Quiz game teaching format versus didactic lectures Ma’en Aljezawi and Mohammed Albashtawy
Key words: Game teaching ■ Nursing ■ Education ■ Community nursing ■ Jordan
L
ecturing has been the core teaching strategy in university education in all disciplines for centuries. On the other hand, the educational potential of non-traditional game teaching has been recognised by a number of educationists over a significant period of time (Schwartzman, 1997). Piaget, one of the early developmental psychologists, proposed that game teaching could help children to master cognitive skills and expand their imagination (Anonymous, 1952). Other learning theories pointed out Ma’en Aljezawi, Assistant Professor, Faculty of Nursing; Mohammed Albashtawy, Associate Professor, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan Accepted for publication: January 2015
86
Background The efficacy of this particular style of quiz game teaching has been reported in a number of studies. In one, business students were asked to compare the usefulness of two game-teaching formats, crossword puzzles and a Jeopardy!-style quiz game.
© 2015 MA Healthcare Ltd
Abstract
Background: Lecturing has been traditionally used as the core teaching strategy in university education in all disciplines. However, new research in education suggests that other formats such as game teaching could be more effective. Aim: To compare students’ performance, satisfaction and retention of knowledge between a Jeopardy!-style game format and a didactic lecture format in teaching the subject of models for organising patient care to fourth-year nursing students. Methods: A parallel-group randomised controlled trial was conducted. Participants were fourth-year nursing students who registered in the second semester of 2012–2013 and enrolled in the Nursing Management and Ethics in Nursing Course in the Community Health Department. Results: 66 students completed the study (34 in the quiz game group and 32 in the lecture group). Pre-test results showed no significant difference between the two groups in their achievement scores. However, in the immediate achievement post-test and the retention test the students in the quiz group scored significantly better than those in the lecture group. A satisfaction questionnaire showed that the game format was well liked and accepted by students as a more satisfying teaching method. Conclusion: This study is the first of its kind in Jordan to explore the effectiveness of this particular game format versus the lecture format. Results suggest that the game format was well liked and accepted by students as a more satisfying teaching method. Additionally, it appeared to be a better method of education as it promoted greater information retention.
that effective teaching needs immediate feedback and active involvement, which is best achieved through game teaching (Ritzko and Robinson, 2006). Game teaching also provides the most comprehensive possible view of the subject (Cleland and Quince, 2012). Nowadays, games are increasingly being implemented in education as a teaching method. Examples include Jeopardy!style quizzes, snakes and ladders, card games and computer games (Steinman and Blastos, 2002; Howard et al, 2002; Amory et al, 2002; Telner et al, 2010; Khan et al, 2011). They are readily available and easy to introduce for different types of learner and for different topics (Schmitz et al, 1991; Bhoopathi and Sheoran, 2006; Telner et al, 2010; Khan et al, 2011). It has also been reported that games are pioneering and challenging educational methods that encourage team learning, participation and active learning, and offer a better learning milieu (Cleland and Quince, 2012). Games also improve the mood, facilitating greater creativity and boosting student morale (Mann et al, 2002). As a consequence, a number of educators have realised these benefits and started using games as a teaching technique for both children and adults in a variety of settings (Hill et al, 2003; Kim, 2011), including the medical field. The quiz show format used in this study is one example of game teaching. Jeopardy! is a long-running American television quiz show featuring trivia from many subjects, including literature, science and arts. The game show is based on presenting answers in the form of clues. Trivia categories are posted on the board, with a column of five clues below each category. The clues are hidden by dollar amounts, which increase in value from top to bottom. The greater the dollar amount, the tougher the clue. Players begin by choosing a category and a dollar amount. The game host (facilitator) reads out the clue, and the contestants must buzz in with a hand-held buzzer for the opportunity to answer the question. The twist in the game is that the answers must come in the form of a question (Montpas, 2004; Linneman, 2013). In view of the benefits of game teaching, this study aimed to compare students’ performance, satisfaction and retention of knowledge between the quiz game format and the didactic lecture format in teaching the subject models of organising patient care to nursing students.
