Gamification versus Traditional Health Education for Sexual Health Knowledge among School-going Adolescents in Perambalur District, India: A School-Level Quasi-Experimental Study

Background: In India, Sexual Health Education (SHE) faces barriers such as cultural taboos and a lack of engaging methodologies, often leading to poor knowledge among school-going adolescents. The present study was undertaken to compare the effectiveness of gamification and traditional health education in improving sexual health knowledge and to assess post-intervention differences in motivation, attitude, and engagement among school-going adolescents in Perambalur district, Tamil Nadu. Methods: A quasi-experimental comparative study was conducted among 100 adolescents aged 12–14 years from two schools in Perambalur district, Tamil Nadu. Two schools were selected randomly from the district, and one school was allocated to the gamification arm while the other was allocated to the traditional health education arm. Pre- and post-intervention knowledge was assessed using a structured and pre-tested questionnaire. Post-intervention assessment also included motivation, attitude, and engagement. Statistical Analysis: Between-group post-intervention scores were compared using analysis of covariance (ANCOVA). Within-group change was assessed by a paired t -test. Effect sizes (Cohen’s d) and 95% confidence intervals are reported alongside every P value. Results: After baseline adjustment, individual-level ANCOVA showed a higher composite knowledge score in the gamification arm (adjusted mean difference 2.97, 95% CI 1.17 to 4.77, P = 0.002; Cohen’s d 0.73). Domain-level ANCOVA showed statistically significant adjusted advantages for gamification in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) (adj. diff 0.55, 95% CI 0.05 to 1.05, P = 0.032), good touch/bad touch (adj. diff 0.94, 95% CI 0.27 to 1.62, P = 0.006), and puberty (adj. diff 1.42, 95% CI 0.49 to 2.36, P = 0.003); the peer-pressure adjusted difference was borderline (adj. diff 0.62, 95% CI −0.04 to 1.29, P = 0.067). Conclusions: A short, school-delivered gamified intervention improved adolescent sexual health knowledge, motivation, engagement, and attitude beyond a matched-content lecture programme. Given the single-cluster-per-arm design, these findings should be interpreted as complementary evidence supporting scaled evaluation of digital gamified modules within the existing National AIDS Control Organisation’s Adolescent Education Programme (NACO AEP) framework.