Online Game-Based Learning for Hand Hygiene Practices Among Young Children in Indonesia: A Quasi-Experimental Study
DOI:
https://doi.org/10.58524/oler.v6i1.997Keywords:
Early childhood, Game-based education, Hand hygiene, Online learningAbstract
Hand hygiene remains a cornerstone of infection prevention due to its crucial role in reducing the transmission of infectious diseases across community and healthcare settings. However, establishing consistent handwashing habits among young children remains challenging despite school-based health education programs. Game-based learning has emerged as a promising approach to enhance engagement and support behavior change in early childhood education, yet empirical evidence from developing countries remains limited. This study aims to evaluate the effectiveness of an online game-based educational intervention in improving hand hygiene performance among early childhood children in Indonesia. A quasi-experimental pretest–posttest design was conducted with 50 parent–child pairs involving children aged 4–6 years in Bekasi City. Participants accessed an online educational game designed to teach proper handwashing practices over one week. Baseline and follow-up observations were conducted to assess behavioral change. As the data were not normally distributed (Shapiro–Wilk W = .97, p = .03), the Wilcoxon signed-rank test was applied. Results showed a significant improvement in hand hygiene scores from pretest (Mdn = 3.0) to posttest (Mdn = 15.0), Z = −6.034, p < .001, with a large effect size (r = .60). These findings support the use of digital games as an effective and innovative learning tool to promote health-related behaviors among young children.
References
Abdulrahman, A. O., & Rawf, K. M. H. (2022). Usability methodologies and data selection: Assessing the usability techniques on educational websites. International Journal of Electronics and Communications Systems, 2(2), 49–56. https://doi.org/10.24042/ijecs.v2i2.15045
Agil, H. M., Gowinda, D., Zulviana, & Nurdiantami, Y. (2023). The effectiveness of game-based education “ICANDO” to empowering children to do oral hygiene. Systems and Empowerment Sciences for Lifespan Development (SYSTED), 43–47.
Alzyood, M., Jackson, D., Aveyard, H., & Brooke, J. (2020). COVID-19 reinforces the importance of handwashing. Journal of Clinical Nursing, 29(15–16), 2760–2761. https://doi.org/10.1111/jocn.15313
Ancona, A., Corea, F., Lombardo, C., Gentili, D., Mistretta, & Antonio. (2011). Serious games in child and adolescent health education campaigns: a systematic review. Ann Ist Super Sanità, 47(4), 363–372.
Badan Penelitian dan Pengembangan Kesehatan. (2018). Laporan Riskesdas 2018 Nasional.pdf. In Lembaga Penerbit Balitbangkes. https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/Laporan Riskesdas 2018 Nasional.pdf
Behnamnia, N., Kamsin, A., Ismail, M. A. B., & Hayati, S. A. (2023). A review of using digital game-based learning for preschoolers. Journal of Computers in Education, 10(4), 603–636. https://doi.org/10.1007/s40692-022-00240-0
Chu, C., Paatsch, L., Kervin, L., & Edwards, S. (2024). Digital play in the early years: A systematic review. International Journal of Child-Computer Interaction, 40, 100652. https://doi.org/10.1016/j.ijcci.2024.100652
Curtis, V., & Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the community: A systematic review. Lancet Infectious Diseases, 3(5), 275–281. https://doi.org/10.1016/S1473-3099(03)00606-6
de Wit, S., & Dickinson, A. (2009). Associative theories of goal-directed behaviour: A case for animal–human translational models. Psychological Research PRPF, 73(4), 463–476. https://doi.org/10.1007/s00426-009-0230-6
