Initial Development of ”Infection Defender”: A Children’s Educational

Game for Pandemic Prevention Measurements

Ivan Nikolov and Claus Madsen

Department of Architecture, Design and Media Technology, Aalborg University, Rendsburggade 14, Aalborg, Denmark

Keywords:

Health, Education, Pandemic, COVID-19, Web Application, Serious Games.

Abstract:

Using serious games to communicate and teach complex topics to children and adolescence has gained a lot of

popularity, especially in the medical ﬁelds. The spread of COVID-19 and the need to change everyday habits

has opened up the need to teach children the required precautions for limiting the spread of potential pan-

demics. In this paper we present the initial development of the game Infection Defender, promoting children’s

awareness of closing schools, social distancing, testing and hospitalization for ﬁghting the spread of infectious

diseases in Denmark. These activities are given in the hands of children, between 10 and 13 years old, and

the goal of the game is achieving a balanced response to a possible infectious decease outbreak. We present

the game, its design considerations and how the learning objectives are integrated into it. An analysis of the

game by pedagogical workers is made and a pilot test is carried out assessing children’s reactions to it. Initial

positive feedback shows that the game sparks interest and discussion in children and can be used as part of the

study curriculum to help children understand the need for certain measurements. The game code is available

online - https://github.com/IvanNik17/InfectionGame.

1 INTRODUCTION

Serious games and gamiﬁed experiences are becom-

ing more and more widely used for teaching com-

plex topics to both children and adults, especially in

the ﬁeld of health education (Lu and Kharrazi, 2018).

The tendency of developing such games has shown

a steady increase starting from the early to mid two

thousands and their target audiences have expanded

from professionals, to children and adolescents. The

topics of such games have also expanded to cover a

wide array of health concerns, problems and good

practices. Such topics range from oral health edu-

cation games (Malik et al., 2017), to mental health

education games (Lau et al., 2017) and improving

eating habits (Chow et al., 2020). Serious games

have proven especially important, with communicat-

ing best practices and behaviours for prevention of the

spread of diseases. These serious games can be build

as e-learning packages (Eley et al., 2019), that can

be implemented as part of the curriculum of students,

as a package of educational experiences (Hale et al.,

2017) or as mobile (Molnar and Kostkova, 2018) or

as virtual (Clack et al., 2018) and augmented real-

ity (Kang and Chang, 2019) experiences. Games that

address directly infection and disease understanding

and prevention are being researched (Castro-S

anchez

et al., 2016), especially with the rise of education

needs in the face of pandemics like the COVID-19

one. In this paper we present the initial development

and testing of an educational infection prevention se-

rious game ”Infection Defender”. The game is di-

rected towards 10 to 12 year old children and aims

to introduce the concepts of social distancing, infras-

tructure lockdown and the problems with hospital ca-

pacity. We go through the process of designing the

game experience, as well as the initial evaluations,

both from teachers, as well as from students.

Figure 1: A view from the developed game ”Infection De-

fender” presented in the paper.

Nikolov, I. and Madsen, C.

Initial Development of ”Infection Defender”: A Children’s Educational Game for Pandemic Prevention Measurements.

DOI: 10.5220/0010284102530260

In Proceedings of the 16th International Joint Conference on Computer Vision, Imaging and Computer Graphics Theory and Applications (VISIGRAPP 2021) - Volume 1: GRAPP, pages

253-260

ISBN: 978-989-758-488-6

253

2 STATE OF THE ART

It has been shown that serious games can improve stu-

dent engagement, help with topic understanding and

inﬂuence learning outcomes, when introduced as part

of the learning curriculum (Huizenga et al., 2017).

Even with these beneﬁts, the introduction of serious

and educational games in classes is still very lim-

ited. For health education, serious games are used as

tools to help with getting a better understanding about

vaccinations (Ohannessian et al., 2016), food hygiene

(Young et al., 2019), antibiotic resistance in bacteria

(Molnar, 2017; Govindan, 2018).

With the increased need for proper information

dissemination to both adults, children and adoles-

cences with the spread of the COVID-19 pandemic,

a number of educational games have been developed.

