The Good-Bye To Dengue Game Debriefing Study

SIMULATION
Lennon, Coombs
& /GAMING
GOOD-BYE
/ September
TO DENGUE
2005 GAME 10.1177/1046878105279194
The GOOD-BYE TO DENGUE GAME:

Debriefing study
Jeffrey L. Lennon
Foundation University
David W. Coombs
University of Alabama at Birmingham
This study examined the use of postgame debriefing of a health educational board game activity on dengue
fever in a Filipino student population. The debriefing used a series of specific open-ended questions, explor-
ing students’ feelings about the game and game-related questionnaires, students’ perceptions of important
information about dengue from the game, new information learned about dengue, areas of improvement on
students’ dengue control skills, and suggested areas of improvement for the game. Eighty-one students in
Grade 5, Grade 6, and High School Year 1 participated in the in-school debriefing, conducted by seven Fili-
pino student teachers. Eighty out of 81 students indicated “liking” the game. Reasons for liking the game
were divided among responses based on their learning about dengue, and also perceived fun. Dengue con-
trol and prevention yielded the greatest category response to the question on perceived important material
covered by the game.
KEYWORDS: board game; debriefing; dengue fever; Philippines; students
Dengue fever has increasingly become a worldwide health problem especially

affecting school-age children (McBride & Bielefeldt-Ohmann, 2000). Health educa-
tional strategies to address dengue fever have included countries such as Thailand
(Swaddiwudhipong et al., 1992) and the Philippines (Lennon & Gonzales, 1995).
Dengue-related health educational strategies should always include a focus on school-
age children. To that aim, a health educational game called the GOOD-BYE TO
DENGUE GAME (GBD) was created as an educational tool for school-age children
AUTHORS’NOTE: The authors thank the administration of Foundation University for their approval of this
study. Technical assistance of Chona F. Lennon and Fernando N. Florendo is gratefully acknowledged. The
efforts of student teacher debriefers L. Calapis, M. Monceda, L. Capuno, L. Nepa, D. Tomogsoc, J. Dialog,
and R. Uyanib are also gratefully acknowledged. The authors thank the grade school and high school stu-
dents from Foundation University who participated in the study. Advice from Drs. George Howard, Ricardo
Izureta, David M. Macrina, and LeaVonne Pulley from the University of Alabama at Birmingham is grate-
fully acknowledged. The authors also thankfully acknowledge the guidance of the reviewers as well as David
Crookall in the publication process. This debriefing was conducted as part of a greater study on the utility of
the GOOD-BYE TO DENGUE GAME for school use. This study was conducted in cooperation with the
University of Alabama at Birmingham, USA, and Foundation University, Dumaguete City, Philippines.
Also, the John L. Sparkman Center for International Public Health Education of the University of Alabama
at Birmingham and the International Technical Assistance Group, Seattle, Washington, USA, are specially
thanked for their financial support of this study.
SIMULATION & GAMING, Vol. 36 No. 4, December 2005 499-517
DOI: 10.1177/1046878105279194
© 2005 Sage Publications
499
Downloaded from sag.sagepub.com at UNIV FEDERAL DA SANTA MARIA on March 14, 2016
500 SIMULATION & GAMING / September 2005
(Lennon, 1996). In 2001, the effectiveness of this health education game was studied
in a population of Filipino primary- and secondary-level school students. A postgame
participants debriefing was carried out during the GBD study (Lennon, 2001).
The purpose of this study was to examine the debriefing of Filipino students after
the playing of the health education game on dengue fever. The debriefing sought to
determine students’ opinions about the game, their understanding about dengue fever,
and explore possibilities for game improvement.
Crookall (1992) indicated that “debriefing is perhaps the most important part of a
simulation/game” (p. 141). Therefore, it is valuable to understand the background of
debriefing and its utility.
Debriefing had its early role in behavioral and psychological research. It was done
for ethical considerations. In these types of studies, debriefing was performed to
uncover any deception related to the study and to relieve any of the participants’ stress
or anxiety (Lederman, 1992; Steward, 1992).
In educational studies, especially with educational gaming functions, debriefing
serves more as a post-activity learning experience rather than a recovery time for
undoing deceptive practices (Lederman, 1992; Stewart, 1992). Thus, postgame de-
briefing is currently viewed as a learning experience. Learning is accomplished by
reflection on the previous game activity. Thiagarajan (1994) concludes that “people
don’t learn from experience (including simulated experience). They learn by reflect-
ing on their experience” (p. 532).
For debriefing to be effective, it is best accomplished in an organized framework.
It is often conducted in stages or sequences. These stages or sequences may be
introduced through a question. Authors vary on the number of debriefing stages.
The literature suggest anywhere from three stages (Lederman, 1992) to seven stages
(Thiagarajan, 1992). Common elements of debriefing include a recap of the previous
game process, participants’ likes and dislikes, lessons learned, and how participants
can improve the game or improve their responses to the topic discussed in the game
(Lederman, 1992; Thiagarajan, 1992, 1994). Regardless of the number of debriefing