Faqih, M. V. A., Widiarni, A., Andini, N., Saregar, A., Sharov, S., & Faraj, B. M. (2023). Fisikawaii adventure: An effort to increase students’ learning participation through gamification and virtual reality. Online Learning in Educational Research (OLER), 3(2), 95–116. https://doi.org/10.58524/oler.v3i2.294
Febrini, D., Aryati, A., Asvio, N., & Syams, W. (2024). Exploring technology integration in islamic character education: Perspectives from early childhood education. Online Learning In Educational Research (OLER), 4(2), 131–142. https://doi.org/10.58524/oler.v4i2.482
Graichen, J., Stingl, C., Pakarinen, A., Rosio, R., Terho, K., Günther, S. A., Salanterä, S., & Staake, T. (2024). Improving hand hygiene of young children with a digital intervention: A cluster-randomised controlled field trial. Scientific Reports, 14(1), 1–10. https://doi.org/10.1038/s41598-024-56233-9
Haryandi, S., Misbah, M., Arlinda, R., Harto, M., Muhammad, N., Qamariah, Q. (2025). Game-based learning in science education: Bibliometric analysis. Online Learning in Educational Research (OLER), 5(1), 113–128. https://doi.org/10.58524/oler.v5i1.626
Herlinawati, H., Marwa, M., Ismail, N., Junaidi, Liza, L. O., & Situmorang, D. D. B. (2024). The integration of 21st century skills in the curriculum of education. Heliyon, 10(15), e35148. https://doi.org/10.1016/j.heliyon.2024.e35148
Hidayati, N., & Rudiyanto. (2021). Distance learning in early childhood education during Pandemic Covid-19. Proceedings of the 5th International Conference on Early Childhood Education (ICECE 2020), 538(Icece 2020), 207–211. https://doi.org/10.2991/assehr.k.210322.045
Hirai, M., Graham, J. P., Mattson, K. D., Kelsey, A., Mukherji, S., & Cronin, A. A. (2016). Exploring determinants of handwashing with soap in Indonesia: A quantitative analysis. International Journal of Environmental Research and Public Health, 13(9), 868. https://doi.org/10.3390/ijerph13090868
Ismail, N. M., & Sabrina. (2023). Virtual learning and memory dissonance. Jurnal Ilmiah Peuradeun, 11(3). https://doi.org/10.26811/peuradeun.v11i3.904
Joseph, V. V. (2022). The impact of public health interventions in a developing nation: an overview. South Sudan Medical Journal, 15(4 SE-Research Article), 147–151. https://doi.org/10.4314/ssmj.v15i4.6
Khan, K. M., Chakraborty, R., Brown, S., Sultana, R., Colon, A., Toor, D., Upreti, P., & Sen, B. (2021). Association between handwashing behavior and infectious diseases among low-income community children in urban New Delhi, India: A cross-sectional study. International Journal of Environmental Research and Public Health, 18(23), 12535. https://doi.org/10.3390/ijerph182312535
Lagu, A. M. H. R., Thaha, R. M., Syafar, M., Hadju, V., & Kurniati, Y. (2022). Using games to promote healthy behavior in children: A narrative review. Open Access Macedonian Journal of Medical Sciences, 10(E), 1904–1910. https://doi.org/10.3889/oamjms.2022.8851
Nitae, K., Nuangchalerm, P., & Safkolam, R. (2025). Bringing science to life: STEM-based instructional strategies for primary students in Thailand. Online Learning In Educational Research (OLER), 5, 73–80. https://doi.org/10.58524/oler.v5i1.570
Plotka, R., & Guirguis, R. (2023). Distance learning in early childhood during the COVID-19 crisis: Family and educators’ experiences. Early Childhood Education Journal, 51(8), 1359–1370. https://doi.org/10.1007/s10643-022-01384-5
