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. 2026 Jan 2;26:179. doi: 10.1186/s12909-025-08486-9

Impact of gamification-based nutrition education on nursing students’ knowledge and performance: a before-after intervention study

Reza Ghafari Bavil 1, Taha Samad-Soltani 2, Solmaz Ghanbari-Homaie 3, Laleh Payahoo 4,5,✉
PMCID: PMC12865993  PMID: 41484596

Abstract

Objectives

College students are at risk of chronic diseases owing to lifestyle changes, moving away from the home environment, adopting unhealthy diets, and skipping meals. As an innovative educational method, gamification enhances the retention of educational content and improves students’ motivation to learn. The present study examined the effect of gamification-based healthy nutrition education on the knowledge and performance of nursing students.

Methods

This pre-post interventional study was undertaken on 40 nursing students at Tabriz University of Medical Sciences in Iran between 2021 and 2023. The participants received instruction on healthy nutrition principles via gamification software, covering food groups and their calories, healthy food selection using traffic light system, interpretation of food labels, cooking methods by considering advantages and disadvantages, food pyramids as well as designing a balanced meal plan as a healthy plate. The intervention lasted two months. At the baseline and end of the study, knowledge (n = 10) and performance (n = 11) questionnaires were completed. The paired t-test method was employed to compare the differences between groups. P < 0.05 were considered statistically significant.

Results

At the end of the intervention, significant changes were observed in the nutritional knowledge and performance scores of students (p < 0.001). Notably, the proportion of students answering > 6 performance questions correctly rose from 17% to 92% (p < 0.001).

Conclusion

Gamification significantly boosted nursing student’s nutritional knowledge and performance.

Practice implications

Future studies are recommended to generalize these findings to other medical courses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08486-9.

Keywords: Gamification, College students, Medical sciences, Nutritional knowledge and performance, Chronic disease, Educational method, Digital technology

Introduction

The prevalence of chronic diseases in medical college students is high [1, 2]. Lifestyle-related challenges, such as unhealthy diet, poor sleep quality, low physical activity, as well as, alcohol consumption and smoking, are among the main predisposing factors for chronic diseases among college students [3, 4]. Proper nutrition is a key component of a healthy lifestyle. One of the essential elements necessary to achieve appropriate nutrition is possessing a high level of nutritional knowledge [5, 6]. Such knowledge enables individuals to develop healthy nutritional attitudes and behaviors in daily life to select healthy foods, meet calorie and nutrient requirements appropriately as well as provide physical and mental health [7, 8].

Upon entering university, students often experience disruption in lifestyle, eating behaviors, and sleep patterns [9, 10]. Unhealthy dietary pattern such as consuming calorie dense, nutrient poor foods, sweetened beverages, skipping main meals, and replacing them with snacks (e.g., chips, crackers, sweets, and muffins) are frequently reported among college students [5, 8, 9]. Reliance on ready-to-eat meals and prolonged junk food consumption fail to meet the recommended dietary intake, increasing susceptibility of students to become overweight and obese [10–12]. Sometimes, students skip main meals to manage weight and adopt irregular eating patterns such as grazing [13].

Being obese and/or overweight is linked to negative self-esteem and are depression, anxiety, and reduced quality of life in this population [14, 15]. Another contributing factor in the incidence of obesity is excessive smartphone and tablet use, lowering physical activity. As future healthcare professionals, medical students play a key role in promoting healthy lifestyles and dietary habits. Motivating this group toward healthier eating and increased physical activity can foster broader societal benefits [16].

With the rise of new educational technologies, traditional teaching methods have become less effective [17]. In passive learning methods, student engagement and motivation are low, interaction between learners is poor, memory retention is limited, and the process is often boring [18]. In contrast, innovative tools can enhance the retention of concepts, result in a deeper understanding of content, promote active participation of learners, and motivate students to adopt healthier behaviors [19–21]. Among innovative educational tools, gamification is widely recognized for boosting motivation, engagement, and knowledge retention in education [22–24]. The main strengths of gamification include enhanced motivation, active participation, experiential learning, problem-based learning, and the interactive transfer of knowledge as well as educational content to the target group [25]. By creating environments for targeted problem-solving, gamification improves learning through repetitive practice and enjoyment [26]. Crucially, it facilitates behavior change, highlighting its value in academic settings [27–29].