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
88
and happy with this format than those in the lecture format (Khan et al, 2011). Precision in the results from this study could be suspect because no measures were taken to minimise the bias of information feeding between the time of the post test and the retention test. Howard (2002) investigated the same issue but with no comparison with a control group (lecture format). She developed an innovative educational game format to teach pulmonary physiology among first-year medical students. No comparison was held with a regular teaching format, but the researcher used an evaluation instrument to measure the effectiveness of her new format. Findings revealed that the game format was effective, creating more excitement and fun. Conversely, when Telner (2010) conducted a study about stroke management and prevention among medical students, he found no statistically significant differences between the game-based and the case-based learning groups. To sum up, game teaching methods have been found to motivate students and create an interactive, competitive learning environment. Their use in medical and nursing education has not been fully explored, and there are controversies and shortcomings in the literature (O’Leary et al, 2005; Telner et al, 2010; Akl et al, 2010; Khan et al, 2011).The challenge for nursing educators to increase students’ retention of knowledge and increase their active participation might be achieved through game teaching. In Jordan (where this study was conducted), there have been no previous studies to test the effectiveness of the games strategy in nursing education, making this a pioneering study in the country (Akl et al, 2010).
Methods In order to accomplish the aim of this study a parallel-group randomised controlled trial was set up.
Participants and setting After obtaining ethical approval, this study was conducted in the Department of Community and Mental Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan. In order to compensate for any dropout from the study, all fulltime nursing students enrolled in the Nursing Management and Ethics course were asked to participate.
Study procedure The study was conducted during the second semester of the academic year 2012–2013.There were two groups of students in the selected course, which made it a convenient choice. The new teaching strategy (i.e. the Jeopardy!-style game) was randomised to one of the two groups. This means that one group received teaching in the customary didactic lecture format, while the other received teaching in the quiz game format on the same content. To minimise bias, the primary investigator was the teacher who gave instructions and implemented both formats in the same classroom and timing; he was not the course assessor. Further, the same content was delivered over the same length of time for both groups, and students were told that participating in this study would not affect their grades or evaluation in any way. At first, before the game and lecture methods were
© 2015 MA Healthcare Ltd
The results from this study were in favour of the quiz game format. In this study there was no comparison with a regular teaching format (Ritzko and Robinson, 2006). A different study compared the results of two groups of microbiology students. The first group was taught through the same style of quiz game format, and the second through regular lectures on the same content. Results showed that the game group had significantly better results (Blewett and Kisamore, 2009). This study compared the results of the game group with those from previous years for students who were taught using the lecture format. In this case other confounding factors outside the researcher’s control could have affected the study results. The literature has reported a number of studies that investigated the effectiveness of other types of game format in different disciplines. For example, a study that compared game teaching with lecturing for information technology students found that game teaching increased the IT students’ problem-solving ability and improved their programming skills (Hwang et al, 2010). Different studies compared the use of card teaching (a form of game teaching) with regular teaching in foreign languages (Kim, 2011) and learning biological principles (Schneider et al, 2005). Although the last two studies reported that game teaching had significantly better post-test results, no measures for knowledge retention were reported. The literature also reported some qualitative studies that investigated the same issue. In one qualitative study a shift from traditional teaching (teacher-centered) to game teaching (student-centered) was reported in history teaching; the game-format students were found to be more active and engaged learners (Watson et al, 2011). A different qualitative study for students of psychosocial topics reported an increased understanding of these topics and an increased desire to learn (Jirasevijinda and Brown, 2010). Although the last two studies supported the game-teaching format, they used a qualitative approach without any comparison with the regular teaching format. Only a few studies were found that compared game teaching and lectures in nursing education. For instance, in a quasi-experimental study conducted in Wayne State University in the USA to compare nursing students’ achievements and retention of geriatric nursing concepts, it was found that students in the lecture format achieved more in the immediate post-test period than students in the Jeopardy!