Efficacy of Stop Tb Cricket : A Mobile Phone Game for Edutainment

Efficacy of Stop Tb Cricket : A Mobile Phone Game for Edutainment Anjali Singh Assistant Professor, Department of Development Communication and Extension, Lady Irwin College, University of Delhi, India Abstract Mobile learning solutions are effective and mobile learning content delivery is being used as an ICT based learning method for development communication and edutainment and reaching out to grassroots communities. Tuberculosis (TB) is becoming a growing concern in India and youth comprise a large share of the Tuberculosis patients. Several mobile phone games on development issues are available today. A game on tuberculosis Stop TB Cricket was selected for field testing to study its efficacy as a media for edutainment for youth (male and female) living in a resettlement colony of Delhi (India). An increase in the awareness of youth about tuberculosis was found after playing the game. The game was liked by a majority of the youth. It was found to be easy to play and an innovative way of disseminating information on a serious health concern TB. The youth wanted to acquire this game in their own mobile phones and share it with their friends and family. Several suggestions were offered to improve the game and its overall gaming experience. Several topics were suggested for developing new games. The game was found to be an effective, quick, convenient and innovative media for edutainment. Key words: Mobile phone games, m learning, edutainment, Tuberculosis Introduction Mobile phones have changed the entire communication scenario of the World. They have become multipurpose tools which are being used for communication, education and gaming or accessing information. Development practitioners and communication experts see mobile phones as important tools in the hands of all communities for social development. Tuberculosis (TB) is the leading cause of death from curable infectious diseases. Globally more than 1.3 million people die of the disease every year (RNTCP Status Report, 2010). In India, TB kills more adults in the most productive age group (15-54 years) than any other infectious disease. The disruption caused to both society and economy is incalculable. A patient of TB takes an average of three or four months to recuperate, losing that much income. The loss is disastrous for those struggling against poverty and under-development (TB India, 2006). Government of India under its TB control programme, Revised National Tuberculosis Control Programme (RNTCP), offers free treatment and medicines at various health centres and government hospitals. DOTS (Directly Observed Treatment Short Course) a strategy recommended by WHO, is the only effective means of TB treatment and is practiced in more than 180 countries (Freedomtb, 2011). Use of ICTs in Health Management ICTs cover a broad range of services, applications and technologies using various types of contemporary equipments and software. Modern ICT services include cellular and mobile telephone, email transfer of files from one computer to another computer and the use of the internet. The health sector stands to benefit greatly from the use of ICTs and ICT applications, for example Vol. 3, No. 1, January 2014 2

through the more efficient delivery of healthcare services and the provision of health information to the general public. The use of ICTs in the health sector also improves the collection, storage, retrieval and transmission of individual patient information. Furthermore, given the soaring use of mobile technologies worldwide, m health (which refers to medical and public-health practices supported by mobile devices) holds huge promise for improving the delivery of health services to an increasing share of the world s population. Thus, ICTs have the potential to contribute to more effective delivery of health services and to increase the efficiency of health systems (OECD 2001). Edutainment Edutainment is a blend of two words - "Education" and "Entertainment" or educational entertainment. Edutainment content assists in active form of learning, helps in increasing retention and builds skills and competence. It helps to create interesting, situational learning environments that closely reflect a learner's true working environment. Edutainment deepens understanding by introducing the elements of fun for enhancing and retaining knowledge (ZMQ, 2010). Mobile Phones With the geometric increase of number of devices in the world, mobile phones have a potential of delivery of sustainable learning on a massive scale. Mobile phones are much more accessible and practical tool for most people in the world. Mobile is a self-learning device and has successfully been able to reach out to the last mile - to the grass-root communities. It is the device of the future, whether it is communication, information, enterprise