Gamification increases tuberculosis awareness in schools from Catalonia: a multi-centre quasi-experimental pre-post intervention study

Background Tuberculosis (TB) remains one of the world’s deadliest infectious diseases and continues to be hindered by poor public awareness, stigma, and misinformation, all of which can contribute to delayed diagnosis, ongoing transmission, and poor treatment adherence. In low-incidence settings, limited public attention to TB may further reduce basic knowledge and represent an additional barrier to control efforts. We evaluated the feasibility and educational potential of ‘ Tuberculosis Alert ’, the first board game specifically designed around TB, as a gamification tool to support TB awareness among adolescents in a low-incidence country. Methods We conducted a quasi-experimental, multicentre pre-intervention/post-intervention study with follow-up among 370 students aged 14–17 years from diverse settings across Catalonia, Spain. The educational intervention was based on ‘ Tuberculosis Alert ’, and its association with TB-related knowledge was assessed using questionnaires administered before, after, and 3–5 months after the intervention. Ordinal logistic regression was used to evaluate changes in score categories after the intervention. Results Ordinal logistic regression showed a shift in the score distribution towards higher performance categories after the intervention, with participants having significantly higher odds of achieving a higher score category after playing ‘ Tuberculosis Alert ’ (OR = 19.76, 95% CI 13.88–28.57, p < 0.001). Follow-up scores remained above baseline, although not all follow-up comparisons reached statistical significance. Exploratory subgroup analyses did not reveal clear or robust relevant differences according to age, gender, or school area socioeconomic context. Conclusion ‘ Tuberculosis Alert ’ may be a feasible and useful educational tool to support TB awareness and knowledge acquisition among adolescents in low-incidence settings. These findings support the potential value of gamification-based strategies for TB education, although further controlled studies are needed to confirm their effectiveness and long-term impact.