Acceptance of Gamified Web-Based Education in Mental Illness Courses: A Survey of Medical Students’ Perceptions Over 5 Years

Document Type : Original Article


1 Department of Medical Education, Jahrom University of Medical Sciences, Jahrom, Iran

2 Department of English Language, Jahrom University of Medical Sciences, Jahrom, Iran

3 Department of E-Learning in Medical Sciences, Virtual School, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Gamified learning can make students more focused and can lead to learning at a deeper level. The aim of this study was to investigate the students’ perceptions of gamified web-based learning. In this study, we aimed to find out the students’ viewpoints about the dimensions of gamification acceptance and their correlation to each other.
Methods: This survey study was conducted in 2022 on 350 students of Public Health, Medicine, and Laboratory Science who had taken three courses in mental health, health psychology, and mental health and addiction, and were taught through gamified learning between late 2017 and 2021. The Game Acceptance Questionnaire was used in this study. The questionnaire consisted of 21 questions divided into seven components: Perceived ease of use, Perceived usefulness, Perceived enjoyment, Perceived control, Concentration, Attitude towards using, and Behavioral intention. Each component had three questions. The Likert scale was used in this questionnaire, with a range of 5 to 1, where 5 means strongly agree and 1 means strongly disagree. The cut-off point was 3. Content validity and face validity were examined by experts and students. The reliability of the instrument, as measured by Cronbach’s alpha, was 0.872. Data were analyzed using IBM SPSS Statistics V22.0. 
Results: The highest mean scores were related to attention to play (4.15±0.64), concentration during play (4.03±0.59), attitude towards playing as a good idea (4.025±0.65), ease of learning (3.99±0.70), and interesting gamification (3.96±0.74). Students’ perspectives did not differ significantly by the field of study. Differences in the acceptance of gamification components were significant by gender only in the field of enjoyment (P=0.02).
Conclusions: The use of gamification is an emerging technology in many countries, including developing countries, and useful and practical information about it can facilitate its expansion and proper use.