These serious games tend to tackle ideas such as

social distancing, infection spread, the importance

of testing and good hygiene practices. Some of

these gamiﬁed experiences are directed at instructing

personal on proper containment procedures (Suppan

et al., 2020) and takes the form of e-learning ma-

terials containing a mix of interactive experiences,

videos and tests. Other experiences use the pandemic

data present online, to create simulation like environ-

ments to visualizing how infections spread on a lo-

cal (Observable, 2020) and global (Tuovinen, 2020)

scale. These experiences put the power of choice in

the hands of players and use these choices to achieve

different ending. Through these endings, users can

see how following best practices can help not only

themselves, but the people around them. These games

adapt a more serious tone and clean design, which

can be deemed not appealing to younger children.

Other educational games rely more on the simpliﬁed

representation of a pandemic and use more simple

and easy to grasp game mechanics and visuals (Jacob

and Wiseman, 2020; LuluLab, 2020), more suited for

younger children. These games simplify the ideas of

social distancing, treatment, wearing mask.

For developing our proposed solution we try to

strike a balance, between a simpliﬁed approach to rep-

resentation of the many different problems associated

with dealing with pandemics and developing a game

that can be used for self-reﬂection and evaluation of

the players choices. To do this we develop a simple

gameplay concept, inspired by the approach presented

by (Molnar and Kostkova, 2018) and combine it with

a system that takes into account the different player

choices, which can be later viewed and accessed in

easily to understand and clean graphical form.

3 METHODOLOGY

The game development will be discussed in this sec-

tion, going from the initial idea inception, through the

choice of the main topics of the game - closing in-

frastructures, social distancing, testing and hospital-

ization to limit infection spread. We will also look

at how each of these topics has been introduced in

the game and how the idea of achieving balance be-

tween lowering the infection rates and keeping peo-

ple safe and dealing with the consequences of pro-

longed lockdown measurements. Finally, we will dis-

cuss the tools used for visualizing the consequences

of the players’ actions and how they can be used as a

positive teaching feedback loop.

The application is built in the Unity game engine,

utilizing a simple one screen style, which is easy to

port to different platforms like mobile and tablet or

web-based. The visual style relies on a 2.5D combina-

tion of polygonal objects and sprites, which is aimed

at a younger audience and emphasises lightweight vi-

suals, which should run on a wide array of hardware.

3.1 Initial Idea

The driving force for developing the game is creating

a engaging, easy to understand and educational appli-

cation, which can be used as a supervised tool, part of

a study curriculum. Pandemic and COVID-19 spread

visualization materials currently present are directed

more to the general public (Observable, 2020; Tuovi-

nen, 2020) and lack an easy to comprehend interface

and engaging gameplay, that would make them ap-

peal to younger children. On the other hand, there are

the children oriented education games like (Jacob and

Wiseman, 2020; LuluLab, 2020), which try to teach

good habits to children, but lack a more serious look

on how, the players’ choices have affected the game’s

outcome, which is proven to be a strong learning tool

(Taub et al., 2020).

The main topics we look at are social distancing,

closing of infrastructures, hospitalization and the ef-

fect of the pandemic and social precautions on peo-

ple’s mental health. The most important topic is social

distancing, as this is an idea that has become prevalent

in lowering the transmission rates of infections. It can

also be seen as a new concept for younger children,

which changes the way they interact with one another,

their family, teachers and random people in their ev-

eryday life. The second topic is the closing of infras-

tructures like schools, parks, shops and others, which

help limit the spread of infections, but also drastically

changes the day to day lives of children. The testing

and hospitalization are also topics, which can prove

GRAPP 2021 - 16th International Conference on Computer Graphics Theory and Applications

254

hard to explain to younger children. Finally, the topic

of the consequences of all these measurements on the

mental state of everyone that experiences them.

Next a design philosophy for the developed game

needs to be selected. We choose to build the game

around the idea of balancing between four main fac-

tors - amount of people sick in society, the maxi-

mum possible hospital capacity, the possibility to en-

force stronger or lighter social distancing measure-

ments and the mental health strain that these can have

on people. The game should have multiple levels, as

this has shown to produce more engagement (Wehbe

et al., 2017; Korchi et al., 2020) and each level should

last for a set time limit, shown to the players as days.

This would again mimic the real world problems of

prolonged social distancing. A view from the main

screen of ”Infection Defender”, can be seen in Figure

3.2 Designing the Gameplay

The main factors of the game can be extremely

complicated to visualize and communicated, even to

adults. This is why special care needs to be taken for

expressing them in a way that children can understand

and relate to. It is shown that children respond better

to visual cues and explanations (Javora et al., 2019),

even though these visual do not help with learning,

they help with directing and keeping the attention of

children. The majority of the game design concerning

pandemic topics is thus developed as visual concepts.