-style format. However, students in the game format had significantly better results in the retention test (Montpas, 2004).This study did not use randomisation to assign students to the study and control groups, which could represent a weakness and limit the generalisability of the results. A different quantitative study conducted in Saudi Arabia investigated the difference in performance, satisfaction and knowledge retention when teaching viral exanthema to fifthyear medical students. Using a parallel-group randomised controlled trial, this study found that students in both methods showed no significant difference in achievement (immediate post-test results); however, students in the quiz game group were significantly better in information retention 2 months after the intervention.To measure satisfaction in the Saudi study, a five-point Likert scale survey was used. Students in the quiz game group were significantly more satisfied
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
EDUCATION implemented, both groups underwent a pre-intervention test in order to measure their baseline level of knowledge in the chosen content. The students in the group assigned to the quiz game format were divided into six sub-groups with equal numbers in each. The principal investigator explained the role of each group and the rules of the quiz game teaching method. The topic to be taught was models of organising patient care. This topic was divided into six different categories: total patient care nursing (case method nursing), functioning nursing care, team nursing, modular nursing care, primary nursing care and case management. One of the students was selected to be the scorekeeper. Using Microsoft PowerPoint, questions were projected on the screen at the front of the classroom in full view of all the students. Each one of the six sub-groups elected a leader to represent them and answer the questions. During the process, the sub-group leader answered each question after an intragroup discussion. Sub-groups were awarded a point for each correct answer and lost a point for each wrong answer. If the sub-group found the question difficult and did not want to answer it, they could pass it onto the next sub-group without losing a point; in this way, the game continued with the aim of meeting the teaching objectives. At the end, the team with the highest score received a token gift. The second group (students assigned to the lecture format) received a standard lecture using Microsoft PowerPoint. After implementing these two teaching formats, students in both groups were immediately given a post-intervention test to measure their knowledge achievement. They were also given a questionnaire to measure their satisfaction. In order to assess the students’ retention of knowledge, a retention test was given after 10 weeks.
© 2015 MA Healthcare Ltd
Instrument In order to meet the objectives of the study, two instruments were used. The first comprised 15 topic-specific multiplechoice questions. The questions were written by a panel of faculty experts, then revised and validated by an external panel of experts to measure the level of knowledge. The same 15 topic-specific multiple-choice questions were used in the pre test, post test and retention test in order to minimise testing bias. There was no post-test review; correct answers were discussed with students after the retention test was over. The second instrument was a self-assessment satisfaction survey. This was used to determine the satisfaction of both groups of students with the education format. It comprised 10 statements and the students’ responses were based on a five-point Likert scale (0=strongly disagree, 1=disagree, 2=neutral, 3=agree, 4=strongly agree). The questions in the satisfaction survey were adapted from a similar validated study in medical education and shown to have adequate face and content validity (O’Leary et al, 2005). A different study reported that the satisfaction questionnaire was judged by a panel of educational researchers and shown to be valid and reliable (Khan et al, 2011). In addition, the questionnaire contained demographic details, including the age, gender and academic year of the students, in order to have a picture of the study participants. The questionnaire was introduced in Arabic; it had been
British Journal of Nursing, 2015, Vol 24, No 2
translated from English to Arabic by an individual who was proficient in both languages and then back-translated from Arabic to English by another individual who was also proficient in both languages. A committee of three experts who had experience in the research topic and competence in both Arabic and English assessed the content validity of the translated versions. It was then tested on a group of 15 student nurses to detect any problems.
