Mobile Game-Based Versus Classic First Aid Education in Adolescents: Randomized Controlled Trial

Design: Three-arm, parallel-group, stratified randomized controlled trial with a pretest-posttest design and outcome-assessor blinding, reported according to CONSORT 2025.

Interventions: (1) "CanKurtaranKahraman" mobile serious game covering the Protection-Notification-Rescue sequence, characteristics of the first aider, information to give the 112 emergency call centre, basic first aid definitions, and the chain of survival, with immediate written feedback; each student plays individually on a separate device; (2) classic education delivered by a certified first aid instructor to the whole arm at once, with standardized scripted content covering the same learning objectives; (3) an attention control session on reading food labels, delivered by an experienced dietitian to the whole arm at once with a standardized script. Planned duration is 8-10 minutes in all three arms. All arms are delivered simultaneously in separate rooms on a single day to minimize contamination.

Randomization: Individual 1:1:1 allocation, stratified by grade level (9th, 10th, 11th, 12th), using permuted blocks of variable size (3 and 6). The computer-generated sequence is produced by an independent faculty member not involved in recruitment, intervention delivery, outcome assessment, or analysis. On the day of the study, after attendance is taken and before the baseline test, the same person applies the sequence to the list of participant codes in a prespecified order (central allocation), so that allocation remains concealed from the investigator. Students go directly to their allocated room and complete the baseline test there; the rooms are similar, no study materials are present, and intervention providers enter only after the baseline tests are collected.

Blinding: Students and intervention providers cannot be blinded. Test scoring, data entry, and statistical analysis are performed by personnel blinded to group allocation, using coded group labels.

Sample size: The sample size was calculated with G*Power 3.1 for ANCOVA (fixed effects, planned contrast, numerator df = 1, 3 groups, 2 covariates) for the primary comparison (mobile game vs attention control). Based on meta-analytic evidence on digital serious games for knowledge outcomes (pooled SMD 0.66 overall; 0.43 for single-session interventions), an effect size of d = 0.5 was assumed (f = 0.236 after adjustment for a pretest-posttest correlation of r = 0.50), with a two-sided alpha of 0.05 and 80% power. The required sample is 48 students per arm (144 in total). Allowing for 15% attrition, at least 171 students (57 per arm) will be randomized. The comparison between the mobile game and classic education is a secondary comparison and will be reported as an effect estimate with a 95% confidence interval.

Statistical analysis: The primary analysis is ANCOVA with the posttest knowledge score as the dependent variable, study arm as the factor, and the pretest score and grade level (stratification factor) as covariates. Hypotheses are tested in a fixed sequence at alpha = 0.05: (1) mobile game vs attention control (primary), (2) classic education vs attention control, (3) mobile game vs classic education (secondary; interpreted mainly through the adjusted mean difference and its 95% confidence interval). Adjusted mean differences with 95% confidence intervals and Hedges' g are reported. The primary analysis follows the intention-to-treat principle with multiple imputation for missing posttest data; complete-case and per-protocol analyses are performed as sensitivity analyses.

Pilot: A pilot with 24 students (3 girls and 3 boys from each grade, randomly selected among consenting students) is conducted one day before the main study, using the same procedures and a separate allocation list, to test feasibility and timing. Pilot participants are excluded from the main study.