development, education or edutainment. As the devices are gaining strength, there is a simultaneous gain in scope (ZMQ, 2011). Mobile Phone Gaming Games are an exciting way to communicate and connect with a large number of people. Rich mobile games, combined with connected near distance multiplayer gaming over Bluetooth and internet using cellular networks, opens the door for totally new gaming concepts. Mobility will add a whole new dimension to innovative and creative games concepts and will provide opportunities for the games and telecom industry alike (Goggin, 2010). E-learning The term e-learning comprises a lot more than online learning, virtual learning, distributed learning, networked or web-based learning. As the letter e in e-learning stands for the word electronic, e-learning would incorporate all educational activities that are carried out by individuals or groups working online or offline, and synchronously or asynchronously via networked or standalone computers and other electronic devices (Dede, 2000; 1996). M-learning Any activity that allows individuals to be more productive when consuming, interacting with, or creating information, mediated through a compact digital portable device that the individual carries on a regular basis, has reliable connectivity, and fits in a pocket or purse. Mobile Learning is an ideal solution today as it facilitates learning anytime-anywhere. Mobile Learning is highly effective for social learning solutions in healthcare programs, awareness programs and literacy programs like basic numeracy and basic alphabetization for the communities with lesser literacy level (ZMQ, 2010). Stop TB Cricket- a mobile phone game MDR-TB Partnership has come up with an innovative approach to create awareness on Tuberculosis among children through edutainment and games. Stop TB Cricket is a mobile phone Vol. 3, No. 1, January 2014 3

based cricket game developed to make young people play and learn about TB anytime anywhere. The primary aim is to create TB awareness among youth and bring a change using interactive mobile phone games (Freedomtb, 2011). Stop TB Cricket is a game which uses cricket as a sport to deliver messages on Tuberculosis. In Stop TB Cricket there is two teams Safety XI and TB Germs XI. One has to bat and chase a set of score after choosing his or her team. After every shot, a dialogue box containing facts about the disease of information countering popular myths and misconceptions associated with it is displayed. When a player scores runs, information on how to prevent TB get displayed on screen. When a player loses a wicket, information on how TB is transmitted and its cure is flashed (Jha, 2011). It has been evidenced that interactive games blended with socially relevant messages help in effective, quicker and easier understanding of the message (Khanna A, Soni J and Singh A, 2011). Digital gaming is an interactive way of engaging people and disseminating development messages. In the light of the emerging scenario it became imperative to seek answers to the following questions: What are the mobile phone gaming practices of youth? What types of mobile phone games are liked by them? How frequently do they play games on mobile phones? How do they acquire mobile phone games? What is their gaming experience with Stop TB Cricket? Is the game able to increase their awareness about Tuberculosis? Is there any difference is the opinion of male and female youth regarding the game? What is the opinion of the youth about edutainment games especially in mobile phones? Assessing the efficacy of Stop TB Cricket - a mobile phone game on Tuberculosis would give feedback to development communication practitioners, programme planners and game developers. Hence the study was designed with the following objectives: General To study the efficacy of a mobile phone game Stop TB Cricket for creating awareness on Tuberculosis amongst youth. Specific 1) To analyze the contents of Stop TB Cricket mobile phone game. 2) To find out the mobile phone gaming practices of the youth. 3) To assess awareness of the youth about Tuberculosis before and after playing the selected mobile phone game. 4) To seek the opinion of youth regarding the following aspects of Stop TB Cricket : Instructions for playing the games Ease of playing Ease of understanding the messages Scoring pattern and levels of the game Gaming experiences Entertainment value Quality of graphics 5) To seek the suggestions of the youth for improving the selected game. 6) To elicit the youth s view about mobile phone games as a media for disseminating development messages. Hypothesis HO: The game Stop TB Cricket does not increase the awareness of youth about TB. HA: The game Stop TB Cricket increases the awareness of youth about TB. Vol. 3, No. 1, January 2014 4