The core playability of the designed game re-

volves around the formula of catching and dodging.

These types of fast passed gameplay are shown to

have a positive inﬂuence in the possibility of chil-

dren learning and understanding the information, be-

ing given through the gameplay experience. Hav-

ing chosen the main gameplay loop, each of its parts

needs to be connected to one of the four main factors.

The three parts of the catching and dodging loop are:

• Obstacles and rewards are spawned at one part of

the game ﬁeld

• A player-controlled character dodges obstacles

and collects rewards at the center of the game ﬁeld

• A end zone collects the missed obstacles and re-

wards, changing a player score

The ﬁrst part of the gameplay loop, is where

healthy and infected people can spawn. A cartoon 3D

model of a person is created for this (Figure 2a), for

easier association, where healthy people are spawned

with blue shirts and infected people with red shirts.

This is done for easier color differentiation. To make

the visual representation of this easier to understand,

these people are spawned from houses, which are

shown as part of society (Figure 2b). They can then

go into one of four possible infrastructures - a super-

market, a school, a park with a pool and an amuse-

ment park (Figure 2e). This represents what a person

could do in a normal everyday life context, without

any social distancing restrictions in play. Here the

ﬁrst interaction possibility is given to users - they can

choose to open or close these infrastructures, effec-

tively limiting the number of people that can spread a

possible infection. Once a infrastructure is closed, an-

other of the main factors comes into play - the gradual

decrease in people’s happiness. This happiness is de-

creased every day, while the infrastructure is closed,

until it’s reopening, when it starts to increase.

The second part of the gameplay loop is repre-

sented a player controlled character that can catch in-

fected people and send them to the hospital. For the

character we have chosen a representation of an am-

bulance, where sick people can be intercepted (Figure

2c). Here another of the chosen factors is developed

- the player can try to catch every infected and send

them to the hospital, but that would take up all of the

hospital’s capacity (Figure 2d). The third part of the

loop is the end zone, where the healthy people and

the infected ones, missed by the player would end up.

This is represented with houses, which represent peo-

ple visiting their friends, family or relatives and if in-

fected, unknowingly spreading the infection (Figure

2f).

Four endings are possible for each level, repre-

senting problems faced by people and governments

at times of epidemics spread:

• The player lets too many infected people pass and

the infection spreads too much

• The player hospitalizes too many infected people,

resulting a shortage of hospital beds

• The player leaves the infrastructures closed for

too long, resulting in in a deterioration of people’s

mental health and happiness

• The player manages to navigate the epidemic for

a set number of days, without any of the ﬁrst three

endings happening

This combination of endings creates a sense of un-

certainty and the possibility of experimentation with

different play strategies, which have been shown to

help with engagement and interest (Nugroho et al.,

2018; Tancred et al., 2018). This ties to the post-level

experience, where the consequences of the players ac-

tions are visualized.

Initial Development of ”Infection Defender”: A Children’s Educational Game for Pandemic Prevention Measurements

255

(a) (b) (c) (d)

(e) (f)

Figure 2: Parts of the gameplay loop - infected and healthy people (Figure 2a), houses which spawn new people (Figure 2b),

ambulance used by the player to catch infected people (Figure 2c), hospital building, where infected people go and which

has maximum possible capacity (Figure 2d), different infrastructures, which can be closed to slow down the infection spread

(Figure 2e) and houses representing society (Figure 2f).

(a) (b)

Figure 3: Two of the end screens of the game giving information to the player. Figure 3a is the end of level visualization,

showing what were the end results from the decisions of the player. The results are separated into - how many people were

hospitalized, how many people have spread the infection and how many days was each of the infrastructures closed. From

this screen users can either go directly to the next level with higher challenge or go and see the more detail results Figure 3b.

Details screen, shows the day by day choices and progress of the player, for how many people were hospitalized, how many

left the hospital, how many were missed and how the happiness and mental health changed depending on the opening and

closing of infrastructures.

3.3 Post-level Statistics

Once a level is ﬁnished, no matter the achieved end-

ing, the post-level statistics are visualized. These are

separated in two screens. The ﬁrst one (Figure 3a)

represents a more easily approachable overview of the

consequences from the level, where everything is pre-

sented in the form of a combination of images and

snippets of text. In this screen the overview of how

much infected people have been hospitalized, how

many have been missed and how many days have the

different infrastructures been closed is given. The sec-

ond screen is given as a optional experience, which is

designed to be used, as part of a class discussion or

together with an teacher or parent. In this screen the

day by day changes in the overall infected and hospi-

talized people, as well as the decrease in happiness for

each closed place, through the played level are given

(Figure 3b). Here users can freely move through the

different days and see how their choices have inﬂu-

enced the different parts of the game and where po-

tential problems have started to arise.