Previous studies support gamification’s efficacy in improving dietary knowledge and behaviors, particularly among youth [30, 31]. Santos Chagas et al., in a randomized, protocol-based intervention study, found that Rango Cards, a game-based digital tool, significantly improved nutritional knowledge and self-efficacy among Brazilian health students [31]. In another study, Jimoh et al. observed that a smartphone-based educational app (FoodWiz2) increased fruit consumption and lowered the intake of chocolate snacks and sugary drinks during the 4–5 week intervention, with higher acceptability and less boredom compared to traditional methods [32].

Given the importance of employing novel educational technologies for college students, it is critical to employ tools of an engaging nature that have the ability to enhance motivation and effectiveness in helping students retain knowledge in daily life. Furthermore, considering the pivotal role of knowledge in promoting nutrition-related behaviors, this study aimed to design and evaluate the impact of gamification-based software on both the knowledge and nutrition-related behaviors of nursing students at Tabriz University of Medical Sciences. To the best of our knowledge, this is the first study to examine gamified nutrition education among nursing students in Iran.

Materials and methods

This before-after interventional study was conducted on 40 nursing students enrolled at Tabriz University of medical sciences between 2021 and 2023. The total number of nursing students are studying in Tabriz University of medical sciences is approximately 450 students, however, the nutrition course is taken in the fourth semester for nursing students, which has comprised around 80 students. The participants were selected using a convenience sampling method from nursing students. This study was conducted in two phases: the first phase which was time-consuming, focused on software design, while the second phase involving a primary interventional study to ascertain whether the designed software could cover the main objective of the study, namely improving nutrition knowledge and performance. Inclusion criteria consisted of nursing students of both genders enrolled in the fourth semester of nursing, possessing an Android smartphone, and demonstrating willingness to participate (these criteria were chosen since nursing students generally have no prior knowledge of nutrition, and the majority of the target group use Android phones). The software was installed on the students’ phones and they were instructed to utilize the software for one hour daily. Weekly follow-up was done via phone calls to ensure the use of the software. The educational content of the software was developed based on the latest editions of nutrition textbooks, including Modern Nutrition in Health and Disease and Krause’s Food & the Nutrition Care Process. The regional ethics committee of the Tabriz University of Medical Science approved the protocol of the study and assigned the IR.TBZMED.REC.1401.038 number. A written informed consent form was completed for eligible subjects.

The software was designed as a scenario-based gamified application featuring five progressive stages (ranging from beginner to advanced levels) incorporating game mechanics such as classification and progression systems. The scenario included comprehensive information about food groups, healthy food selection whilst shopping using the traffic light system, advantages and disadvantages of the food pyramids as well as cooking methods and preservation of nutritional value during the cooking preparation, interpretation of food labels, along with the principles of designing a healthy plate. Following installation on Android devices, the participants received initial training on software navigation and game stage progression (presented through a character-based interface). Each stage started with explanatory content specific to that level. Each stage of the game consisted of two phases: an instructional tutorial, followed by an assessment section. The assessment section provided users with feedback required for progression to subsequent levels.

The first stage introduced food groups (cereals, milk and dairy products, fruits, vegetables, fats, meat and meat products) including their caloric values per serving, along with constituent food items. In the subsequent section, users engaged in a classification exercise where correctly sorted foods elevated their score, while incorrect selections triggered visual feedback (via a “wrong” indicator) as part of the game’s immediate feedback mechanics (Fig. 1: Food groups).

Fig. 1.

Fig. 1

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Food groups

In the second stage, a traffic light system- comprising red (avoid), green (consume liberally), and orange (caution) was employed to classify food items as healthy or unhealthy. Thereafter, the users were presented with a variety of nutritious and detrimental foods. Correctly identifying these items based on their health properties (beneficial or harmful) highlighted their score, thereby integrating reward and scoring mechanisms into the learning process (Fig. 2; Traffic light system).

Fig. 2.

Fig. 2

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Traffic light system

The third stage introduced users to four distinct dietary pyramids. Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Vegetarian, and Western diets (Figs. 3, 4, 5 and 6: Food pyramids). In the subsequent assessment component, the users answered questions about these pyramids, with correct responses contributing to their cumulative score.