Presta, V., Guarnieri, A., Laurenti, F., Mazzei, S., Arcari, M. L., Mirandola, P., Vitale, M., Chia, M. Y., Condello, G., & Gobbi, G. (2024). The impact of digital devices on children’s health: A systematic literature review. In Journal of Functional Morphology and Kinesiology (Vol. 9, Issue 4, p. 236). https://doi.org/10.3390/jfmk9040236
Ryan, R. ., & Deci, E. . (2020). Self-determination theory. American Psychologist, 55(1), 296–312. https://doi.org/10.4324/9780429052675-23
Sailer, M., Hense, J. U., Mayr, S. K., & Mandl, H. (2017). How gamification motivates: An experimental study of the effects of specific game design elements on psychological need satisfaction. Computers in Human Behavior, 69, 371–380. https://doi.org/10.1016/j.chb.2016.12.033
Sari, E. F. N., Siregar, N. M., Nugroho, S., Riza, L. S., Ali, M., & Asri, N. (2025). Game-based training model: Does it improve fundamental badminton young athletes’ skills? Journal of Coaching and Sports Science, 4(2), 188–198. https://doi.org/10.58524/jcss.v4i2.905
Sari, I. M., Ghinatri, N., Saepuzaman, D., & Amsor, A. (2025). Gamification in learning Newton’s laws: Enhancing students’ problem-solving skills. Jurnal Ilmiah Pendidikan Fisika Al-Biruni, 14(1), 21–31. https://doi.org/10.24042/jipfalbiruni.v14i1.24829
Shaluhiyah, Z., Qatrannada, S. A., Kusumawati, A., & Miah, M. S. (2025). The effect of digital health intervention in promoting healthy behavior: A systematic scoping review on strategies to prevent non-communicable diseases. Dialogues in Health, 7, 100258. https://doi.org/10.1016/j.dialog.2025.100258
Suggate, S. P., Lenhart, J., Vaahtoranta, E., & Lenhard, W. (2021). Interactive elaborative storytelling fosters vocabulary in pre-schoolers compared to repeated-reading and phonemic awareness interventions. Cognitive Development, 57, 100996. https://doi.org/10.1016/j.cogdev.2020.100996
Tan, C. Y., Jang, S. T., Lam, S. M., An, A. Q., & Lo, U. K. V. (2025). Teaching and learning challenges due to the COVID-19 pandemic: A systematic review. Educational Research Review, 47, 100667. https://doi.org/10.1016/j.edurev.2025.100667
Tidwell, J. B., Gopalakrishnan, A., Unni, A., Sheth, E., Daryanani, A., Singh, S., & Sidibe, M. (2020). Impact of a teacher-led school handwashing program on children’s handwashing with soap at school and home in Bihar, India. PLoS ONE, 15(2), 1–8. https://doi.org/10.1371/journal.pone.0229655
Wan, Z. H., Jiang, Y., & Zhan, Y. (2021). STEM education in early childhood: A review of empirical studies. Early Education and Development, 32(7), 940–962. https://doi.org/10.1080/10409289.2020.1814986
Wang, L., Zhang, S., & Rozelle, S. (2024). Do the pathways of child development before age three matter for development at primary school? Evidence from rural China. Humanities and Social Sciences Communications, 11(1), 1578. https://doi.org/10.1057/s41599-024-04104-z
WHO. (2009). WHO guidelines on hand hygiene in health care.
WHO. (2017). Diarrhoeal disease.
Younie, S., Mitchell, C., Bisson, M. J., Crosby, S., Kukona, A., & Laird, K. (2020). Improving young children’s handwashing behaviour and understanding of germs: The impact of A Germ’s Journey educational resources in schools and public spaces. PLoS ONE, 15(11 November), 1–19. https://doi.org/10.1371/journal.pone.0242134
Yusaini, Y., Muslim, B., Rusli, R., Darmawati, D., & Hasyim, S. (2024). Covid-19’S effect on lecturer performance and management functions in educational implementation. Jurnal Ilmiah Peuradeun, 12(2), 613–638. https://doi.org/10.26811/peuradeun.v12i2.1185
Zosh, J. M., Hopkins, E. J., Jensen, H., Liu, C., Neale, D., Hirsh-Pasek, K., Solis, S. L., & Whitebread, D. (2017). Learning through play: A review of the evidence (Issue November).
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