The two post-level statistical screens are designed,

with the idea to provoke discussion and a sense of cu-

GRAPP 2021 - 16th International Conference on Computer Graphics Theory and Applications

256

riosity. Users should be able to easily see, how their

interactions and choices have invoked a certain level

ending sequence. And more importantly these parts

of the game are designed to provide a sense of reﬂec-

tion and the desire to understand and try again.

4 TESTING

The main concepts of the game and the gameplay loop

are initially tested through a series of internal collabo-

rator testing. Once the overall feel of the game and its

components, menus and basic visuals are selected, the

second part of the evaluation is done through a collab-

oration with an external primary school teacher. The

teacher evaluated the application and the possibility of

using it as part of a curriculum or self-study sessions

on the topic of decease and infection prevention. Fi-

nally, an unstructured playtesting session is arranged

with a class of 11 to 12 year old children. After the

play session, kids are asked question about what they

liked and disliked about the game, as well as what

they learned and what was hard to understand.

4.1 Internal Testing

Through the process of developing the educational

game, an internal collaborator testing was set up,

where participants could test the developed game

parts and provide feedback about the usability of the

menus, the level of difﬁculty, the gameplay elements

and feeling of the game. For this early a set of strict

guidelines are set up. As the participants are older

people the main concern at this stage are - the difﬁ-

culty of the game, the overall clearness of the message

and evaluation of the different game parts. The par-

ticipants were given the game and left to test it out at

their pace. They were given an online questionnaire

containing both open ended questions evaluating the

experience, as well as questions regarding their play

setup - using a computer, table, phone, as well as the

maximum reached level.

The main point that participant feedback focused

on was a balance between challenge and user interest

and to facilitate that a gradual increase in difﬁculty

is introduced for each successfully passed level. This

increase is tied to the basic ideas present in the simpli-

ﬁed mathematical modeling of infection diseases, as

presented in the Susceptible, Exposed, Infectious, or

Recovered (SEIR) model (Li and Muldowney, 1995).

These types of models are used for predicting the

possible spread, total number of infections, the time

needed for the disease to die down, etc. Taking inspi-

ration of these types of models, we base the increase

in difﬁculty of the game to a number of factors:

• The chance of spreading the infection - repre-

sented by the stochastic chance of spawning an

infected person. This chance becomes higher with

each successful level and is capped after a certain

values

• Time to recover - represented by the time spawned

people taken to the hospital would become

healthy, lowering the number of infected in it

• Number of hospital beds and number of possible

infected in society, before the spread becomes too

much. This is represented in the game as lowering

values, making it harder for the player to achieve

the a positive level outcome

The amount by which these values increase or de-

scries, as well as the caps to how much they can

change are set, after a number of testing sessions, end-

ing with participant feedback and discussions.

Another important factor of this initial internal

testing is providing a easy to learn and use controls

and menus for the game. Early on it was chosen that

the game needs to be playable in a web browser, with

an additional version for mobile and touch screen de-

vices. This inﬂuenced the design of the interactions

with the game, which mostly consist of swipes and

presses. Both the mechanic of catching the infected

people and opening and closing infrastructures are de-

signed to be used with just presses and swipes. All

menus are also designed to be easily navigated, with

only button presses and dragging motions.

4.2 Teacher Feedback

Once a stable internal prototype is created, the next

step is an evaluation by a primary school teacher. This

evaluation is done so feedback can be given on any

possible problems or places where children might ﬁnd

context hard to understand or navigate. In addition,

parts of the game that need to be added or changed

can be identiﬁed, to make the game better suited as

a possible part of a study curriculum. The evaluation

guidelines given to the teacher were more relaxed -

they could test the prototype and use a think-aloud

method for asking questions and giving feedback to

their experience.