Variables Dependent: Increase in the awareness of youth about Tuberculosis Independent: Age, sex, education and occupation of the youth Control: Mobile phone hand set used for field testing the game Minimum score (30 runs) that a player had to make on the game before taking the Post Test for awareness Methodology The study was conducted in Delhi. For field testing a sample of 80 youth were selected. For content analysis a sample of 20 experts was selected. Methodology used for data collection is described below: Feedback from the youth: For the study, the resettlement colonies of Badarpur (especially around Molarband Village) in South Delhi (near Delhi-Haryana boarder) were selected. Badarpur is a mixture of urban and rural settlements comprising of a population of 2 lakhs and has four major clusters dominated by migrants from North Indian States. The sample comprised of 80 youth (equal number of boys and girls). Data pertaining to the objective of the study was collected by using a semi structured interview schedule and an Awareness Test administered before and after playing the game. All the youth played the game on the same mobile phone. Data was subjected to quantitative and qualitative analysis. Total score for each respondent was calculated for the pre and post Awareness Test. All the data was reported in terms of frequencies, percentages and other important statistical parameters. Suitable statistical tests were applied to arrive at conclusions. Feedback from Experts: Twenty experts from the fields of communication and extension, education, medicine and computer were selected for the content analysis of the game. An objective type of schedule containing the messages in the game was given to them. Their opinion about the relevance, accuracy, ease of understanding the messages and suggestions for improving them were sought. Based on the feedback received messages were graded as Excellent, Good, Average, Poor and Very poor. Major Findings Socio Economic Profile of the youth: All the respondents were between 15-25 years and comprised of equal number of males and females. The youngest respondent was 15 years and the oldest was 25 years. The average age of the respondents was 18.65 years. It was found that 68.75% were in the age group of 15-19 years. There were about 40 (50%) males and 40 (50%) females that were included in the study. Most of the respondents were school going. Of these 50% of the youth were 10 th class pass where as 37.5% were 12 th class pass. More boys as compared to girls were found to be class 12 th passed. Only 8.75% youth were graduates. No one in the sample was post graduate. A majority of the youth (85%) was students and hence a very few were employed. Mobile phone gaming practices of youth: Frequency of playing mobile phone games: All the respondents had played mobile phone games earlier. A large majority (81.25%) of the youth played mobile phone games occasionally. Only 7.5% of the youth reported that they played mobile phone games every day. A few youth (5%) stated that they played once a week and 6.25% played mobile phone games occasionally. Purpose of playing mobile phone games: Most of the youth (81.25%) reported that they played mobile phone games for entertainment and pass time and the remaining played to make their mind sharp. Age at which started playing mobile phone game: About half of the youth (50%) reported that they started playing the mobile phone game at the age of 16-20 years whereas 38.75% started playing Vol. 3, No. 1, January 2014 5

the game at the age of 10-15 years. A few youth reported that they started playing games on mobile phones when they were less than 10 years of age. Duration of playing mobile phone games: An average mobile phone gaming session was reported to be under 15 minutes for more than half the youth (56.25%), 33.75% played the game for about 16-30 minutes, 10% played for 31-60 minutes and the remaining youth played for 1 hour or more at a stretch. The duration of playing mobile phone games was found to be similar for both male and female youth. On statistical analysis it was found that there was no association between sex, age group and occupation of the youth with the duration of playing mobile phone games. However, a significant association was found between the level of education of the youth and duration of playing mobile phone games. Place for playing mobile phone games: It was found that 70% of the youth preferred playing mobile phone games at their home. They also played while travelling, sitting in a park or at friend s house. Favourite mobile phone games: The youth liked a variety of mobile phone games. The most popular type of games were sports based games (51.40%) like Cricket, Rapid roll and Football, followed by adventure games (liked by 31.7% of the youth) and Puzzles and racing games were liked by 8.5% youth significantly related to their sex. On statistical analysis it was found that the type of game liked by the youth was found to be