Statistical analysis The Statistical Package for Social Sciences (SPSS) version 17 was used to analyse the study variables. The a-level (significance level) was set at 0.05. Descriptive statistics (mean, standard deviation, mode and frequencies) were used with all of the study variables. Inferential statistics were also used to measure the difference between the test scores and satisfaction questions among the study groups. A paired t-test was used with multiple-choice test scores to check for any significant difference both between the two study groups and within the same group at different time intervals. The Wilcoxon signed ranks test was used to test for any significant difference between the two study groups in regard to the satisfaction questions (ordinal-level data) measured on the Likert scale. This test is usually used when the independent variable is continuous and data are not normally distributed, or the data are measured on the ordinal level (which is the case in this study) (Field, 2009). Moreover, the Wilcoxon signed ranks test is preferred here over the t-test because it has been shown that it outperforms the t-test for any sample size or any chosen a-level when comparing data on the ordinal level (Nanna and Sawilowsky, 1998; Campbell et al, 2007; Field, 2009).Using the Wilcoxon test will thus be more statistically accurate and will add to the reliability of the results.
Ethical considerations Ethical approval was sought and granted by the Research and Ethics committees at Al al-Bayt University. Signed consent was obtained from students who agreed to participate, also they were informed that they had the right to withdraw from the study at any point and that it would not affect their course evaluation. Confidentiality and the anonymity of the students were ensured throughout the study; code numbers replaced names. As soon as the data were entered into the computer, the questionnaires were disposed of.
Results Sixty-nine students initially agreed to participate, although the final number who actually completed the study was 66 (34 students in the quiz game group, 32 students in the lecture group) as three of the original students were not available at the time of the lectures. The mean age of participants was 21.42 years (SD=3.47). Women comprised 61% of the sample. The majority of the students (71%) were in their fourth year of study. According to the paired t-test there was no statistical difference between the two groups with regard to educational level (p=0.161) or age (p=0.577). Before implementing either of the two teaching formats, results from the paired t-test indicated no statistically significant difference between the pre-test scores of the lecture group
89
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
Lecture group
Quiz game group
Significant level
Mean pre-test score ± (SD)
4.84 ± (1.78)
5.19 ± (1.97)
p=0.396
Mean post-test score ± (SD)
9.63 ± (1.79)
11.34 ± (2.17)
p
Key words: Game teaching ■ Nursing ■ Education ■ Community nursing ■ Jordan
L
ecturing has been the core teaching strategy in university education in all disciplines for centuries. On the other hand, the educational potential of non-traditional game teaching has been recognised by a number of educationists over a significant period of time (Schwartzman, 1997). Piaget, one of the early developmental psychologists, proposed that game teaching could help children to master cognitive skills and expand their imagination (Anonymous, 1952). Other learning theories pointed out Ma’en Aljezawi, Assistant Professor, Faculty of Nursing; Mohammed Albashtawy, Associate Professor, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan Accepted for publication: January 2015
86
Background The efficacy of this particular style of quiz game teaching has been reported in a number of studies. In one, business students were asked to compare the usefulness of two game-teaching formats, crossword puzzles and a Jeopardy!-style quiz game.
© 2015 MA Healthcare Ltd
Abstract
Background: Lecturing has been traditionally used as the core teaching strategy in university education in all disciplines. However, new research in education suggests that other formats such as game teaching could be more effective. Aim: To compare students’ performance, satisfaction and retention of knowledge between a Jeopardy!-style game format and a didactic lecture format in teaching the subject of models for organising patient care to fourth-year nursing students. Methods: A parallel-group randomised controlled trial was conducted. Participants were fourth-year nursing students who registered in the second semester of 2012–2013 and enrolled in the Nursing Management and Ethics in Nursing Course in the Community Health Department. Results: 66 students completed the study (34 in the quiz game group and 32 in the lecture group). Pre-test results showed no significant difference between the two groups in their achievement scores. However, in the immediate achievement post-test and the retention test the students in the quiz group scored significantly better than those in the lecture group. A satisfaction questionnaire showed that the game format was well liked and accepted by students as a more satisfying teaching method. Conclusion: This study is the first of its kind in Jordan to explore the effectiveness of this particular game format versus the lecture format. Results suggest that the game format was well liked and accepted by students as a more satisfying teaching method. Additionally, it appeared to be a better method of education as it promoted greater information retention.
