaluation and refinement were underpinned by the activity theory, DBR and participatory design (PD) research. Findings: Participants in the gamified learning platforms demonstrated higher average scores on their post-tests than their counterparts subjected to the traditional teaching classroom. Also, gamified learning groups commented positively on the effectiveness of their instructional approach than their counterparts in the traditional learning group. The stakeholders’ involvement in developing gamified learning provided a good understanding of the importance of the game to the adolescent students and how it was going to be used to address the problem identified. The application of PD contributed to the effectiveness of the game. It involved various actors from various fields who were relevant to the game. Also, engaging targeted users from the beginning resulted in the creation of a better correspondence with the preferences of end-users. Practical implications: This study has contributed to a better understanding of sex education and knowledge in the area of adolescent reproductive health issues, using developed innovative game mechanics features and its applicability in low-tech settings. Originality/value: The study will be a recommendation for future researchers in applying this gamified learning concept and its suitability in their teaching practice, particularly regarding sexual health education and adolescent reproductive health issues in low-tech settings of SSA.

Background: Sexual education has become increasingly important as unhealthy sexual practices and subsequent health risks become more prevalent during adolescence. Traditional sex education teaching methodologies are limiting for digital natives exposed to various digital technologies. Harnessing the power of technology applications attractive to the younger generation may be a useful approach for teaching sex education. Objective: The aim of this study was to improve sexual health knowledge and understanding of the problems associated with unhealthy sexual practices and address sexual and reproductive health challenges experienced in a low-tech setting. Methods: A participatory design approach was used to develop the digital gamified methodology. A sample of 120 secondary school students aged 11-15 were randomly assigned to either experimental or control group for each of the 3 teaching approaches: (1) gamified instruction (actual serious games [SG] in teaching); (2) gamification (GM; making nongames, such as game-like learning); and (3) traditional teaching (TT) methods. Results: The SG and GM approaches were more effective than TT methods in teaching sexual health education. Specifically, the average scores across groups demonstrated an increase of mean scores from the pre- to posttest (25.10 [SD 5.50] versus 75.86 [SD 13.16]; t119=41.252; P<.001 [2 tailed]). Analysis of variance indicated no significant differences across groups for pretest scores (F2,117=1.048, P=.35). Significant differences across groups were evident in the posttest scores. Students in the SG and GM groups had higher average scores than the TT group (F2,117=83.98; P<.001). Students reported increased learning motivation, attitude, know-how, and participation in learning (P<.001) when using SG and GM approaches. Conclusions: Digital health technologies (particularly teaching and learning through gamified instruction and other novel approaches) may improve sexual health education. These findings may also be applied by practitioners in health care settings and by researchers wishing to further the development of sex education.

Purpose: This study aims to assess students’ learning performance and perceived need satisfaction between a gamified flipped classroom (GFC) and flipped classroom (FC) instruction in a low-tech setting. The iSpring Learn learning management system was used as a low-tech gamification application in gamifying the flipped learning class.Design/methodology/approach: A quantitative research approach was used for collecting the data. Three formative assessments were used to examine students’ learning performance during the intervention period, and a post-questionnaire survey was used to support the data collection process with regard to students’ perceived needs satisfaction. In total, 56 students were involved in a non-randomised experiment with a control group design.Findings: The results reveal that Assessment 1 showed no significant difference between the two intervention groups (p> 0.05), while Assessments 2 and 3 were significantly different (p< 0.05). The survey results confirm that participants in the GFC have achieved a great level of motivation because their innate psychological needs for competence, autonomy and relatedness are satisfied.Practical implications: The use of game-like features can be a powerful means to produce more engaging and fun activities in the FC context. The study has confirmed that integrating the gamification concept into FC instruction by adding challenges, incentives, points and rewards to quiz questions promoted a more engaging and enjoyable experience for learners.Originality/value: Gamification as a current concept of a twenty-first-century instructional skill has proven to be remarkably influential. This study suggests that the FC and gamification concept might be possibly implemented in a low-tech information environment – without the required advanced technology platform.