significantly associated with their sex. No statistically significant association was found between the type of mobile phone game liked and the youth s age, education and occupation Choice of brand for mobile phone gaming: The most preferred brand of handset for playing mobile phone games was reported to be Nokia by 75% respondents. Other brands were Motorola, Sony Ericson, Spice, and phones by Reliance and Tata Indicom. Price of mobile phone used: A large number of youth (63.75%) were found to be using mobile phones in the price band of Rs.1000-2000. It was found that low cost mobile phones under Rs 5000/- were used by a majority of the youth. The others were found to be using more expensive phones. Method of acquiring mobile phone games: Only one-third of the sample was aware that mobile phone games could be loaded through internet (33.75%) or by using Bluetooth technology (16.25%). A few respondents were aware that mobile phone games can also be loaded by using a data cable and a computer. A large number (40%) were of the view that mobile phone games came preloaded from the manufacturer only. It was observed that more boys than girls were aware that new games could be loaded in mobile phones by them. Frequency of acquiring mobile phone game: Nearly one-third (31.25%) of the youth revealed that they sometimes acquired mobile phone games. Whereas 63.75% revealed that they had never acquired a new game in their mobile phone. It was found that more boys (50%) than girls (17.5%) had tried acquiring new games in their mobile phones. Ability to download mobile phone game: The youth were asked whether they were able to download mobile phone games and found the process of downloading easy or difficult. About half of the youth (52.5%) reported that they found the process of downloading a game difficult. On statistical analysis it was found that the ability to load games in a mobile phone was related to the sex of the youth. No statistically significant association was found between the type of mobile phone game liked and the youth s age, education and occupation. Advantage(s) of playing mobile phone games: About half of the youth (46.25%) stated that playing mobile phone games helped them to gain information, become mentally alert (23.75%) and sharpen their memory. Disadvantage(s) of playing mobile phone games: The youth listed a few disadvantages of playing mobile phone games. About 42.5% of the youth felt that the major disadvantage of playing mobile phone games was wastage of time, 30% felt they could not concentrate on their studies and some believed that playing mobile phone games would weaken their eye sight. Vol. 3, No. 1, January 2014 6

Problems encountered while playing mobile phone games: The youth were asked to share some of the problems that encountered while playing mobile phone games. The most frequently encountered problems while gaming were reported to be low battery life (45%) and small buttons (28.75%). Other problems reported were small size of the screen, poor sound and graphics. Feedback about Stop TB Cricket: Figure: Stop TB Cricket- mobile phone game Subject of the game Stop TB Cricket: Although a majority of the youth (80%) stated that the game they played was about TB. However, the remaining mentioned that the game was on cricket- of these 30% were girls and 10% were boys. Time taken to gain proficiency in playing Stop TB Cricket: A majority of the youth (90%) took only 1-2 times to play the game and develop proficiency in it. A similar trend was observed in both boys and girls. Thus, it can be concluded that the game Stop TB Cricket was easy to understand and play. Ease of playing the game: The game was found easy to play by a majority of the youth. About 20% of the youth found the game very easy to play and 53.75% reported that it was easy to play. About one-fourth of the youth (26.75%) found the game difficult to play. Ease of understanding the instructions for playing the game: Half of the youth (50%) reported that they found the instructions for playing the game clear where as 23.75% reported that they were very clear. Nearly one-fourth of the youth (26.25%) reported that the instructions were unclear - of these girls were found to be more in number as compared to boys. Problems encountered while playing Stop TB Cricket: A large number of the youth (65%) did not report any problem in playing the game. However, the others reported problems related to size of buttons on handset, difficulty in understanding some instructions and some messages. It was observed that more girls than boys reported problems while playing the game. Appeal of the game: Almost all the youth (95%) found the game quite appealing in general. A large number of the youth (70%) found the game very appealing. The TB game was based on cricket which is a very popular sport in India. This was cited as the main reason for liking the