Intention to Utilize Mobile Game-Based Learning in
Nursing Education From Teachers' Perspective: A
Theory of Planned Behavior Approach
Manuel B. Garcia Ryan Michael F. Oducado
College of Computer Studies College of Nursing
FEU Institute of Technology West Visayas State University
Manila, Philippines Iloilo City, Philippines
Abstract—With the significant adverse impact of a pandemic
like coronavirus disease 2019 (COVID-19) towards the teaching
and learning experience, numerous educational institutions are
looking for ways to improve their current practices and meet the
challenges of this global threat. Despite the recommendations of
applying Information and Communications Technologies (ICT)
like video games to alleviate the negative effects of the pandemic,
it is still not clear whether nursing teachers are willing to use it.
Consequently, this study explored nursing teachers’ behavioral
intention to employ mobile game-based learning (MGBL), and
its relationship amongst core factors of the Theory of Planned
Behavior (i.e., perceived behavioral control, subjective norms,
and, attitude). Descriptive statistics revealed that most of the
nursing teachers were female, a master's degree holder, with an
Fig 1. Theory of Planned Behavior
academic rank of instructor, not a licensed professional teacher,
and a permanent and full-time employee at private institutions In minimizing the teaching and learning challenges during
in the Visayas region of the Philippines. Moreover, they do not and precipitated by the COVID-19 pandemic, the integration
play mobile games and do not have an experience when it comes of ICT within the curriculum has been recommended [12, 13].
to MGBL. Lastly, Spearman's correlation analysis revealed that Specifically, the technological modality in the form of digital
Theory of Planned Behavior factors correlated positively with game-based learning has been emerging again in the literature
the intention of nursing teachers to use MGBL. This descriptive- as a complementary tool during emergency online education
exploratory study serves as a preliminary exploration of MGBL [14-16]. Even before the pandemic, capturing the attention of
in nursing education and a future study will cover the prediction
nursing students was a challenge [17] as they preferred the use
of nursing teachers’ intention to use MGBL in the classroom.
of active teaching strategies such as gaming [18]. On the other
hand, nurse educators have been relaxed when it comes to the
Keywords—Theory of Planned Behavior, Nursing Education, adoption of new teaching methods, and still use the traditional
Game-Based Learning, Mobile Learning Games lecture as the principal teaching mode [19]. With a systematic
literature review concluding that the application of gaming in
I. INTRODUCTION undergraduate nursing education resulted in positive student
The unexpected arrival of COVID-19 pandemic has forced comments, higher test scores, and increased knowledge [20],
a massive shift in nursing education [1]. In order to continue there is an opportunity for nursing teachers to implement it
the teaching and learning while complying with prevention during emergency online education. Nevertheless, it is unclear
and control guidelines and recommendations issued by World whether nursing teachers are willing to use gaming during this
Health Organization (WHO) and government agencies, many global health crisis. Consequently, this study explored nursing
educational institutions relocated from traditional face-to-face teachers’ behavioral intention to incorporate MGBL, and its
to virtual teaching and learning environments [2]. Fortunately, relationship amongst the core factors of the Theory of Planned
the positive acceptance and attitude towards online education Behavior such as perceived behavioral control, and attitude,
in undergraduate nursing courses have been well documented subjective norms. In addition, the profile of nursing teachers
in the literature [3-5]. Furthermore, there are corroborations in terms of location, sex, age, academic rank, work schedule,
illustrating readiness among lecturers for online classes during employment status, type of institution, license in professional
pandemic [6, 7] although such ‘readiness’ is multifaceted and education, daily gameplay duration, and MGBL experience
requires employing a contextual perspective [8]. For nursing were also described as a supplementary information. With this
students, however, recent studies show that conducting fully exploration, the findings could help educational institutions to
online courses during the pandemic is entirely a different story formulate strategies on how to encourage nursing teachers on
as it increases the responsibility for studies [9], reduces social using MGBL in the classroom either face-to-face or online. As
interaction resulting in a negative effect on mental health [10], to why MGBL was selected rather than computer game-based
and is very stressful [11]. On top of the policies that must be learning, mobile is at the forefront of gaming [21] and that the
put in place by health policymakers and nursing regulatory former offers more learning opportunities than the latter [22].
bodies [2], it is likewise recommended for nursing teachers to This study serves as a preliminary exploration of MGBL in
support students who are experiencing a declining interest, a nursing education, and a future study will cover the prediction
lack of motivation, and difficulties on online learning [1]. of nursing teachers’ intention to use MGBL in the classroom.
