Research report: A nurse-facilitated gamified health literacy intervention for substance use prevention among borderland ethnic school children in Northern Thailand: a preliminary quasi-experimental study

The study, conducted in Chiang Khong District of Chiang Rai Province, enrolled 54 students in Grades 4 to 6 and reported 100 percent retention, with every participant completing both the baseline assessment and a follow-up one month after the intervention ended.

Primary school children living in borderland regions face heightened vulnerability to early substance exposure because of socio-economic disparities and linguistic barriers, the researchers note. Gamified health literacy interventions are considered a promising way to engage young learners, but empirical evidence on nurse-facilitated digital interventions in borderland ethnic contexts has remained limited. The new study was designed to evaluate the short-term effectiveness of a novel intervention targeting substance use prevention among ethnic primary school students in this setting.

The research team, led by Pimpisa Chomsri and Surinporn Likhitsathian, with co-authors including Mullika Matrakul, Soontaree Suratana, Charoenchai Wongwatkit and Panida Chaiwang, used a two-arm quasi-experimental design with a non-randomized control group across two primary schools. Twenty-seven students were assigned to the six-week nurse-facilitated computer-based gamified intervention, and 27 received the standard school health curriculum as a control. Outcomes were measured at baseline and again one month after the intervention, with the total health literacy score serving as the primary outcome.

Secondary outcomes covered six health literacy subdomains and self-reported substance exposure risk scores assessed with an adapted ASSIST-Y scale. Between-group post-intervention comparisons for health literacy were analyzed using analysis of covariance, adjusting for baseline scores and baseline age differences as continuous covariates. Substance exposure risk scores were analyzed with independent samples t-tests and verified with non-parametric Mann-Whitney U tests. The study followed the TREND reporting guidelines for nonrandomized designs.

At the one-month follow-up, after controlling for baseline scores and age, the intervention group showed a statistically significant higher total health literacy score than the control group: 192.26 plus or minus 44.16 versus 166.67 plus or minus 28.38, an adjusted mean difference of 22.89 (95 percent confidence interval 1.83 to 43.94; F(1,50)=4.765, p=.034, partial eta squared=.087). Among the subdomains, the intervention group showed significant improvement in Understanding of Health Information (F(1,50)=4.518, p=.038, partial eta squared=.083, 95 percent confidence interval 0.27 to 9.37).

For the secondary substance risk outcomes, all participants scored within the low-risk threshold, a range of 0 to 3, at both baseline and follow-up. Nevertheless, at follow-up the intervention group reported a statistically significant lower alcohol risk score than the control group: 1.00 plus or minus 1.44 versus 3.00 plus or minus 2.65, a mean difference of -2.000 (t=-3.449, p=.001; Mann-Whitney U=202.50, p=.002). No significant between-group differences were detected for illicit drugs or volatile substances, with p-values above .05 for those outcomes.

The authors conclude that participation in the six-week nurse-facilitated computer-based gamified intervention was associated with short-term improvements in total health literacy, enhanced health understanding, and lower self-reported alcohol risk scores among ethnic primary school students in a borderland setting. They stress, however, that these findings should be considered preliminary evidence because of the non-randomized design, a baseline age imbalance between groups, and the brief one-month follow-up window.

Future multi-center randomized controlled trials incorporating longer follow-up timepoints are warranted, the team writes, to establish sustained outcome retention and broader adaptability of the approach. The study was not registered as a clinical trial; the authors state it was an educational, school-based health literacy evaluation conducted within regular academic hours among a nonclinical student population, involving no clinical patients, pharmacological agents, or healthcare interventions. Full prospective ethical approval was granted before the study began by the Human Research Ethics Committee of the Chiang Rai Provincial Public Health Office (Approval Code CRPPHO No. 235/2566). The article was published open access on 22 October 2026 as a peer-reviewed, accepted research paper.

Because the comparison groups were not randomized and the follow-up captured only a single month, the reported differences reflect short-term associations within this specific two-school sample rather than established long-term effects. The authors frame the work as an early step toward testing whether nurse-facilitated gamified learning can support substance use prevention education in borderland communities, with larger and longer trials needed before broader conclusions can be drawn.

Subject of Research: A nurse-facilitated gamified health literacy intervention for substance use prevention among ethnic primary school children in borderland Northern Thailand.

Article Title: A nurse-facilitated gamified health literacy intervention for substance use prevention among borderland ethnic school children in Northern Thailand: a preliminary quasi-experimental study

Article References: Chomsri, P., Likhitsathian, S., Matrakul, M., Suratana, S., Wongwatkit, C., & Chaiwang, P. (2026). A nurse-facilitated gamified health literacy intervention for substance use prevention among borderland ethnic school children in Northern Thailand: a preliminary quasi-experimental study. BMC Nursing. https://doi.org/10.1186/s12912-026-05456-4

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05456-4

Keywords: health literacy, gamification, substance use prevention, school children, nurse-led intervention, quasi-experimental study, Thailand, borderland health, alcohol risk, ASSIST-Y, BMC Nursing, primary schools