game. Language of the Messages: It was found that only about one-third (36.25%) of the respondents found the messages in the game very clear, 57.5% stated that they found the messages clear and the few remaining found them unclear. Although the game was in Hindi, the words used in some messages were found to be difficult to understand. For example, words like sankraman, DOTS pranalee, etc. were found difficult to understand. Efficacy of Stop TB Cricket in enhancing awareness about Tuberculosis: To assess the effectiveness of Stop TB Cricket in enhancing the youth s awareness about Tuberculosis an Awareness Test comprising of 16 objective type questions was administered to the respondents before and after playing the game. Each question was given 1 mark. The average score on the Awareness Test before playing the game was found to be 10.75 and increased to 12.50 after playing the game. Hence, the average gain in score was 1.75. The gain in average awareness score was found to be more in female respondents (2.08) as compared to male respondents (1.80). Vol. 3, No. 1, January 2014 7

The lowest score before playing the game was 6 and the highest score before playing the game was 15 amongst all the youth. The lowest score after playing the game was 9 and the highest score was 16. The minimum gain in score after playing the game was 1 and maximum was 7. A few respondents (5%) did not show any change in awareness score after playing the game. Increase in the awareness scores clearly indicated that the game Stop TB Cricket was quite effective in increasing awareness of the youth about Tuberculosis. This was also confirmed by statistical analysis. It was concluded that awareness about TB after playing the game Stop TB Cricket was significantly higher amongst the youth. It was concluded that the game Stop TB Cricket is successful in increasing the awareness of youth about TB. It was also concluded that increase in awareness of youth about TB was significantly correlated to the education of the youth. Variables like age group, sex and occupation were not found to have any correlation with the performance of the youth on the awareness test. Willingness to acquire edutainment based mobile phone games: Nearly all the youth (93.75%) expressed willingness to acquire edutainment based mobile phone games in their phones as they found these games to be very informative and entertaining. Issues suggested for making edutainment based mobile phone games: Most of the youth had a lot of suggestions to give about the kind of new mobile phone games they wanted to be developed. The youth suggested that new mobile phone games should be prepared on health (83.75%), social issues (12.5%) and environment (7.5%). They were found willing to participate in the game development process. Such initiatives could be supported by the local government, NGOs, corporate, especially mobile phone manufacturers and network service providers, and other institutions concerned with community development (as a part of their Corporate Social Responsibility strategy). Method of sharing information about edutainment based games: All the youth expressed willingness to share information about edutainment based mobile phone games with their family and friends. They suggested a wide variety of ways by which mobile phone games with development messages could be introduced to more people in the community. These included street theatre (28.75%), internet (22.5%), sms on mobile phones (18.75%), and advertisements in newspapers (18.75%), visits in schools and homes (16.25%) and TV advertisements (12.5%). Posters/pamphlets, meetings and information stalls were suggested by very few respondents. Suggestions for improving Stop TB Cricket : A lot of suggestions were offered to improve the game: 17.5% suggested that the game should have different types and levels, 16.25% wanted the content and language to be simpler, 13.75% wanted both male and female players in the game, 12.5% wanted better graphics and 10% wanted better readability in terms of larger font size and slower speed of scrolling of text. Feedback from Experts- Analysis of messages appearing in the game: There were the total 16 messages in the game. It was found that the game contained no message on signs and symptoms of TB. A lay person identifies a disease by seeing certain signs and symptoms. Hence it was very important to have messages creating awareness about signs and symptoms of a disease. There were 3 messages on Causes, 4 messages on Diagnosis and Treatment, 5 messages on Prevention and Myths and Misconceptions and 1 General message on Tuberculosis. Based on feedback from experts it was concluded that out of 16 messages in the game 1 message were rated as Excellent, 9 messages were rated Good, 6 messages were rated Average, none of the messages were graded as Poor and Very Poor. The suggestions given by the experts were used to revise the messages in the game. The revised messages can be incorporated in the next edition of the game by the game developer. Content analysis of the game gave valuable insights about the choice of language and nature of messages to be included in a game on Tuberculosis for mass distribution in Hindi language. Vol. 3, No. 1, January 2014 8