Fig. 3.

Fig. 3

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Food pyramids

Fig. 4.

Fig. 4

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Food pyramids

Fig. 5.

Fig. 5

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Food pyramids

Fig. 6.

Fig. 6

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Food pyramids

In the fourth stage, the users learned about cooking methods, describing the features, benefits and disadvantages of steaming, blanching, grilling, boiling, frying, and roasting, with particular emphasis on preserving nutritional value. The evaluation ascertained users’ understanding of these techniques through questions, with correct answers contributing to their cumulative score (Fig. 7: Designing a healthy plate).

Fig. 7.

Fig. 7

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Designing a healthy plate

In the fifth stage, the users were instructed on interpreting food labels and creating nutritionally balanced plates, enabling them to make healthier, calorie appropriate choices. The practical exercise required users to design a sample meal plate. The system provided immediate feedback by issuing warnings for unhealthy or excessively calorie-dense selections (Fig. 8: Various cooking methods: features, advantages and disadvantages).

Fig. 8.

Fig. 8

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Various cooking methods: features, advantages and disadvantages

The software was ascertained by twelve experts using the “Standard Questionnaire for Evaluation of Program Usability and User Satisfaction”. The validity of the questionnaire had previously been established, and its reliability was confirmed with a Cronbach’s alpha coefficient of 0.76 [33]. The instrument comprised five sections appraising general functionality, screen capabilities, the software terminology, learning capabilities, and overall software performance, using a nine-point Likert scale (0–9). The software remained accessible to students for a two-month period.

The participants completed a questionnaire entitled “Surveying the status of nutritional knowledge and performance of students” before and after software implementation. The instrument is composed of 10 knowledge questions using a “true-false-don’t know” format and 11 performance questions rated on a Likert scale ranging from “completely agree” to “completely disagree”. The validity was established through expert panel review, yielding a content validity ratio (CVR) of 1 and content validity index (CVI) of 0.96, respectively. Reliability was confirmed with a Cronbach’s alpha coefficient of 0.77 (Supplementary 1). The sample size of 40 participants was determined based on the “prepare healthy meals” variable from a similar study, reporting a mean of 3.4 and standard deviation of 1.1 in the intervention group, with a 10% margin of error [31].

Statistical analysis

Statistical analysis was performed using SPSS version 26. The Kolmogorov-Smirnov test assessed normality of data distribution and Levene tests evaluated homogeneity of variance. Normally distributed data were presented as mean ± standard while non-normally distributed data were expressed as median (25-75th percentile). Categorical variables were reported as frequency (percentage). Paired t-test compared knowledge and performance variables before and after the intervention, whereas independent sample t-test explored between group differences. Changes in performance score were additionally reported as frequency (percentage).

Results

The mean age of the participants was 21.22 ± 2.18 years, with 52.5% male. About 57% of students had a body mass index (BMI) < 25 kg/m². All participants had enrolled in their fourth semester of the undergraduate nursing courses. Table 1 presents the demographic characteristics.

Table 1.

Demographic characteristics of nursing student participants (n = 40)

Variables Values
Age (year)* 21.22 ± 2.18

Gender **

 -Male

 21 (52.5)
Weight (kg)* 73.07 ± 16.83

BMI (kg/m2)**

 -< 25

 - ≥ 25

23 (57.5)

17 (42.5)
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BMI Body Mass Index, *Mean (SD), **Frequency (%)

Of the ten designed knowledge questions, the correct answer for six questions (items 2, 3, 4, 6, and 9, 10) was the option labeled “correct”. For the remaining questions, the correct answer was the option labeled “Incorrect”. For instance, in response to the item “As a vegan, I do not eat eggs”, 52.5% of students answered correctly before the intervention, which rose to 72.5% after the intervention (p = 0.023). At baseline, only 10% of the participants chose the correct answer to the item " Processed meat have red color in terms of traffic lights " while this rate grew to 57.5% at the end of the intervention period (p < 0.001). Regarding the item “Does each unit of the cereal food group have 120 kcal of energy?” 52.5% of students chose correct answer at baseline, while this proportion increased to 77.5% at the end of study (p = 0.011).

