COVID-19, health literacy and ‘serious’ games.

COVID-19, health literacy and ‘serious’ games.

Addressing the COVID-19 pandemic, and its aftermath, requires individuals to rapidly acquire and then use public health information to modify their behaviour¹. In order to do this effectively individuals must first recognise which information is trustworthy and which is not. They must then understand and evaluate the trustworthy information and apply it to their own lives in a meaningful way; this is 'health literacy'. 

“We’re not just fighting an epidemic; we’re fighting an infodemic” Tedros Adhanom Ghebreyesus, WHO Director-General. 

A recent study found that health literacy in Europe is relatively poor with 47% having limited (insufficient or problematic) health literacy. This makes it more difficult to successfully acquire and apply vital public health information². The study identifies subgroups with even lower levels of health literacy; typified by existing health problems, financial deprivation, low social status, low education, or old age². 

For effective control of COVID-19 and orderly management of the aftermath, public health messages must be seen and acted upon by as many people as possible. Poor health literacy is a barrier to this, and it must be considered when planning public health information. Information must be easy to access and easy to understand so that individuals develop an accurate 'big picture' of the problem and their role in the solution. Individuals must be given simple and practical ‘calls to action’ that lead to sustained positive behavioural changes. 

Effective communication will be important when a COVID-19 vaccine is developed because ‘vaccine hesitancy’ and anti-vaccine misinformation must be challenged to increase vaccination rates and achieve ‘herd immunity’.

We believe that many of the current methods of delivering public health messages are less effective and engaging than they could be. We also believe that 'serious' games can help to overcome health literacy barriers. 

With the effective use of game mechanics and gamification we can reach a wider audience and make meaningful interactions more likely to happen, more engaging, more memorable, and ultimately more effective. 

We have been developing educational games for use in health and social care since 2004. Our largest partner and customer is the UK National Health Service (NHS). We have developed games in partnership with Health Education England (HEE) and Public Health England (PHE) addressing different aspects of infection prevention and control. Our games are also being used in a wide range of countries

We have developed several digital games that address infection-related public health issues and evidence suggests that they are effective at increasing knowledge and encouraging positive behavioural changes.

Flu Bee Game -

Designed to improve uptake of the seasonal flu vaccination by challenging common myths and misconceptions about the flu and the vaccine. Developed with the NHS to improve vaccine uptake among frontline staff. 

Since its launch in 2016 Flu Bee Game has been used extensively by health and social care providers in the UK and Europe. In 2019 we asked 1,801 NHS staff members to answer some questions after playing Flu Bee Game and in response to this question:

Has the Flu Bee Game changed your perception of flu vaccination? 28% reported a more positive view of the vaccine. 

In 2019 Queen's University Belfast carried out a study with students to investigate the impact of Flu Bee Game:

“…their knowledge, likelihood to get the vaccination and likelihood to recommend the vaccination to patients and the public improved after playing the game…an innovative learning tool associated with highly statistically significant improvements in knowledge.” Dr Gary Mitchell, Queen’s University Belfast.

Dementia Awareness Game -

Developed as part of a research initiative at Queen's University Belfast intended to improve public attitudes toward people living with dementia. The study found that players developed a significantly greater optimistic view of the abilities of people with dementia and what might be achieved by them.

“…after playing the game, a person's attitudes to people living with dementia improves. This statistically significant information is being prepared for an international journal.” Dr Gillian Carter, Queen's University Belfast.

COVID-19 Game

In March 2020 we used these games as a foundation to develop the COVID-19 Game. It is a relatively simple free-to-play game offering facts and challenging myths. It is a web app that runs through a web browser on any device. The information in the original game came from the  UK government and National Health Service (NHS) and the game has been updated several times to reflect changing guidance.

Since we made the game available over 5,000 people, from different continents, have played the game. We did not promote the game widely and we relied on informal social media marketing and word-of-mouth; we believe that with more extensive promotion a game could reach millions of people.

Here is some feedback from a science teacher in Egypt: "My students are in COVID-19 isolation and their response to eLearning was disappointing. I sent them the COVID-19 Game. It was like magic! They were engaged, they learned and were entertained."

We have translated the game in French and that version is now being offered on the website of the health ministry in France and via several large hospital groups. We are currently working on versions of the game for Africa.


¹ Zarocostas J. How to fight an infodemic. Lancet 2020; 395: 676.

² Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European Health Literacy Survey (HLS-EU). Eur J Public Health 2015; 25: 1053–58.

COVID-19: information; the best protection

Going through COVID-19