Conclusions and Recommendations Youth played mobile phone games frequently primarily for entertaining themselves. The most popular type of games liked by the youth were based on sports and adventure. Stop TB Cricket was liked by most of the youth. It was found to be effective in creating awareness about Tuberculosis amongst both male and female players. This was confirmed by statistical analysis. Thus, the game can be used to disseminate messages on TB to people in a cost and time efficient manner. Almost all the youth wanted to have Stop TB Cricket in their mobile phones. A majority did not have internet connection activated in their phones. Therefore the game could not be loaded in their phones. Technology should be developed to make it possible to load mobile phone games through Bluetooth to reduce dependence on a live internet connection. This will make it easy to share mobile games amongst people who do not have internet activated on their phones. Stop TB Cricket should include male and female players to increase its appeal, especially to female gamers. There must be levels in the game like 20-20 or test match so that it excite more of the youth. There could be options to choose male and female players in a team, directions for bowling, sound of audience cheering whenever a player hits a 4 or 6 or gets out. Instructions for playing should be provided in Hindi and English. Mobile phone games should be developed with superior graphics, sound effects and ease of controlling to enhance the gaming experience. Youth suggested that new mobile phone edutainment games should be developed on issues like gender, environment, health, nutrition and on topics from their school syllabus. Developing a mobile phone costs about 5-6 lakh Rupees. Such an initiative can be supported by the local government, NGOs, corporates, especially mobile phone manufacturers and network service providers as a part of their corporate social responsibility, and other institutions associated with community development. Messages for Stop TB Cricket should be framed in simple spoken language so that they are easy to understand. More messages on TB can be included in Stop TB Cricket, especially on signs and symptoms and myths and misconceptions. Out of the 16 messages in the game, experts rated only 1 message as Excellent and 9 messages as Good, 6 messages were rated as Average. None of the messages were rated as Poor or Very Poor. Mobile phone edutainment games should be widely publicized through the mass media to inform the public about their purpose, source and method of acquiring. Gaming tournaments can be organized to create interest and awareness amongst the public about these games. Mobile phone edutainment games should be available for free download on all mobile network service providers to facilitate widespread dissemination of development messages to the masses. References [1] Dede, C. (1996). Emerging technologies and distributed learning. American Journal of Distance Education, 10(2), 4-36. [2] Dede, C. (2000). Emerging technologies and distributed learning in higher education. In D. Hanna (Ed.), Higher education in an era of digital competition: Choices and challenges. New York: Atwood. [3] Edutainment Content, ZMQ Software Systems. Retrieved from http://www.zmqsoft.com/multimedia/main_edutainment_content.htm Accessed on 20 th November 2010 [4] Freedomtb- Stop Tb Carnival, ZMQ Software Systems, 2011. Retrieved from http://www.freedomtb.org/awareness.html Accessed on 5 th February 2011 [5] Goggin, G. (2010). Global Mobile Media. Sydney: Routledge. Page no.-99 [6] Khanna, A. Soni J. and Singh, A. Mobile Phone Games for Edutainment NCICT Allahabad, March 2011. [7] Mobile Phones, ZMQ Software Systems. Retrieved from http://www.zmqsoft.com/elearning2/index.htm Accessed on 20 th march 2011 [8] Mobile Learning, ZMQ Software Systems. Retrieved from http://www.zmqsoft.com/mobile/main_mobile_learning.htm Accessed on 20 th November 2010 Vol. 3, No. 1, January 2014 9

[9] Organization for Economic Cooperation and Development (OECD) (2001). Understanding the information the Information Economy. Paris: Organisation for Economic Cooperation and Development. [10] RNTCP Status Report 2010, Ministry of Health and Family Welfare. Retrieved from http://www.tbcindia.org/pdfs/tb%20india%202010.pdf Accessed on 20 th march 2011, 1 2 [11] TB India 2006, Ministry of Health and Family Welfare. Retrieved from http://www.tbcindia.org/pdfs/annual%20report%20tb%202006.pdf Accessed on 5 th February 2011, 10 Vol. 3, No. 1, January 2014 10