that effective teaching needs immediate feedback and active involvement, which is best achieved through game teaching (Ritzko and Robinson, 2006). Game teaching also provides the most comprehensive possible view of the subject (Cleland and Quince, 2012). Nowadays, games are increasingly being implemented in education as a teaching method. Examples include Jeopardy!style quizzes, snakes and ladders, card games and computer games (Steinman and Blastos, 2002; Howard et al, 2002; Amory et al, 2002; Telner et al, 2010; Khan et al, 2011). They are readily available and easy to introduce for different types of learner and for different topics (Schmitz et al, 1991; Bhoopathi and Sheoran, 2006; Telner et al, 2010; Khan et al, 2011). It has also been reported that games are pioneering and challenging educational methods that encourage team learning, participation and active learning, and offer a better learning milieu (Cleland and Quince, 2012). Games also improve the mood, facilitating greater creativity and boosting student morale (Mann et al, 2002). As a consequence, a number of educators have realised these benefits and started using games as a teaching technique for both children and adults in a variety of settings (Hill et al, 2003; Kim, 2011), including the medical field. The quiz show format used in this study is one example of game teaching. Jeopardy! is a long-running American television quiz show featuring trivia from many subjects, including literature, science and arts. The game show is based on presenting answers in the form of clues. Trivia categories are posted on the board, with a column of five clues below each category. The clues are hidden by dollar amounts, which increase in value from top to bottom. The greater the dollar amount, the tougher the clue. Players begin by choosing a category and a dollar amount. The game host (facilitator) reads out the clue, and the contestants must buzz in with a hand-held buzzer for the opportunity to answer the question. The twist in the game is that the answers must come in the form of a question (Montpas, 2004; Linneman, 2013). In view of the benefits of game teaching, this study aimed to compare students’ performance, satisfaction and retention of knowledge between the quiz game format and the didactic lecture format in teaching the subject models of organising patient care to nursing students.
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
88
and happy with this format than those in the lecture format (Khan et al, 2011). Precision in the results from this study could be suspect because no measures were taken to minimise the bias of information feeding between the time of the post test and the retention test. Howard (2002) investigated the same issue but with no comparison with a control group (lecture format). She developed an innovative educational game format to teach pulmonary physiology among first-year medical students. No comparison was held with a regular teaching format, but the researcher used an evaluation instrument to measure the effectiveness of her new format. Findings revealed that the game format was effective, creating more excitement and fun. Conversely, when Telner (2010) conducted a study about stroke management and prevention among medical students, he found no statistically significant differences between the game-based and the case-based learning groups. To sum up, game teaching methods have been found to motivate students and create an interactive, competitive learning environment. Their use in medical and nursing education has not been fully explored, and there are controversies and shortcomings in the literature (O’Leary et al, 2005; Telner et al, 2010; Akl et al, 2010; Khan et al, 2011).The challenge for nursing educators to increase students’ retention of knowledge and increase their active participation might be achieved through game teaching. In Jordan (where this study was conducted), there have been no previous studies to test the effectiveness of the games strategy in nursing education, making this a pioneering study in the country (Akl et al, 2010).
Methods In order to accomplish the aim of this study a parallel-group randomised controlled trial was set up.
Participants and setting After obtaining ethical approval, this study was conducted in the Department of Community and Mental Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan. In order to compensate for any dropout from the study, all fulltime nursing students enrolled in the Nursing Management and Ethics course were asked to participate.