  1. Horton W. Designing courseware for mobile devices, Mobile learning for expending educational opportunities. In: Tokyo, Japan: Workshop Report. 2005. p. 16–20.
  2. Barzegar R, Dehghan Zadeh H, Moghadam Zadeh A. From electronic learning to mobile learning: theoretical principles. Interdiscip J Virtual Learn Med Sci. 2020;3(2):35–41.
  3. Zare M, Sarikhani R. Obstacles to Implementation of Mobile Learning in Universities of Medical Sciences. Iran J Med Educ. 2015;15:571–8.
  4. Yordanova K. Mobile learning and integration of advanced technologies in education. In: Proceedings of the 2007 international conference on Computer systems and technologies. 2007. p. 1–6.
  5. Kooloos JGM, Bergman EM, Scheffers MAGP, Schepens‐Franke AN, Vorstenbosch MATM. The effect of passive and active education methods applied in repetition activities on the retention of anatomical knowledge. Anat Sci Educ. 2020;13(4):458–66.
  6. Bruder P. Game on: Gamification in the classroom. Educ Dig. 2015;80(7):56.
  7. López-Belmonte J, Parra-González M, Segura-Robles A, Pozo-Sánchez S. Scientific mapping of gamification in web of science. Eur J Investig Heal Psychol Educ. 2020;10(3):832–47.
  8. van Gaalen AEJ, Brouwer J, Schönrock-Adema J, Bouwkamp-Timmer T, Jaarsma ADC, Georgiadis JR. Gamification of health professions education: a systematic review. Adv Heal Sci Educ. 2021;26(2):683–711.
  9. Susi, T., Johannesson, M., & Backlund, P. Serious games—An overview. Technical Report HS- IKI -TR-07-001, School of Humanities and Informatics, University of Skövde, Sweden, 2007;73(10). p 28.
  10. Pozo Sánchez S, López Belmonte J, Fuentes Cabrera A, López Núñez JA. Gamification as a methodological complement to flipped learning—an incident factor in learning improvement. Multimodal Technol Interact. 2020;4(2):12.
  11. González MEP, Robles AS, Guerrero AJM, López-Belmonte J. Elaboration and validation of the scale to measure the experience on gamification in education (EGAMEDU). JOTSE. 2022;12(1):217–29.
  12. Ripp J, Peccoralo L, Charney D. Attending to the emotional well-being of the health care workforce in a New York City health system during the COVID-19 pandemic. Acad Med. 2020;
  13. Moreira MA, González CSG. De la enseñanza con libros de texto al aprendizaje en espacios online gamificados. Educ Siglo XXI. 2015;33(3 Noviembr):15–38.
  14. Chou Y. Actionable Gamification: Beyond Points, Badges, and Leaderboards. Scotts Valley, CA: Create space Independent Publishing Platform, Kindle Edition, 2015
  15. Teixes F. Yu-Kai Chou (2016). Actionable Gamification: beyond points, badges and leaderboards. Octalysis Media: Fremont. CA. RIO Rev Int Organ. 2017;(18):137–44.
  16. Vermeir JF, White MJ, Johnson D, Crombez G, Van Ryckeghem DML. The effects of gamification on computerized cognitive training: systematic review and meta-analysis. JMIR serious games. 2020;8(3):e18644.
  17. Kim J, Castelli DM. Effects of gamification on behavioral change in education: A meta-analysis. Int J Environ Res Public Health. 2021;18(7):3550.
  18. Liu T, Lipowski M. Sports gamification: Evaluation of its impact on learning motivation and performance in higher education. Int J Environ Res Public Health. 2021;18(3):1267.
  19. Yuen AHK, Ma WWK. Gender differences in teacher computer acceptance. J Technol Teach Educ. 2002;10(3):365–82.
  20. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q. 1989;319–40.
  21. Carlsson C, Carlsson J, Hyvonen K, Puhakainen J, Walden P. Adoption of mobile devices/services-searching for answers with the UTAUT. In: Proceedings of the 39th annual Hawaii international conference on system sciences (HICSS’06). IEEE; 2006. p. 132a-132a.
  22. Magsamen-Conrad K, Upadhyaya S, Joa CY, Dowd J. Bridging the divide: Using UTAUT to predict multigenerational tablet adoption practices. Comput Human Behav. 2015;50:186–96.
  23. Escobar-Rodríguez T, Carvajal-Trujillo E, Monge-Lozano P. Factors that influence the perceived advantages and relevance of Facebook as a learning tool: An extension of the UTAUT. Australas J Educ Technol. 2014;30(2).
  24. Liu C-H, Huang Y-M. An empirical investigation of computer simulation technology acceptance to explore the factors that affect user intention. Univers Access Inf Soc. 2015;14(3):449–57.
  25. Venkatesh V, Thong JYL, Xu X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. MIS Q. 2012;157–78.
  26. Hwang G-J, Wu P-H, Chen C-C. An online game approach for improving students’ learning performance in web-based problem-solving activities. Comput Educ. 2012;59(4):1246–56.