Table 2 reports the outcomes of gamification-based nutrition education on participants’ knowledge in detail. Following the intervention, students’ nutritional knowledge improved significantly. Figure 9 displays the effect of gamification-based nutrition education on the overall knowledge scores of nursing students.

Table 2.

Impact of gamification-based nutrition education on the knowledge level of nursing students (n = 40)

Questions Before After P
Correct Incorrect Correct Incorrect
Does each unit of the cereal food group have 120 kcal of energy? 21 (52.5) 19 (47.5) 31 (77.5) 19 (47.5) 0.011
The Mediterranean food pyramid is beneficial in reducing cardiovascular diseases 24 (60) 16 (40) 28 (70) 12 (30) 0.440
As a vegan, I do not eat eggs 21 (52.5) 19 (47.5) 29 (72.5) 11 (22.5) 0.023
The DASH food pyramid is not suitable for kidney patients 12 (30) 28 (70) 24 (60) 16 (40) 0.009
The vegetarian food pyramid is low in vitamin B9 14 (35.5) 26 (65) 25 (62.5) 15 (37.5) 0.014
The determining factor of energy obtained by the meat group is its fat content. 23 (57.5) 17 (42.5) 30 (75) 10 (25) 0.051
Poultry is consumed daily in the Mediterranean food pyramid 19 (47.5) 21 (52.5) 12 (30) 28 (70.5) 0.090
Blanching method destroys vitamin C in fruits and vegetables 17 (42.5) 23 (57.5) 19 (47.5) 21 (52.5) 0.660
Processed meat have red color in terms of traffic lights 4 (10) 36 (90) 23 (57.5) 17 (42.5) < 0.001
Processed meat is at the base of the Western food pyramid 12 (30) 28 (70) 23 (57.5) 17 (42.5) 0.020
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Data are presented as frequency (%), *Paired t-test

Fig. 9.

Fig. 9

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The effect of gamification-based nutrition education on the overall knowledge of nursing students

Nutritional performance also improved significantly in most items at the end of the study. In response to the item “For designing my food plate, I choose to fill half with whole grains”, at baseline, 27.5% of participants chose correct answer and this rose to 62.5% at the end of study (p < 0.001). Considering the items “At restaurants, I choose salad instead of French fries” and “When buying dairy products, I choose low-fat products”, the participants illustrated significant improvements in performance by the end of intervention period (p < 0.001 and p = 0.002, respectively). Table 3 outlines the results of the gamified nutritional software on the performance of students in detail.

Table 3.

The effect of the gamification-based nutrition education on the performance of nursing students (n=40)

Questions Before After p
Correct Incorrect Correct Incorrect
For designing my food plate, I choose to fill half with whole grains 11 (27.5) 29 (72.5) 25 (62.5) 15 (37.5) < 0.001
For cooking meat, often I use grilling 9 (22.5) 31 (77.5) 11 (27.5) 29 (72.5) 0.667
Due to high blood cholesterol, I follow the recommendations of the Western food pyramid - 40 (100) 24 (60.0) 16 (40.0) 0.006
I use olive oil at home and in shopping. 9 (22.5) 31 (77.5) 34 (85.0) 6 (15.0) < 0.001
I avoid using chia seeds and quinoa in my daily diet 8 (20.0) 32 (80.0) 14 (35.0) 26 (65.0) 1.000
At restaurants, I choose salad instead of French fries 8 (20.0) 32 (80.0) 37 (92.5) 3 (7.5) < 0.001
In my household food basket, I use canned fruits rather than fresh fruits 4 (10.0) 36 (90.0) 25 (62.5) 15 (37.5) 0.001
While shopping, I read food labels to gather nutritional information. 4 (10.0) 28 (70.0) 14 (35.0) 26 (65.0) 0.303
When buying dairy products, I choose low-fat products. 25 (62.5) 15 (37.5) 37 (35.0) 3 (7.5) 0.002
Instead of starchy vegetables, I include non-starchy vegetables on my lunch or dinner plate, along with low-fat yogurt or buttermilk 15 (37.5) 25 (62.5) 29 (72.0) 11 (27.5) 0.006
When designing my hunch or dinner plate, I choose low fat yogurt or dough 27 (67.5) 13 (32.5) 28 (70.0) 12 (10.0) 0.309
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At baseline, only 17.5% of students answered more than five performance questions correctly, whereas post intervention results indicated that 92.5% of students chose more than five correct answers. Figure 10 presents the comprehensive results of the gamified nutritional software on the performance of students. Analyses of the potential influence of gender and BMI based on ANCOVA test on knowledge and performance revealed no statistically significant differences (p > 0.05).