The teacher is experienced in teaching students

between 10 and 13 years old and is used to imple-

menting activities, games and participation experi-

ences in the day to day curriculum. After analysing

the game a number of points were given about the us-

ability, ease of understanding and lessons that can be

learned from it. A number of concerns are given for

Initial Development of ”Infection Defender”: A Children’s Educational Game for Pandemic Prevention Measurements

257

the possibility that students can get incorrect under-

standing of the spread of infections or how the differ-

ent measures would change the spread. In addition, it

is pointed out that the reliance of images and smaller

amount of text, could make understanding and get-

ting into the game’s ﬂow a problem. Finally, some of

the visualizations in the game are pointed out as ei-

ther being too hard to understand or posing a risk of

stressing out the students. To address these concerns

a number of improvement are made to the experience,

to contextualize and reﬁne its visuals and messages.

The main changes made from this feedback is the

addition of ”How To Play” (Figure 4a) section to the

start menu of the game, as well as an extended vi-

sual tutorial (Figure 4b), which runs users through

the main parts of the game and explains how they

function and what is required. In addition, the main

playable character is changed to a bed, where in-

fected people can be cough and send to the hospital.

This is made to make it less stressful to children and

lower the association to ambulances and emergency

situations. The interface is also made more reactive,

with the implementation of additional visual cues and

sound effects to signal to children that there are prob-

lems.

4.3 Student Feedback

As part of the evaluation a number of students from

third, fourth and ﬁfth grade were shown the prototype

and could try it out. For the evaluation the teacher

ﬁrst would show the game to the students and ex-

plain the overall structure and goal. The students then

play the game, initially with the teacher as a facilita-

tor and later by themselves. Once they felt that they

had played enough the teacher asked the whole class

what were their thoughts and questions.

The third grade students are shown to be receptive

to the overall message of the application with com-

ments like - ”If you close schools not many people

will be infected. It ﬁts that it got better in Denmark

when we closed the schools” and ”You lose, if you

close things for too long”. It is also shown that there

is still some confusion, about the rate at which the

infection spreads - ”It’s a strange game because it’s

mega easy to get infected in that game. It doesn’t go

that fast in reality”. The game needs to communi-

cate better the generalization of the infection spread

from real life to game form and what simpliﬁcations

are used.

Students from fourth and ﬁfth grade were testing

the application, from a point of view of using it as

a source to spread awareness. Students had observa-

tions on the messages communicated by the prototype

- ”You get isolated at home. It is only if things have

gone awry that you get to the hospital”, as well as the

need to position the game as part of a larger contex-

tual explanation of infection spread - ”It shows nicely

enough how it develops, but if you had not been told

in advance that it was a model of infection spread,

and have just played the game, you probably would

not have caught it. It requires that you have been told

the meaning of the game from the start”. An interest-

ing insight in the students’ understanding of infection

spread, many comments were made about the need

for differentiating between different groups of peo-

ple - older, younger or ones with pre-existing condi-

tions and how some are more susceptible, than others.

Comments like ”It does not show at all how bad it

can be for other people. It does not show that people

are different” and ”It’s weird if they come down from

their home, then to school and then down to another

home. Is it their grandparents’ home - so they can

infect them?”, show that a better separation between

the visualized people and houses needs to be done, so

the idea of not going out and staying home to lower

infection rates can be more easily communicated.

Overall the even it this early prototype stage, the

game has been shown to produce a lot of discussion

on the topic of infection spreading and how to prevent

it in a sustainable way. By seeing the consequences of

their decisions in each level, students could get a bet-

ter understanding of what was shown and try to do

better. A number of problems and possible optimiza-

tions are extracted from the students feedback. The

most important take always can be summarized as:

• The simpliﬁcation of the real world infection

spread, to a simple game form needs to be ex-

plained in bigger detail - what are the houses rep-

resenting, what are the closed and open facilities

representing, why it’s important to have some in-

fected going to the hospital, which it’s important

to not let the infection spread too much.

• There needs to be a separation between different

groups of people - the ones more vulnerable to the

effects of a possible infection and the ones less

vulnerable. Different measurements can be em-

ployed to address different people.

• Make the experience more personal - children

want to see familiar things so they can empathise,

with what’s unfolding on the screen.

• A larger study context needs to be provided for

the game experience. It can be used as a part of a

infection prevention study, with other similar ex-

periences.

GRAPP 2021 - 16th International Conference on Computer Graphics Theory and Applications

258

(a) (b)

Figure 4: Screens added after the initial testing by the teacher - a ”How to Play” screen (Figure 4a), which can be easily access

from the start menu and would give a starting understanding of what is the main idea of the game. The second screen is an

interactive tutorial (Figure 4b), which gives a deeper look on the different system. The tutorial cannot be skipped the ﬁrst time

the game is started.