stages, it is essential to focus on the perceptions of the players and not on the teacher’s
views (Steinwachs, 1992).
The manner in which the debriefing is carried out depends on the number of partici-
pants and time constraints. For groups of more than 20 participants, it is suggested that
they be divided into small groups for the debriefing (Steinwachs, 1992).
Board games are characterized by open information. By design, there is no hidden
mystery or deception in this type of game in contrast to card games (Parlett, 1990).
Therefore, in this study, debriefing was not designed to undo any deceptive practice. It
focused on debriefing as an educational learning vehicle for both the participants and
the facilitator.
Lennon, Coombs / GOOD-BYE TO DENGUE GAME 501
Materials and methods
Participants
There were 81 participants in the debriefing study. These participants came from
Foundation University Grade School and High School in Dumaguete City, Philip-
pines. All participants were Filipinos. The numbers of participants from Grade 5,
Grade 6, and High School Year 1 were 22, 19, and 40, respectively. It should be noted
that High School Year 1 is the 7th consecutive academic year in the education system.
The percentages of male and female participants were 45.7% and 54.3%, respectively.
Study participation was based on active consent. All participants and parents signed
informed consent agreements to participate in the study. All study information was
held in confidence. No individual identity of a participant was revealed. The study had
approval of both the Institutional Review Board for Research for the participating uni-
versity in the United States and also the approval of the university administration in the
Philippines that governed the participating grade school and high school in this study
(Lennon, 2001).
Materials
The debriefing employed a specialized form with open-ended questions (see
Appendix A; Lennon, 2001). This was a modified version of Thiagarajan’s (1992) 7-
point debriefing sequence.
In this debriefing sequence, the first step was a recollection of what happened in the
game, or a clarification of the game’s objectives, followed by the second question on
feelings about the game. This was a reverse of Thiagarajan’s (1992) sequence. This
debriefing, which began with recollection on the first step, followed a pattern used in
post-role-play debriefing. This was accomplished to clarify the actions of the game’s
activities and its purposes (Lennon & Coombs, 1992).
Procedures
The debriefing occurred after the Filipino grade and high school students had
played the GBD. Students participated in pretest questionnaires, a trial game play, and
another series of posttest questionnaires over a 3-day period. The study also had a
comparison group, which did not play the GBD. Only students in the experimental
group participated in the use of the GBD debriefing form. The GBD debriefing form
was administered on the 3rd day of the study after administration of the posttest ques-
tionnaires. The dates of the debriefings for students in Grade 6, Grade 5, and High
School Year 1 were as follows: 16 February 2001, 22 February 2001, and 1 March
2001. The debriefing lasted approximately 30 minutes. All debriefings were held in
their respective school libraries (Lennon, 2001).
Students to be debriefed were divided into groups of three and four students. These
were the same groups that participated in the game trial, that is, students playing the
board game were divided into groups and the same groups were assigned to the
debriefing. One debriefer was available for each group. There was a total of seven de-
briefers. All the debriefers were university student teachers and Filipinos. Also, all
debriefers were research assistants who had participated in the research project. Each de-
briefer read the questions and items from the Game Debriefing form to each student
individually (see Appendix A). All questions and items on the form were covered one
at a time before debriefing the other members of the group. All questions were initially
read in English. If there was any pause or sign of difficulty, the question or item was
repeated in Visayan (also referred to as Cebuano), the regional language. Debriefers
asked students for any clarifications needed on the questions and items. The debriefers
were allowed to probe further when there were ambiguous responses. Thus, for exam-
ple, debriefers might ask, “What do you mean? Can you say anything more?” The stu-
dents responded to the questions and items in both the English and Visayan languages.
The Visayan responses were translated into English. The debriefers recorded all
responses on the form. At the end of each session, all forms were collected. After the
collection of the forms, the purpose of the game trial was restated to the students. They
were thanked for their participation.
Data organization
The data for the debriefing were organized through an inductive process. Re-
sponses to the items were recorded first as general responses. Then, specific subclassi-
fications were derived from the general items. For example, questions and items
related to dengue content were sorted according to the major game content classifica-
tion, such as dengue control and prevention, dengue signs and symptoms, dengue
treatment, and mosquito characteristics (Lennon, 2001). Then, a second classification
was created based on specific measures related to the above four major dengue-related
areas.
Details of student responses
The responses to Questions 1, 2, 3a, 3b, 4, 5, 6, and 7 were categorized in summa-