Fig. 10.

Fig. 10

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The effect of gamification-based nutrition education on the overall performance of nursing students

Discussion

Improving community health requires focused attention on individual attitudes and behaviors [12, 34, 35]. Since universities serve as key institutions for knowledge dissemination, enhancing nursing students’ nutritional knowledge, attitudes, and performance is of utmost importance, ultimately contributing to a more health-literate society. Medical students represent a pivotal demographic in health promotion, as their health-related behaviors significantly influence community practices through role modeling [36]. This study ascertained the impact of gamified nutrition education software on nursing students’ knowledge and performance, demonstrating statistically significant improvements in both domains (p < 0.05).

Previous literature supports these findings. Ezezika et al. [37] documented positive behavioral changes following gamified nutrition education among adolescents, including increased fruit and vegetable consumption and lowered intake of processed foods. Likewise, evaluation of the FRapp game application found improved dietary intake in adolescents aged 11–14 [38]. FoodGame software enhanced dietary attitudes and behaviors in 15 years old adolescents, though adherence to the Mediterranean diet remained unchanged [39].

A systematic review reported that gamification augmented vegetable consumption from 21.3 to 42.5 g, while fruit intake remained unchanged [40]. Contrasting evidence also exists, however. Çevik et al. [41] found no significant differences in nutritional attitudes across game-based, traditional, and control groups among 9-12-year-olds, despite observed BMI reductions. Likewise, gamification using the AdobeXD application failed to produce significant differences in dietary habits between intervention (app-based education) and control (slide-based education) groups of children aged 7–8 years [42]. According to previous studies, use of visual and engaging methods such as traffic lights, food labels, and similar strategies has proved to be more effective in facilitating learning. These methods, while being exciting and increasing motivation, promote the memorization of the material [43, 44].

Compared to traditional methods, gamified approaches offer distinct advantages, particularly in modifying behaviors. They deliver comprehensive nutritional information through engaging mechanisms such as reward systems, making the learning experience more interactive and memorable. Their effectiveness appears to be contingent upon software design characteristics; tools with simple, adaptable interfaces that minimize disruption to normal eating patterns demonstrate particular utility [45]. Nowadays, gamification is applied in various fields such as the hospitality industry (e.g., airlines, hotels), fitness, tourism (e.g., travel guide maps) and even in managing children’s bedwetting [46–50]. User-friendly, time-efficient, and easy-to-use software yielded better outcomes [51].

Higgins et al. [52] reported 50% completion rates for photographic food records compared with frequent omissions in traditional methods. The NutriGame, a story-based game app, successfully enhanced nutrition awareness and curtailed processed as well as ultra-processed food consumption among adolescents, with high user engagement reflected in immersion scores [53].

The main strength of this study was the comprehensive design of a piece of graphical nutrition software, ranging from basic to advanced content, implementation for the first time, covering most behaviors influencing individuals’ dietary habits. Implementation with a relatively larger sample size within the nursing student population compared to earlier investigations was another strength of this study [32, 37, 38]. Nevertheless, the study had some limitations, the most significant being the absence of a control group, which would have enabled a more robust comparison of results. Other limitations include the time-consuming nature of software design, absence of interactive question and answer features, self-reporting questionnaires, and iOS incompatibility owing to budgetary constraints.

Conclusion

This before-after intervention study ascertained the effectiveness of gamification based healthy nutrition education on nutritional knowledge and performance among 40 nursing students at Tabriz University of Medical Sciences. The findings indicated statistically significant improvements in both knowledge acquisition and practical performance following the intervention. Future research with a longer duration and the inclusion of a control group is needed to explore the long-term effects and to identify the mechanisms underlying behavioral changes. It is recommended to implement such interventions across academic disciplines and broader community populations.

Supplementary Information

Supplementary Material 1. (31.3KB, docx)

Acknowledgements

The authors would like to acknowledge Tabriz University of Medical Sciences for supporting this research. The authors also thank all students who contributed to this research.