Study procedure The study was conducted during the second semester of the academic year 2012–2013.There were two groups of students in the selected course, which made it a convenient choice. The new teaching strategy (i.e. the Jeopardy!-style game) was randomised to one of the two groups. This means that one group received teaching in the customary didactic lecture format, while the other received teaching in the quiz game format on the same content. To minimise bias, the primary investigator was the teacher who gave instructions and implemented both formats in the same classroom and timing; he was not the course assessor. Further, the same content was delivered over the same length of time for both groups, and students were told that participating in this study would not affect their grades or evaluation in any way. At first, before the game and lecture methods were
© 2015 MA Healthcare Ltd
The results from this study were in favour of the quiz game format. In this study there was no comparison with a regular teaching format (Ritzko and Robinson, 2006). A different study compared the results of two groups of microbiology students. The first group was taught through the same style of quiz game format, and the second through regular lectures on the same content. Results showed that the game group had significantly better results (Blewett and Kisamore, 2009). This study compared the results of the game group with those from previous years for students who were taught using the lecture format. In this case other confounding factors outside the researcher’s control could have affected the study results. The literature has reported a number of studies that investigated the effectiveness of other types of game format in different disciplines. For example, a study that compared game teaching with lecturing for information technology students found that game teaching increased the IT students’ problem-solving ability and improved their programming skills (Hwang et al, 2010). Different studies compared the use of card teaching (a form of game teaching) with regular teaching in foreign languages (Kim, 2011) and learning biological principles (Schneider et al, 2005). Although the last two studies reported that game teaching had significantly better post-test results, no measures for knowledge retention were reported. The literature also reported some qualitative studies that investigated the same issue. In one qualitative study a shift from traditional teaching (teacher-centered) to game teaching (student-centered) was reported in history teaching; the game-format students were found to be more active and engaged learners (Watson et al, 2011). A different qualitative study for students of psychosocial topics reported an increased understanding of these topics and an increased desire to learn (Jirasevijinda and Brown, 2010). Although the last two studies supported the game-teaching format, they used a qualitative approach without any comparison with the regular teaching format. Only a few studies were found that compared game teaching and lectures in nursing education. For instance, in a quasi-experimental study conducted in Wayne State University in the USA to compare nursing students’ achievements and retention of geriatric nursing concepts, it was found that students in the lecture format achieved more in the immediate post-test period than students in the Jeopardy!-style format. However, students in the game format had significantly better results in the retention test (Montpas, 2004).This study did not use randomisation to assign students to the study and control groups, which could represent a weakness and limit the generalisability of the results. A different quantitative study conducted in Saudi Arabia investigated the difference in performance, satisfaction and knowledge retention when teaching viral exanthema to fifthyear medical students. Using a parallel-group randomised controlled trial, this study found that students in both methods showed no significant difference in achievement (immediate post-test results); however, students in the quiz game group were significantly better in information retention 2 months after the intervention.To measure satisfaction in the Saudi study, a five-point Likert scale survey was used. Students in the quiz game group were significantly more satisfied
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
EDUCATION implemented, both groups underwent a pre-intervention test in order to measure their baseline level of knowledge in the chosen content. The students in the group assigned to the quiz game format were divided into six sub-groups with equal numbers in each. The principal investigator explained the role of each group and the rules of the quiz game teaching method. The topic to be taught was models of organising patient care. This topic was divided into six different categories: total patient care nursing (case method nursing), functioning nursing care, team nursing, modular nursing care, primary nursing care and case management. One of the students was selected to be the scorekeeper. Using Microsoft PowerPoint, questions were projected on the screen at the front of the classroom in full view of all the students. Each one of the six sub-groups elected a leader to represent them and answer the questions. During the process, the sub-group leader answered each question after an intragroup discussion. Sub-groups were awarded a point for each correct answer and lost a point for each wrong answer. If the sub-group found the question difficult and did not want to answer it, they could pass it onto the next sub-group without losing a point; in this way, the game continued with the aim of meeting the teaching objectives. At the end, the team with the highest score received a token gift. The second group (students assigned to the lecture format) received a standard lecture using Microsoft PowerPoint. After implementing these two teaching formats, students in both groups were immediately given a post-intervention test to measure their knowledge achievement. They were also given a questionnaire to measure their satisfaction. In order to assess the students’ retention of knowledge, a retention test was given after 10 weeks.
