Online Games to Help Canadian and U.S. Adults Identify COVID-19 and Vaccine Misinformation: Three Sequential Randomized Studies

NCT07758309 | Completed

• 3 other identifiers: Pro0009940020302731330729
• Study Type: interventional
• Target: 3,637
• Locations: 1 country
• Sites: 1

Brief Summary

COVID-19 misinformation contributed to vaccine hesitancy and preventable illness. This record covers three sequential randomized studies (conducted in Canada and the United States, November-December 2020) testing whether a brief online game helps adults identify COVID-19 and vaccine misinformation. In the game, participants judged whether statements about COVID-19 or COVID-19 vaccines were true or false and immediately received the correct answer with a brief evidence-based explanation, delivered in a game-like format with points, ranks, and feedback. Study 1 (Canada, n = 2,018) randomized participants to complete the knowledge assessment either before playing the game or immediately after playing it. Studies 2 (U.S., n = 822) and 3 (U.S., n = 797) compared the game against the identical corrective content presented as plain text, for general COVID-19 misinformation and vaccine-specific misinformation, respectively. The hypothesis was that gamified corrective information produces more accurate knowledge than non-gamified information. The primary outcome was accuracy in identifying true and false claims; vaccination intention was a secondary outcome.

Conditions

COVID-19; Vaccine Hesitancy; Health Misinformation; Communication

Keywords

misinformation; refutation; gamification; serious games; health education; vaccine hesitancy; infodemic; belief change; debunking; online intervention

Outcome Measures

Primary Outcomes (1)

• Mean Knowledge Accuracy Score

  Mean score across true/false misinformation items, ranging from 0 to 1, with higher scores indicating greater accuracy. Trial 1 included 6 items, Trial 2 included 19 items, and Trial 3 included 17 items. In Trials 1 and 2, "Unsure" responses received 0.5 points; Trial 3 used forced-choice true/false responses.

  Single session (Day 1). Assessed immediately post-intervention in all intervention and text-control arms; in Trial 1's assessment-first control arm, assessed at the start of the session before game exposure.

Secondary Outcomes (3)

• Vaccination Intention Score - Trial 1

  Immediately post-intervention (single session, Day 1); control arm assessed at session start before game exposure.

• Vaccination Intention Score - Trial 2

  Immediately post-intervention (single session, Day 1).

• Vaccination Intention Score - Trial 3

  Baseline before randomization and immediately post-intervention during the single study session, Day 1.

Study Arms (6)

Trial 1: Assessment-First Control

OTHER

Completed the knowledge assessment before receiving the gamified refutation quiz (single session).

Behavioral: Gamified misinformation refutation quiz

Trial 1: Game

EXPERIMENTAL

Played the gamified refutation quiz using general COVID-19 items with immediate per-item feedback, followed by the post-intervention assessments.

Behavioral: Gamified misinformation refutation quiz

Trial 2: Text Control

ACTIVE COMPARATOR

Judged all general COVID-19 items, then received all refutational content as a single static text block without game elements, confirmed reading the text, and then completed the post-intervention assessments.

Behavioral: Refutational text (active control)

Trial 2: Game

EXPERIMENTAL

Played the gamified refutation quiz using general COVID-19 items with immediate per-item feedback, followed by the post-intervention assessments.

Behavioral: Gamified misinformation refutation quiz

Trial 3: Text Control

ACTIVE COMPARATOR

Judged all vaccine-specific items, then received all refutational content as a single static text block without game elements, confirmed reading the text, and then completed the post-intervention assessments.

Behavioral: Refutational text (active control)

Trial 3: Game

EXPERIMENTAL

Played the gamified refutation quiz using vaccine-specific items with immediate per-item feedback, followed by the post-intervention assessments.

Behavioral: Gamified misinformation refutation quiz

Interventions

Gamified misinformation refutation quiz BEHAVIORAL

Single-session online game: participants judge true/false statements about COVID-19 (Trials 1-2) or COVID-19 vaccines (Trial 3) and immediately after each response receive the correct answer with a brief evidence-based refutation, within a gamified interface (points, ranks, feedback). 6-19 knowledge items depending on trial.

Trial 1: Assessment-First Control; Trial 1: Game; Trial 2: Game; Trial 3: Game

Refutational text (active control) BEHAVIORAL

Identical evidence-based refutational content presented as a single static text block without game elements or item-level feedback. Participants confirmed reading the text before completing the post-intervention assessments.

Trial 2: Text Control; Trial 3: Text Control

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged 18 or older
• Trial 1: Canadian residents residing outside Quebec, with internet access, able to complete the questionnaire in English
• Trials 2-3: Amazon Mechanical Turk workers located in the United States, with a HIT approval rate of at least 95% and more than 100 approved HITs.

You may not qualify if:

• Trial 1: employment in market research, advertising, media, or by a political party

Sponsors & Collaborators

• University of South Carolina: lead
• Digital Public Square: collaborator
• U.S. National Science Foundation: collaborator
• Canadian Heritage: collaborator

Study Sites (1)

Online

Columbia, South Carolina, 29208, United States

Location

MeSH Terms

Conditions

COVID-19; Vaccination Hesitancy; Communication; Health Education

Condition Hierarchy (Ancestors)

Pneumonia, Viral; Pneumonia; Respiratory Tract Infections; Infections; Virus Diseases; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Lung Diseases; Respiratory Tract Diseases; Vaccination Refusal; Treatment Refusal; Treatment Adherence and Compliance; Health Behavior; Behavior; Adherence Interventions; Medication Adherence; Patient Compliance; Patient Acceptance of Health Care

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: Three sequential, independently fielded two-arm parallel randomized trials under one protocol. Trial 1 (Canada): assessment before vs. assessment after gamified quiz (general COVID-19 misinformation). Trials 2-3 (U.S.): gamified quiz vs. identical content as static text (general COVID-19 and vaccine-specific misinformation, respectively). Participants were randomized only between the two arms of their respective trial and were never randomized among all six arms.

Study Record Dates

• First Submitted: July 31, 2026
• First Posted: August 11, 2026
• Study Start: November 20, 2020
• Primary Completion: December 28, 2020
• Study Completion: December 28, 2020
• Last Updated: August 11, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will share
• Shared Documents: ANALYTIC CODE
• Time Frame: Beginning upon publication of trial results; no end date.
• Access Criteria: Data shared with qualified researchers for verification or secondary analysis.

Locations

US (1)