Abbreviations

BMI

Body Mass Index

CVR

Content Validity Ratio

CVI

Content Validity Index

DASH

Dietary Approaches to Stop Hypertension

Authors’ contributions

R.G.B and L.P: Contributed to the design, data interpretation, supervised the study, and approval of the final version of the manuscript.T.S.S: Contributed to design software and statistical analysis.S.G.H Contributed to the sampling and data collection.

Funding

Not applicable.

Data availability

All data generated or analyzed during this study are included in this published article.

Declarations

Ethics approved and consent to participate

According to Helsinki’s declaration, the protocol of the study was approved by the ethics committee of Tabriz University of Medical Sciences. A written informed consent form was completed by participants. The regional ethics committee approved the protocol of the study and allocated the number IR.TBZMED.REC.1401.038.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  • 1.Gazibara T, Pekmezović T, Popović A, Paunić M, Kisić-Tepavčević D. Chronic diseases among university students: prevalence, patterns and impact on health-related quality of life. Vojnosanit Pregl. 2018;75(12):1178–84. [Google Scholar]
  • 2.Bashir M, Alshamsi M, Almahrooqi S, Alyammahi T, Alhammadi W, Alshehhi S, et al. Prevalence of chronic diseases among united Arab Emirates university students: cross-sectional study. Eur J Pub Health. 2022;32(Supplement3):ckac131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Mahmood SE, Ansari SH. Lifestyle disease risk factors among first year medical students in Bareilly. NJIRM. 2013;4(2):50–4. [Google Scholar]
  • 4.La Victoire S, Ukwandu S, Ejuone O, Monday EO. The influence of modern lifestyle on the health of medical students in a medical school in Dominica. 2022.
  • 5.Ali A, Al Naabi F, Al-Hakamani H, Al-Fahdi H, Waly M. Assessment of nutritional knowledge, dietary habits, nutrient intake and nutritional status of Omani university students. Can J Clin Nutr. 2020;8(2):35–52. [Google Scholar]
  • 6.Payahoo L, Nikniaz Z, Mahdavi R, Abadi MAJ. Perceptions of medical sciences students towards probiotics. Health Promotion Perspect. 2012;2(1):96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Burrows TL, Whatnall MC, Patterson AJ, Hutchesson MJ, editors. Associations between dietary intake and academic achievement in college students: a systematic review. Healthcare: MDPI; 2017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Yahia N, Brown CA, Rapley M, Chung M. Level of nutrition knowledge and its association with fat consumption among college students. BMC Public Health. 2016;16:1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Matthews JI, Doerr L, Dworatzek PD. University students intend to eat better but lack coping self-efficacy and knowledge of dietary recommendations. J Nutr Educ Behav. 2016;48(1):12–9. e1. [DOI] [PubMed] [Google Scholar]
  • 10.James KJ. Assessing Dietary Intake, Eating and Exercise Attitudes and Fitness Levels in College-Aged Students. 2010.
  • 11.Tutunchi H, Asghari Jafarabadi M, Hoojeghani S, Tabrizi S, Farrin N, Payahoo L, et al. General and abdominal obesity is related to socioeconomic status and food choices: a cross-sectional study. Nutr Food Sci. 2020;50(1):61–73. [Google Scholar]
  • 12.Ostadrahimi A, Payahoo L, Somi MH, Khajebishak Y. The association between urinary cadmium levels and dietary habits with risk of Gastrointestinal cancer in Tabriz, Northwest of Iran. Biol Trace Elem Res. 2017;175(1):72–8. [DOI] [PubMed] [Google Scholar]
  • 13.Mariyam S. Prevalence of depression, anexity and stress among Colledge students and correlation of psychological factors and nutrition among them. Ernakulam: St Teresa’s College (Autonomous); 2023. [Google Scholar]
  • 14.Ghartappeh A, Arefi M, Faramarzi S, Pasdar Y. The prediction of quality of life based on Self-esteem, mental health and sleep quality variables in obese and overweight Girl students. J Clin Res Paramedical Sci. 2020;9(2):1–11. [Google Scholar]