© 2015 MA Healthcare Ltd
Instrument In order to meet the objectives of the study, two instruments were used. The first comprised 15 topic-specific multiplechoice questions. The questions were written by a panel of faculty experts, then revised and validated by an external panel of experts to measure the level of knowledge. The same 15 topic-specific multiple-choice questions were used in the pre test, post test and retention test in order to minimise testing bias. There was no post-test review; correct answers were discussed with students after the retention test was over. The second instrument was a self-assessment satisfaction survey. This was used to determine the satisfaction of both groups of students with the education format. It comprised 10 statements and the students’ responses were based on a five-point Likert scale (0=strongly disagree, 1=disagree, 2=neutral, 3=agree, 4=strongly agree). The questions in the satisfaction survey were adapted from a similar validated study in medical education and shown to have adequate face and content validity (O’Leary et al, 2005). A different study reported that the satisfaction questionnaire was judged by a panel of educational researchers and shown to be valid and reliable (Khan et al, 2011). In addition, the questionnaire contained demographic details, including the age, gender and academic year of the students, in order to have a picture of the study participants. The questionnaire was introduced in Arabic; it had been
British Journal of Nursing, 2015, Vol 24, No 2
translated from English to Arabic by an individual who was proficient in both languages and then back-translated from Arabic to English by another individual who was also proficient in both languages. A committee of three experts who had experience in the research topic and competence in both Arabic and English assessed the content validity of the translated versions. It was then tested on a group of 15 student nurses to detect any problems.
Statistical analysis The Statistical Package for Social Sciences (SPSS) version 17 was used to analyse the study variables. The a-level (significance level) was set at 0.05. Descriptive statistics (mean, standard deviation, mode and frequencies) were used with all of the study variables. Inferential statistics were also used to measure the difference between the test scores and satisfaction questions among the study groups. A paired t-test was used with multiple-choice test scores to check for any significant difference both between the two study groups and within the same group at different time intervals. The Wilcoxon signed ranks test was used to test for any significant difference between the two study groups in regard to the satisfaction questions (ordinal-level data) measured on the Likert scale. This test is usually used when the independent variable is continuous and data are not normally distributed, or the data are measured on the ordinal level (which is the case in this study) (Field, 2009). Moreover, the Wilcoxon signed ranks test is preferred here over the t-test because it has been shown that it outperforms the t-test for any sample size or any chosen a-level when comparing data on the ordinal level (Nanna and Sawilowsky, 1998; Campbell et al, 2007; Field, 2009).Using the Wilcoxon test will thus be more statistically accurate and will add to the reliability of the results.
Ethical considerations Ethical approval was sought and granted by the Research and Ethics committees at Al al-Bayt University. Signed consent was obtained from students who agreed to participate, also they were informed that they had the right to withdraw from the study at any point and that it would not affect their course evaluation. Confidentiality and the anonymity of the students were ensured throughout the study; code numbers replaced names. As soon as the data were entered into the computer, the questionnaires were disposed of.
Results Sixty-nine students initially agreed to participate, although the final number who actually completed the study was 66 (34 students in the quiz game group, 32 students in the lecture group) as three of the original students were not available at the time of the lectures. The mean age of participants was 21.42 years (SD=3.47). Women comprised 61% of the sample. The majority of the students (71%) were in their fourth year of study. According to the paired t-test there was no statistical difference between the two groups with regard to educational level (p=0.161) or age (p=0.577). Before implementing either of the two teaching formats, results from the paired t-test indicated no statistically significant difference between the pre-test scores of the lecture group
89
British Journal of Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
Lecture group
Quiz game group
Significant level
Mean pre-test score ± (SD)
4.84 ± (1.78)
5.19 ± (1.97)
p=0.396
Mean post-test score ± (SD)
9.63 ± (1.79)
11.34 ± (2.17)
p
