Research report: Effects of a web-based serious game on postpartum hemorrhage management knowledge, self-efficacy, and self-regulated learning: a randomized controlled trial among nursing students in western Türkiye

A web-based serious game used alongside theoretical instruction was associated with higher immediate scores for postpartum hemorrhage management among third-year nursing students in western Türkiye, according to a two-arm randomized controlled trial. Among 120 participating students, those assigned to the game condition had an adjusted mean knowledge score of 13.27 after the intervention, compared with 11.78 in the control group. The baseline-adjusted mean difference was 1.49 points (95% confidence interval, 0.77 to 2.21; p < .001).

The study measured knowledge as its primary outcome and task-specific self-efficacy and self-regulated learning as secondary outcomes, but it did not test whether the observed differences persisted over time or translated into better clinical performance. The trial was conducted from October 2025 to January 2026 in the nursing department of a public university in western Türkiye. Using census recruitment, investigators invited all 159 eligible third-year nursing students, of whom 120 consented and were randomized in a 1:1 ratio to the intervention or control condition.

Both groups received three theoretical sessions, each lasting 40 minutes. The intervention group additionally completed an individual, self-paced, browser-based serious game lasting 30 to 50 minutes. Its single branching postpartum hemorrhage scenario required clinical decision-making and provided immediate feedback about the physiological consequences of participants’ choices.

Students’ outcomes were assessed with the Postpartum Hemorrhage Management Knowledge Assessment Form, the Postpartum Hemorrhage Management Self-Efficacy Assessment Form and the Self-Regulated Learning Scale for Clinical Nursing Practice. A blinded analyst compared the groups using baseline-adjusted analysis of covariance. The investigators also performed exploratory analyses of indirect associations between group allocation and post-intervention knowledge through self-efficacy and through self-regulated learning.

These analyses used 5,000 bootstrap samples, with statistical significance assessed through confidence intervals around the estimated indirect effects. The secondary outcomes showed adjusted differences in the same direction as knowledge. Self-efficacy scores averaged 39.46 in the intervention group and 37.29 in the control group, an adjusted mean difference of 2.17 points (95% confidence interval, 0.63 to 3.71; p = .006).

Self-regulated learning scores averaged 66.23 and 62.70, respectively, producing an adjusted mean difference of 3.53 points (95% confidence interval, 0.63 to 6.43; p = .017). The exploratory analysis identified a statistically significant indirect association between allocation to the game and post-intervention knowledge through self-efficacy: the estimated indirect effect was 0.27, with a 95% bootstrap confidence interval from 0.03 to 0.68. The indirect association through self-regulated learning was not statistically significant, at -0.03 (95% bootstrap confidence interval, -0.24 to 0.19).

The results are limited by the nature of the comparison. The control group received the same theoretical sessions as the intervention group but was not matched for time and attention, so the trial cannot isolate game-specific effects from other influences associated with additional study time or engagement. The indirect-effect analysis also does not establish causal mediation: the association through self-efficacy is compatible with a possible role for that factor, but it does not demonstrate that increased self-efficacy caused the observed knowledge difference.

Accordingly, the findings show that adding the serious game to instruction was associated with higher immediate knowledge, self-efficacy and self-regulated learning scores in this group of nursing students, rather than establishing that the game alone produced the differences or improved professional competence.

Subject of Research: Randomized trial of a web-based postpartum hemorrhage management game among third-year nursing students in western Türkiye

Article Title: Effects of a web-based serious game on postpartum hemorrhage management knowledge, self-efficacy, and self-regulated learning: a randomized controlled trial among nursing students in western Türkiye

Article References: Demirhan Kayacık, A., Ilcioglu, K., & Tuna, O. (2026). Effects of a web-based serious game on postpartum hemorrhage management knowledge, self-efficacy, and self-regulated learning: a randomized controlled trial among nursing students in western Türkiye. BMC Medical Education. https://doi.org/10.1186/s12909-026-10417-1

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10417-1

Keywords: serious games, nursing education, postpartum hemorrhage, randomized controlled trial, web-based learning, clinical decision-making, self-efficacy, self-regulated learning, medical education, Effects, web-based, serious