978-1-6654-2814-9/21/$31.00 ©2021 IEEE
, Fig 2. Examples of Casual and Educational Mobile Games for Nursing Education: Hospital Dash, a simulator clicker game for mastering time management as a
busy nurse; Rookie Nurse, a fun nursery game where players are responsible for taking care of all the newborns; Nursing Sim, an educational mobile game to
practice the multifactor decision-making process of nurse assignment; Operate Now: Hospital, a simulation game to perform realistic surgeries on patients.
II. BACKGROUND OF THE STUDY implement technology by including high-fidelity simulation to
case scenarios [30], adding podcasts as a supplementary tool
A. The Theory of Planned Behavior. of delivering teaching materials [31], and many more [29]. On
In order to determine the utilization intention of MGBL by the other hand, nursing students perceive technology as useful
nursing teachers, psychological theories such as the Theory of and easy to use although they also acknowledge the possibility
Planned Behavior could be embraced by knowledge explorers of it being a distraction [32]. For practicing nurses, they have
who seek to understand the association of beliefs to behavior. positive perceptions about the use of technology as it increases
This Theory of Planned Behavior suggests that the likelihood care practices, facilitates recording information, and prevents
of committing to a behavior is correlated with the strength of unnecessary labor and loss of work hours [33]. Consequently,
intention to actually do it [23]. In addition, the commitment to the incorporation of technology-based teaching and learning
act is the outcome of several factors such as subjective norms, methodology is a welcomed approach in nursing education.
attitude, and perceived behavioral control (see Figure 1). This
theory developed by social psychologists has been employed C. Mobile Game-Based Learning
in numerous disciplines including nursing education to aid our The majority of research on MGBL (32 out of 36, 88.89%,
understanding of a variety of behaviors (e.g., nursing students' from 2004 to 2016 [34]) is concentrated on its influence on the
intention to seek clinical experiences [24], report medication affective domains rather than cognitive domains. Albeit there
errors [25], follow recommendations [26], and attend lectures is a call for more research to assess student learning by using
[27]). In fact, it is the most often used socio-cognitive theory a test [35], the positive influence of MGBL on attitude, values,
for behavior prediction of healthcare professionals, and that enjoyment, and motivation [18] is still valuable especially for
studies that used this theory had significantly better predictive a time like this where students are getting more stressful [11]
power in comparison with other theories [28]. Therefore, with and having a negative impact on mental health [10] due to the
the goal of identifying the nursing teachers’ intention to utilize COVID-19 pandemic. Mobile- and computer-based games are
MGBL in the classroom, the Theory of Planned Behavior was not new in the field of healthcare. In fact, these games can take
the selected psychological model for this study. many forms, including a pediatric dietary game that employs
mechanisms of implicit learning like fooya! [36] and a speech
B. Technology-Based Nursing Education therapy gaming rehabilitation like Theraphasia [37], to name
The significance of technology integration in schools and a few. Nevertheless, developments and proposals of MGBL is
the effective use of educational technologies by teachers have not as popular in nursing education. Aside from commercial
been reviewed numerous times in the literature. In a synthesis games that can be downloaded from app stores (see Figure 2),
of systematic review research, the learning environments and the literature of nursing-themed mobile games from academic
technologies are divided into seven areas such as (1) adaptive journals, conference papers, and dissertations is limited. This
learning, (2) learning analytics, (3) mobile learning, (4) social calls for future works in this area in order to produce validated
media, (5) massive open online courses, (6) special education and evidence-based mobile learning games that could be used
technology, and (7) game-based learning [29]. In the context in MGBL. Still, with a systematic literature review concluding
of nursing education, technology has provided nurse educators that incorporating gaming in undergraduate nursing education
with the opportunity to incorporate new teaching and learning resulted in positive student comments, higher test scores, and
modalities into the lessons, which supports the demands from increased knowledge [20], there is no denying that MGBL has
the ‘digital native generation’. For instance, nursing teachers a significant role as an educational methodology.