  • 15.Alghawrien Da, Al-Hussami M, Ayaad O. The impact of obesity on self-esteem and academic achievement among university students. Int J Adolesc Med Health. 2022;34(3):20190137. [DOI] [PubMed] [Google Scholar]
  • 16.Villasana MV, Pires IM, Sá J, Garcia NM, Zdravevski E, Chorbev I, et al. Promotion of healthy nutrition and physical activity lifestyles for teenagers: A systematic literature review of the current methodologies. J Personalized Med. 2020;10(1):12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Feyzi K, Rahmani M. ELECTRONIC LEARNING IN IRAN; PROBLEMS & SOLUTIONS WITH EMPHASIS ON HIGHER EDUCATION. 2004.
  • 18.Ningsi N, Hartono H. Developing interactive learning media to enhance elementary school students’ learning motivation. EDUCARE: J Prim Educ. 2025;6(1):81–96. [Google Scholar]
  • 19.Molina V, Agricultura DNONUA. El estado de las guías alimentarias basadas en alimentos en América Latina y el Caribe. Roma, IT: FAO. 2014:30 – 6.
  • 20.Kimonen E, Nevalainen R. Active learning in the process of educational change. Teach Teacher Educ. 2005;21(6):623–35. [Google Scholar]
  • 21.Wolff M, Wagner MJ, Poznanski S, Schiller J, Santen S. Not another boring lecture: engaging learners with active learning techniques. J Emerg Med. 2015;48(1):85–93. [DOI] [PubMed] [Google Scholar]
  • 22.Groh F, Gamification. State of the Art definition and utilization. Inst Media Inf Ulm Univ. 2012;39:31. [Google Scholar]
  • 23.Haiat H, Bar-Mor G, Shochat M. The world of the child: a world of play even in the hospital. J Pediatr Nurs. 2003;18(3):209–14. [DOI] [PubMed] [Google Scholar]
  • 24.Bigdeli S, Kaufman D. Digital games in medical education: key terms, concepts, and definitions. Med J Islamic Repub Iran. 2017;31:52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Barab S, Dede C. Games and immersive participatory simulations for science education: an emerging type of curricula. J Sci Edu Technol. 2007;16(1):1–3. [Google Scholar]
  • 26.Gee JP. Deep learning properties of good digital games: How far can they go? Serious games: Routledge; 2009. pp. 67–82.
  • 27.McGonigal J. Reality is broken: Why games make us better and how they can change the world: Penguin; 2011.
  • 28.Fleury A, Nakano D, Cordeiro J. Mapeamento da indústria brasileira e global de jogos digitais. São Paulo: GEDIGames/USP. 2014:32 – 3.
  • 29.Michael DR, Chen SL. Serious games: games that educate, train, and inform. Muska & Lipman/Premier-Trade; 2005.
  • 30.do Amaral e Melo GR, de Carvalho Silva Vargas F, dos Santos Chagas CM, Toral N. Nutritional interventions for adolescents using information and communication technologies (ICTs): A systematic review. PLoS ONE. 2017;12(9):e0184509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Chagas CMS, Pontes e Silva TB, Reffatti LM, Botelho RBA, Toral N. Rango Cards, a digital game designed to promote a healthy diet: a randomized study protocol. BMC Public Health. 2018;18:1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Jimoh F, Lund EK, Harvey LJ, Frost C, Lay WJ, Roe MA, et al. Comparing diet and exercise monitoring using smartphone app and paper diary: a two-phase intervention study. JMIR mHealth uHealth. 2018;6(1):e7702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Hasannejad M. Developing a web-based system for self-care management of type 1-diabetes [dissertation]. Tehran: Iran University of Medical Sciences. 2013.
  • 34.Payahoo L, Ostadrahimi A, Mobasseri M, Bishak YK, Jafarabadi MA. Effects of zinc supplementation on serum leptin level and insulin sensitivity in obese people. Trace Elem Electrolytes. 2014;31(1):27–32.
  • 35.Dandin E, Karaboga P, Uzun A, Taylor KP, Kristo AS. Nutrition knowledge and diet in female college students in turkey: youth education in nutrition Initiative/Nutrition education works (YENI/NEW)—A Cross-Sectional pilot study. Dietetics. 2023;2(4):344–55. [Google Scholar]
  • 36.Amamoto R, Dozono M, Toyama K. The relationship between dietary life and indefinite complaint in female nutrition department students. Seinan Jo Gakuin Bull. 2004;3:75–85. [Google Scholar]
