Effects of a board game on dengue-related knowledge, attitudes, and confidence among primary healthcare nurses: a cluster randomized controlled trial

Dengue remains a major public health problem in endemic countries such as Indonesia, where primary healthcare nurses are involved in early case detection, initial management, referral, and community prevention. However, workplace-based dengue education is still commonly delivered through lectures, which might not fully support active engagement in busy primary care settings. Practical and engaging educational strategies are needed to strengthen frontline nurses’ capacity for dengue-related practice. This study evaluated the effects of a dengue board game compared to lecture-based education on primary healthcare nurses’ dengue-related knowledge, attitudes, and confidence. A two-arm cluster randomized controlled trial was conducted. Sixteen primary healthcare units in Indonesia were randomized to either board game-based education (intervention group) or lecture-based education (control group). In total, 106 primary healthcare nurses participated (intervention, n = 50; control, n = 56). The board game was informed by Kolb’s Experiential Learning Theory and the ARCS motivational model. Dengue-related knowledge, attitudes, and confidence were assessed at the baseline, immediately after the intervention, and at a 1-month follow-up. Data were analyzed using linear mixed models to account for clustering and repeated measurements. Dengue-related knowledge demonstrated a significant group-by-time interaction ( F = 4.48, p = .01), with knowledge increasing more in the intervention group immediately post-intervention (mean 4.04 to 5.72) than in the control group (mean 4.54 to 5.43). Group-by-time interactions were not statistically significant for attitudes ( F = 2.57, p = .08) or confidence ( F = 0.28, p = .76), with both groups showing similar improvements over time. Learning satisfaction was high in both groups. Knowledge, attitudes, and confidence improved following both educational approaches. Compared to lecture-based education, the board game was associated with a greater immediate improvement in knowledge; however, this finding should be interpreted with caution because the board game session was longer. As a brief and engaging educational strategy, the board game may serve as a promising supplementary approach for dengue education among frontline primary healthcare nurses in endemic settings. This study was registered with ClinicalTrials.gov (NCT07028411). Registered on 19 June 2025; first participant enrolled on 8 August 2025.