Gameful Experience Scale adapted and validated in Brazilian Portuguese for nursing education

Researchers have translated, culturally adapted, and tested the psychometric properties of the Gameful Experience Scale (GAMEX) for Brazilian Portuguese, producing a version intended to measure gamified learning experiences such as escape rooms in nursing education.

The work followed a methodological, quantitative, cross-sectional design organized in three phases: linguistic and cultural adaptation, content validation, and construct validation. The cross-cultural adaptation process followed World Health Organization guidance and the six-stage procedure described by Beaton and colleagues, moving through forward translation, synthesis, back translation, expert committee review, pre-testing, and documentation of the final version. Content equivalence was assessed through expert committee review and pre-testing with representatives of the target population, ensuring that translated items carried the same meaning for Brazilian respondents as in the original instrument.

Construct validity was examined using confirmatory factor analysis with a diagonally weighted least squares estimator and polychoric correlations, an approach suited to ordinal questionnaire data. Reliability was assessed with Cronbach’s alpha and McDonald’s omega, while discriminant validity was tested using the average variance extracted, the Fornell-Larcker criterion, and the heterotrait-monotrait ratio. These analyses together addressed whether the six domains of the scale held together as intended in the new linguistic and cultural context.

The validation sample included 135 participants with a mean age of 30.1 years (standard deviation 13.1, range 17 to 67). It comprised 82 students, accounting for 60.7 percent, and 53 professionals, accounting for 39.3 percent, drawn from the nursing school setting.

Reliability results varied by domain. Enjoyment showed Cronbach’s alpha of 0.911 and McDonald’s omega of 0.910, and Absorption reached 0.917 on both coefficients. Creative Thinking scored 0.866 and 0.869 respectively, and Absence of Negative Affect scored 0.852 and 0.856. Dominance registered 0.770 on both measures. The Activation domain was the weakest, with alpha of 0.657 and omega of 0.556, a level the authors flag as showing weaker psychometric performance.

The confirmatory factor analysis supported the overall six-factor structure of the adapted scale. Fit indices included a chi-square of 581.706 with 309 degrees of freedom, a chi-square to degrees of freedom ratio of 1.883, a comparative fit index of 0.958, and a Tucker-Lewis index of 0.953. The root mean square error of approximation was 0.081 with a 90 percent confidence interval of 0.071 to 0.091, and the standardized root mean square residual was 0.102.

Not all indices were fully satisfactory. The RMSEA and SRMR values were marginally above the prespecified thresholds, and the Activation domain’s weaker reliability adds a caveat to the overall picture. The authors also identified items Q18 and Q19 as requiring further linguistic, experiential, and psychometric refinement before the instrument can be considered fully settled in its Brazilian Portuguese form.

The study concludes that the Brazilian Portuguese adaptation of GAMEX showed promising evidence of structural validity and internal consistency for assessing gamified learning experiences, such as escape rooms, in this nursing education sample. The findings are specific to this population and sample size, and the authors note the identified limitations, including the marginal fit indices and the Activation domain. Further refinement of the flagged items is indicated before broader use of the instrument.

Subject of Research: Cross-cultural adaptation and validation of the Gameful Experience Scale (GAMEX) for Brazilian Portuguese in nursing education

Article Title: Cross-cultural adaptation and validation of the gameful experience scale (GAMEX) for Brazil

Article References: Abi Rached, C. D., Podgorica, N., Nakajima, D. L., Fonseca Paulo, C. D. S., de Souza Farinaci, E., da Cruz, E. A. A., & Cordeiro dos Santos, G. A. (2026). Cross-cultural adaptation and validation of the gameful experience scale (GAMEX) for Brazil. BMC Medical Education. https://doi.org/10.1186/s12909-026-10075-3

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10075-3

Keywords: GAMEX, gamification, nursing education, psychometric validation, Brazilian Portuguese, confirmatory factor analysis, internal consistency, cross-cultural adaptation, escape rooms, measurement scale, Cross-cultural, adaptation