  • 37.Ezezika O, Oh J, Edeagu N, Boyo W. Gamification of nutrition: A preliminary study on the impact of gamification on nutrition knowledge, attitude, and behaviour of adolescents in Nigeria. Nutr Health. 2018;24(3):137–44. [DOI] [PubMed] [Google Scholar]
  • 38.Casperson SL, Sieling J, Moon J, Johnson L, Roemmich JN, Whigham L. A mobile phone food record app to digitally capture dietary intake for adolescents in a free-living environment: usability study. JMIR mHealth uHealth. 2015;3(1):e3324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Aresi G, Giampaolo, Martina, Chiavegatti, Benedetta, Marta E. Process evaluation of food game: a gamified school-based intervention to promote healthier and more sustainable dietary choices. J Prev. 2023;44(6):705–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Yoshida-Montezuma Y, Ahmed. Mustafa, ezika, Obidimma. Does gamification improve fruit and vegetable intake in adolescents? A systematic review. Nutr Health. 2020;26(4):347–66. [DOI] [PubMed] [Google Scholar]
  • 41.Çevik C, Örsal Ö, Amaro S. Comparison of the effect of School-Based game and training intervention on overweight and obese students on weight loss: A randomized controlled trial. J Nursology. 2024;27(1):47–57. [Google Scholar]
  • 42.Rosati R, Regini L, Pauls A, Strafella E, Raffaelli F, Frontoni E. Gamification in nutrition education: the impact and the acceptance of digital game-based intervention for improving nutritional habits. J Computers Educ. 2025;12(2):367–90.
  • 43.Zargaraan A, Dinarvand R, Hosseini H. Nutritional traffic light labeling and taxation on unhealthy food products in iran: health policies to prevent non-communicable diseases. Iran Red Crescent Med J. 2017;19(8):18. [Google Scholar]
  • 44.Thorndike AN, Riis J, Sonnenberg LM, Levy DE. Traffic-light labels and choice architecture: promoting healthy food choices. Am J Prev Med. 2014;46(2):143–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Petkevičius M. The impact of gamification elements on the intention to use health related applications: Vilniaus universitetas.; 2024.
  • 46.Blidby L, Börjes M, Haglund K, Lundbergh O, Solberg Ruhn A. Using gamification to help children with daytime incontinence. 2024.
  • 47.Fallah Tafti S, Hemmati F, Foroutani F, Hakimi J. The effect of gamification on teaching and learning students’ lessons. J New Res Approaches Manage Acc. 2022;6(85):86–102. [Google Scholar]
  • 48.Bladt L, Vermeulen J, Vermandel A, De Win G, Van Campenhout L, Innovative. Technology-Driven, digital tools for managing pediatric urinary incontinence: scoping review. Interact J Med Res. 2025;14(1):e66336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Kim Y-N, Lee Y, Suh Y-K, Kim D-Y. The effects of gamification on tourist psychological outcomes: an application of letterboxing and external rewards to maze park. J Travel Tourism Mark. 2021;38(4):341–55. [Google Scholar]
  • 50.Ozdamli F, Milrich F. Positive and negative impacts of gamification on the fitness industry. Eur J Invest Health Psychol Educ. 2023;13(8):1411–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Aliu J, Oke AE, Abayomi T, Aigbavboa C, Makanjuola S. Exploring the critical success factors for adopting gamification in the Nigerian construction sector. Built Environ Project Asset Manage. 2024;14(2):184–200. [Google Scholar]
  • 52.Higgins J, LaSalle AL, Zhaoxing P, Kasten M, Bing K, Ridzon S, Witten T. Validation of photographic food records in children: are pictures really worth a thousand words? Eur J Clin Nutr. 2009;63(8):1025–33. [DOI] [PubMed] [Google Scholar]
  • 53.de Sousa Santos C, Garcia BC, de Chaves LA, Moreira, Gomes MF, Fernandes BS, Esteves EA. Development, usability, formative assessment, and story immersion of nutrigame, a mhealth nutrition education app. J Interact Syst. 2023;14(1):470–80. [Google Scholar]

Associated Data

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Supplementary Materials

Supplementary Material 1. (31.3KB, docx)

Data Availability Statement

All data generated or analyzed during this study are included in this published article.

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