Nursing Education From Teachers' Perspective: A
Theory of Planned Behavior Approach
Manuel B. Garcia Ryan Michael F. Oducado
College of Computer Studies College of Nursing
FEU Institute of Technology West Visayas State University
Manila, Philippines Iloilo City, Philippines
Abstract—With the significant adverse impact of a pandemic
like coronavirus disease 2019 (COVID-19) towards the teaching
and learning experience, numerous educational institutions are
looking for ways to improve their current practices and meet the
challenges of this global threat. Despite the recommendations of
applying Information and Communications Technologies (ICT)
like video games to alleviate the negative effects of the pandemic,
it is still not clear whether nursing teachers are willing to use it.
Consequently, this study explored nursing teachers’ behavioral
intention to employ mobile game-based learning (MGBL), and
its relationship amongst core factors of the Theory of Planned
Behavior (i.e., perceived behavioral control, subjective norms,
and, attitude). Descriptive statistics revealed that most of the
nursing teachers were female, a master's degree holder, with an
Fig 1. Theory of Planned Behavior
academic rank of instructor, not a licensed professional teacher,
and a permanent and full-time employee at private institutions In minimizing the teaching and learning challenges during
in the Visayas region of the Philippines. Moreover, they do not and precipitated by the COVID-19 pandemic, the integration
play mobile games and do not have an experience when it comes of ICT within the curriculum has been recommended [12, 13].
to MGBL. Lastly, Spearman's correlation analysis revealed that Specifically, the technological modality in the form of digital
Theory of Planned Behavior factors correlated positively with game-based learning has been emerging again in the literature
the intention of nursing teachers to use MGBL. This descriptive- as a complementary tool during emergency online education
exploratory study serves as a preliminary exploration of MGBL [14-16]. Even before the pandemic, capturing the attention of
in nursing education and a future study will cover the prediction
nursing students was a challenge [17] as they preferred the use
of nursing teachers’ intention to use MGBL in the classroom.
of active teaching strategies such as gaming [18]. On the other
hand, nurse educators have been relaxed when it comes to the
Keywords—Theory of Planned Behavior, Nursing Education, adoption of new teaching methods, and still use the traditional
Game-Based Learning, Mobile Learning Games lecture as the principal teaching mode [19]. With a systematic
literature review concluding that the application of gaming in
I. INTRODUCTION undergraduate nursing education resulted in positive student
The unexpected arrival of COVID-19 pandemic has forced comments, higher test scores, and increased knowledge [20],
a massive shift in nursing education [1]. In order to continue there is an opportunity for nursing teachers to implement it
the teaching and learning while complying with prevention during emergency online education. Nevertheless, it is unclear
and control guidelines and recommendations issued by World whether nursing teachers are willing to use gaming during this
Health Organization (WHO) and government agencies, many global health crisis. Consequently, this study explored nursing
educational institutions relocated from traditional face-to-face teachers’ behavioral intention to incorporate MGBL, and its
to virtual teaching and learning environments [2]. Fortunately, relationship amongst the core factors of the Theory of Planned
the positive acceptance and attitude towards online education Behavior such as perceived behavioral control, and attitude,
in undergraduate nursing courses have been well documented subjective norms. In addition, the profile of nursing teachers
in the literature [3-5]. Furthermore, there are corroborations in terms of location, sex, age, academic rank, work schedule,
illustrating readiness among lecturers for online classes during employment status, type of institution, license in professional
pandemic [6, 7] although such ‘readiness’ is multifaceted and education, daily gameplay duration, and MGBL experience
requires employing a contextual perspective [8]. For nursing were also described as a supplementary information. With this
students, however, recent studies show that conducting fully exploration, the findings could help educational institutions to
online courses during the pandemic is entirely a different story formulate strategies on how to encourage nursing teachers on
as it increases the responsibility for studies [9], reduces social using MGBL in the classroom either face-to-face or online. As
interaction resulting in a negative effect on mental health [10], to why MGBL was selected rather than computer game-based
and is very stressful [11]. On top of the policies that must be learning, mobile is at the forefront of gaming [21] and that the
put in place by health policymakers and nursing regulatory former offers more learning opportunities than the latter [22].
bodies [2], it is likewise recommended for nursing teachers to This study serves as a preliminary exploration of MGBL in
support students who are experiencing a declining interest, a nursing education, and a future study will cover the prediction
lack of motivation, and difficulties on online learning [1]. of nursing teachers’ intention to use MGBL in the classroom.