  27. Huang Y-M. Reason and emotion: How they drive students to play a color game. EURASIA J Math Sci Technol Educ. 2018;14(5):1911–24.
  28. Huang Y-M, Huang Y-M. A scaffolding strategy to develop handheld sensor-based vocabulary games for improving students’ learning motivation and performance. Educ Technol Res Dev. 2015;63(5):691–708.
  29. Watson WR, Mong CJ, Harris CA. A case study of the in-class use of a video game for teaching high school history. Comput Educ. 2011;56(2):466–74.
  30. Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: Toward a unified view. MIS Q. 2003;425–78.
  31. Sung H-Y, Hwang G-J. A collaborative game-based learning approach to improving students’ learning performance in science courses. Comput Educ. 2013;63:43–51.
  32. Schepers J WMA, Schepers J, Wetzels M. meta-analysis of the technology acceptance model: Investigating subjective norm and moderation effects. Inf Manag. 2007;44(1):90-103.
  33. Almulla M. Technology Acceptance Model (Tam) And E-Learning System Use For Education Sustainability. Acad Strateg Manag J. 2021;20(4):1–13.
  34. Robson K, Plangger K, Kietzmann JH, McCarthy I, Pitt L. Game on: Engaging customers and employees through gamification. Bus Horiz. 2016;59(1):29–36.
  35. Zhou T. The effect of flow experience on user adoption of mobile TV. Behav Inf Technol. 2013;32(3):263–72.
  36. Davis FD, Bagozzi RP, Warshaw PR. User acceptance of computer technology: A comparison of two theoretical models. Manage Sci. 1989;35(8):982–1003.
  37. Koufaris M. Applying the technology acceptance model and flow theory to online consumer behavior. Inf Syst Res. 2002;13(2):205–23.
  38. Waltz C. F., Bausell B. R. Nursing research: design statistics and computer analysis. Davis FA. 1981
  39. Tao Y-H, Cheng C-J, Sun S-Y. What influences college students to continue using business simulation games? The Taiwan experience. Comput Educ. 2009;53(3):929–39.
  40. Bourgonjon J, Valcke M, Soetaert R, Schellens T. Students’ perceptions about the use of video games in the classroom. Comput Educ. 2010;54(4):1145–56.
  41. Chen H-R, Lin Y-S. An examination of digital game-based situated learning applied to Chinese language poetry education. Technol Pedagog Educ. 2016;25(2):171–86.
  42. Lu Y, Zhou T, Wang B. Exploring Chinese users’ acceptance of instant messaging using the theory of planned behavior, the technology acceptance model, and the flow theory. Comput Human Behav. 2009;25(1):29–39.
  43. Zhou T, Lu Y, Wang B. Integrating TTF and UTAUT to explain mobile banking user adoption. Comput Human Behav. 2010;26(4):760–7.
  44. Jin G, Tu M, Kim T-H, Heffron J, White J. Evaluation of game-based learning in cybersecurity education for high school students. J Educ Learn. 2018;12(1):150–8.
  45. Findley MR. The relationship between student learning styles and motivation during educational video game play. Int J Online Pedagog Course Des. 2011;1(3):63–73.
  46. Wang X, Goh DH-L. Video game acceptance: A meta-analysis of the extended technology acceptance model. Cyberpsychology, Behav Soc Netw. 2017;20(11):662–71.
  47. Rahardja U, Hariguna T, Aini Q. Understanding the impact of determinants in game learning acceptance: An empirical study. Int J Educ Pract. 2019;7(3):136–45.
  48. Malaquias RF, Malaquias FFO, Hwang Y. Understanding technology acceptance features in learning through a serious game. Comput Human Behav. 2018;87:395–402.
  49. Ishak WHW, Yamin FM. Student acceptance on game to support teaching and learning. Int J. 2020;9(3):2517–21.
  50. Tan JL, Goh DH-L, Ang RP, Huan VS. Learning efficacy and user acceptance of a game-based social skills learning environment. Int J child-computer Interact. 2016;9:1–19.
  51. Saleh N, Prakash E, Manton R. Factors affecting the acceptance of game-based learning. Int J Comput Appl. 2014;92(13):1–10.
  52. Ninaus M, Moeller K, McMullen J, Kiili K. Acceptance of game-based learning and intrinsic motivation as predictors for learning success and flow experience. Int J Serious Games. 2022;4.
  53. Ghani MTA, Hamzah M, Ramli S, Ab W, Daud AW, Romli TRM, et al. A questionnaire-based approach on technology acceptance model for mobile digital game-based learning. J Glob Bus Soc Entrep. 2019;5(14):11–21.
  54. López FR, Arias-Oliva M, Pelegrín-Borondo J, Marín-Vinuesa LM. Serious games in management education: An acceptance analysis. Int J Manag Educ. 2021;19(3):100517.