5 NEXT STEPS

Because of lack of long term testing and quantita-

tive data the current study presents just a initial ex-

ploration, which will be build upon in consecutive

studies. A number of next steps are suggested for

the development of the application and its position in

a possible educational package. Further work with

teachers would be made to create a study curriculum

comprising of lectures on the topic of infection spread

and prevention. These lectures will be followed by a

number of animated shorts presenting every day sce-

narios where people could stop the spread of a in-

fections disease by following preventive recommen-

dations, such as social distancing, avoiding contact,

washing their hands and limiting traveling. The pre-

sented game prototype will be followed by a num-

ber of additional interactive applications and physical

boardgames around the same ideas. Children would

be able to play these games both together with teach-

ers, as well as alone. After the activities the knowl-

edge of students on the topics will be tested with a

number of assignments and discussions. This edu-

cational package will be available online for use by

teachers.

6 CONCLUSION AND FUTURE

WORK

In this paper, we presented the ﬁrst steps for creat-

ing a educational game for children between 10 and

13 years old, in the topic of infection spread preven-

tion. We build the application with the main idea of

choices and consequences, where a balance between

preventing infection spreading, shortages of hospital

beds and preserving the population’s morale needs to

be found. To facilitate the idea of choices and conse-

quences, the application contains extensive post-game

statistical summaries, which can be used to reﬂect on

the choices and how they have affected the outcome

of the game.

Initial testing of the prototype was made as a com-

bination of internal developer testing, teacher evalu-

ation and student feedback. A number of improve-

ments were made to the application as a result of

these tests - mainly an better visual representation of

the game world, an implementation of tutorials, more

reactive user interfaces and menus. The application

has proven to facilitate discussion between students

around infection spread and interest and interest in the

topic.

As a next step a structured user testing is pre-

pared for students, where statistics like amount of

time played, maximum level reached, positive versus

negative outcomes reached, as well as hospital space

used, amount of days each infrastructure is closed,

amount of missed infected people, would be analyzed

to better suit the game to the user group. In addition,

a mobile version of the game would be prepared, as

well as implementing all the feedback from the initial

round of feedback.

ACKNOWLEDGEMENTS

This work was partially funded by the The Novo

Nordisk Foundation, grant no. NNF20SA0063089.

This funding is gratefully acknowledged.

Initial Development of ”Infection Defender”: A Children’s Educational Game for Pandemic Prevention Measurements

259

REFERENCES

Castro-S

anchez, E., Kyratsis, Y., Iwami, M., Rawson,

T. M., and Holmes, A. H. (2016). Serious elec-

tronic games as behavioural change interventions in

healthcare-associated infections and infection preven-

tion and control: a scoping review of the literature and

future directions. Antimicrobial Resistance & Infec-

tion Control, 5(1):34.

Chow, C. Y., Riantiningtyas, R. R., Kanstrup, M. B., Pa-

pavasileiou, M., Liem, G. D., and Olsen, A. (2020).

Can games change children’s eating behaviour? a re-

view of gamiﬁcation and serious games. Food Quality

and Preference, 80:103823.

Clack, L., Hirt, C., Wenger, M., Saleschus, D., Kunz, A.,

and Sax, H. (2018). Virtue-a virtual reality trainer

for hand hygiene. In 2018 9th International Confer-

ence on Information, Intelligence, Systems and Appli-

cations (IISA), pages 1–2. IEEE.

Eley, C. V., Young, V. L., Hayes, C. V., and McNulty, C. A.

(2019). Evaluation of an e-learning platform for edu-

cators to improve education around infection preven-

tion and antibiotics. Technology, Pedagogy and Edu-

cation, 28(5):485–501.

Govindan, B. (2018). Bacterial survivor: an interactive

game that combats misconceptions about antibiotic re-

sistance. Journal of microbiology & biology educa-

tion, 19(3).

Hale, A. R., Young, V. L., Grand, A., and McNulty, C. A. M.

(2017). Can gaming increase antibiotic awareness in

children? a mixed-methods approach. JMIR Serious

Games, 5(1):e5.

Huizenga, J., Ten Dam, G., Voogt, J., and Admiraal, W.

(2017). Teacher perceptions of the value of game-

based learning in secondary education. Computers &

Education, 110:105–115.

Jacob, M. and Wiseman, R. (2020). Can you save the world.

https://martin-jacob.itch.io/can-you-save-the-world.