978-1-6654-2814-9/21/$31.00 ©2021 IEEE
, Fig 2. Examples of Casual and Educational Mobile Games for Nursing Education: Hospital Dash, a simulator clicker game for mastering time management as a
busy nurse; Rookie Nurse, a fun nursery game where players are responsible for taking care of all the newborns; Nursing Sim, an educational mobile game to
practice the multifactor decision-making process of nurse assignment; Operate Now: Hospital, a simulation game to perform realistic surgeries on patients.
II. BACKGROUND OF THE STUDY implement technology by including high-fidelity simulation to
case scenarios [30], adding podcasts as a supplementary tool
A. The Theory of Planned Behavior. of delivering teaching materials [31], and many more [29]. On
In order to determine the utilization intention of MGBL by the other hand, nursing students perceive technology as useful
nursing teachers, psychological theories such as the Theory of and easy to use although they also acknowledge the possibility
Planned Behavior could be embraced by knowledge explorers of it being a distraction [32]. For practicing nurses, they have
who seek to understand the association of beliefs to behavior. positive perceptions about the use of technology as it increases
This Theory of Planned Behavior suggests that the likelihood care practices, facilitates recording information, and prevents
of committing to a behavior is correlated with the strength of unnecessary labor and loss of work hours [33]. Consequently,
intention to actually do it [23]. In addition, the commitment to the incorporation of technology-based teaching and learning
act is the outcome of several factors such as subjective norms, methodology is a welcomed approach in nursing education.
attitude, and perceived behavioral control (see Figure 1). This
theory developed by social psychologists has been employed C. Mobile Game-Based Learning
in numerous disciplines including nursing education to aid our The majority of research on MGBL (32 out of 36, 88.89%,
understanding of a variety of behaviors (e.g., nursing students' from 2004 to 2016 [34]) is concentrated on its influence on the
intention to seek clinical experiences [24], report medication affective domains rather than cognitive domains. Albeit there
errors [25], follow recommendations [26], and attend lectures is a call for more research to assess student learning by using
[27]). In fact, it is the most often used socio-cognitive theory a test [35], the positive influence of MGBL on attitude, values,
for behavior prediction of healthcare professionals, and that enjoyment, and motivation [18] is still valuable especially for
studies that used this theory had significantly better predictive a time like this where students are getting more stressful [11]
power in comparison with other theories [28]. Therefore, with and having a negative impact on mental health [10] due to the
the goal of identifying the nursing teachers’ intention to utilize COVID-19 pandemic. Mobile- and computer-based games are
MGBL in the classroom, the Theory of Planned Behavior was not new in the field of healthcare. In fact, these games can take
the selected psychological model for this study. many forms, including a pediatric dietary game that employs
mechanisms of implicit learning like fooya! [36] and a speech
B. Technology-Based Nursing Education therapy gaming rehabilitation like Theraphasia [37], to name
The significance of technology integration in schools and a few. Nevertheless, developments and proposals of MGBL is
the effective use of educational technologies by teachers have not as popular in nursing education. Aside from commercial
been reviewed numerous times in the literature. In a synthesis games that can be downloaded from app stores (see Figure 2),
of systematic review research, the learning environments and the literature of nursing-themed mobile games from academic
technologies are divided into seven areas such as (1) adaptive journals, conference papers, and dissertations is limited. This
learning, (2) learning analytics, (3) mobile learning, (4) social calls for future works in this area in order to produce validated
media, (5) massive open online courses, (6) special education and evidence-based mobile learning games that could be used
technology, and (7) game-based learning [29]. In the context in MGBL. Still, with a systematic literature review concluding
of nursing education, technology has provided nurse educators that incorporating gaming in undergraduate nursing education
with the opportunity to incorporate new teaching and learning resulted in positive student comments, higher test scores, and
modalities into the lessons, which supports the demands from increased knowledge [20], there is no denying that MGBL has
the ‘digital native generation’. For instance, nursing teachers a significant role as an educational methodology.