Accessed: 2020-08-31.

Javora, O., Hannemann, T., St

arkov

a, T., Voln

a, K., and

Brom, C. (2019). Children like it more but don’t learn

more: Effects of esthetic visual design in educational

games. British Journal of Educational Technology,

50(4):1942–1960.

Kang, Y.-S. and Chang, Y.-J. (2019). Using a motion-

controlled game to teach four elementary school chil-

dren with intellectual disabilities to improve hand hy-

giene. Journal of Applied Research in Intellectual Dis-

abilities, 32(4):942–951.

Korchi, A., Dardor, M., Messaoudi, F., and Mabrouk, E. H.

(2020). Progression of a serious game difﬁculty from

a playful and pedagogical point of view: Analyze and

representation. Education and Information Technolo-

gies, pages 1–11.

Lau, H. M., Smit, J. H., Fleming, T. M., and Riper, H.

(2017). Serious games for mental health: are they ac-

cessible, feasible, and effective? a systematic review

and meta-analysis. Frontiers in psychiatry, 7:209.

Li, M. Y. and Muldowney, J. S. (1995). Global stability for

the seir model in epidemiology. Mathematical bio-

sciences, 125(2):155–164.

Lu, A. S. and Kharrazi, H. (2018). A state-of-the-art sys-

tematic content analysis of games for health. Games

for health journal, 7(1):1–15.

LuluLab (2020). Covid-19 educational game. https:

//lululab.org/educationalgames/covid-19-game. Ac-

cessed: 2020-08-31.

Malik, A., Sabharwal, S., Kumar, A., Samant, P. S., Singh,

A., and Pandey, V. K. (2017). Implementation of

game-based oral health education vs conventional

oral health education on children’s oral health-related

knowledge and oral hygiene status. International

Journal of Clinical Pediatric Dentistry, 10(3):257.

Molnar, A. (2017). Children as agents of change in combat-

ting antibiotic resistance. Journal of health services

research & policy, 22(4):258–260.

Molnar, A. and Kostkova, P. (2018). Learning about hy-

giene and antibiotic resistance through mobile games:

Evaluation of learning effectiveness. In Proceed-

ings of the 2018 International Conference on Digital

Health, pages 95–99.

Nugroho, S. M. S., Utama, A. S., Hariadi, M., Yuhana,

U. L., and Purnomo, M. H. (2018). Heirdom: Mul-

tiple ending scenario game for mathematics learning

using rule-based system. In 2018 International Con-

ference on Computer Engineering, Network and Intel-

ligent Multimedia (CENIM), pages 192–197. IEEE.

Observable (2020). People of the pandemic. https://

peopleofthepandemicgame.com/. Accessed: 2020-

08-31.

Ohannessian, R., Yaghobian, S., Verger, P., and Vanhems, P.

(2016). A systematic review of serious video games

used for vaccination. Vaccine, 34(38):4478–4483.

Suppan, M., Gartner, B., Golay, E., Stuby, L., White, M.,

Cottet, P., Abbas, M., Iten, A., Harbarth, S., and Sup-

pan, L. (2020). Teaching adequate prehospital use

of personal protective equipment during the covid-

19 pandemic: Development of a gamiﬁed e-learning

module. JMIR Serious Games, 8(2):e20173.

Tancred, N., Vickery, N., Wyeth, P., and Turkay, S. (2018).

Player choices, game endings and the design of moral

dilemmas in games. In Proceedings of the 2018 An-

nual Symposium on Computer-Human Interaction in

Play Companion Extended Abstracts, pages 627–636.

Taub, M., Azevedo, R., Bradbury, A. E., and Mudrick, N. V.

(2020). 9 self-regulation and reﬂection during game-

based learning. Handbook of Game-Based Learning,

page 239.

Tuovinen, J. (2020). Unusterra. https://github.com/

jarkkotuovinen/UnusTerra/. Accessed: 2020-08-31.

Wehbe, R. R., Mekler, E. D., Schaekermann, M., Lank, E.,

and Nacke, L. E. (2017). Testing incremental difﬁ-

culty design in platformer games. In Proceedings of

the 2017 CHI Conference on Human Factors in Com-

puting Systems, pages 5109–5113.

Young, V. L., Brown, C. L., Hayes, C., and McNulty, C. A.

(2019). Review of risk communication and education

strategies around food hygiene and safety for children

and young people.

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