ries in Tables 1, 2, 3, 4, 5, 6, 7, and 8, respectively. See Tables 1 through 8 for the
response summaries.
Some sample student transcripts of responses are seen in Appendix B.
Discussion
Background
These debriefing data should be viewed in the context of their limitations. Themes,
response categories, and response subcategories were developed after the collection of
TABLE 1: Question 1 Responses
Response Item Category Total
a. Dengue 36
b. Some aspects about dengue
b.i. Dengue control and prevention 22
b.ii. Dengue treatment and cure 3
b.iii. Mosquitoes 5
b.iv. Environmental action plan or clean-up 0
c. Responses that included aspects about questionnaires 1
d. Mentioned only about the GOOD-BYE TO DENGUE GAME (without the name of the game) 11
e. Specific mention of the GOOD-BYE TO DENGUE GAME by name 4
f. Other unique responses 8
a
Total 90
a. 9 students with multiple responses.
a. Positive affect responses

a.i. Happy 49
a.ii. Enjoyed it 23
a.iii. Excited 13
a.iv. Satisfied 3
a.v. I had fun 9
a.vi. Proud 5
a.vii. Liked it 1
a.viii Other positive affect comments 3
b. Negative affect or did not like the game 0
b.i. Negative affect about some game processes but not about the game material 2
c. Wanted to play the game again 8
c.i. Wanted to continue to play the game 1
d. Other comments about the game —
d.i. Learned things about dengue 5
d.ii. The game is easy 1
d.iii. Learned how to play the game 1
d.iv. The game is interesting 1
d.v. The game was fun 4
d.vi. Reason the game was fun—recalling that one went back to the “hospital” position
on the game board many times 1
d.vii. Continued talking about the game with friends after the game 1
a
Total 131
the data. Therefore, it was not our intention nor possible to develop a priori hypothesis
testing with measures of statistical significance related to the debriefing responses.
This debriefing was a qualitative study after an experimental game study. The results
TABLE 3: Question 3a Responses
1. Yes 70
2. Affirmative but no written response 10
3. No 1
Total 81
1. Why one likes the game
1a. Able to play the game 1
1b. It was fun 17
1c. Felt happy 2
1d. Produced laughter 3
1e. It was exciting 15
1f. Learned about dengue (not specific) 22
1g. Learned how to control, reduce, or prevent dengue 16
1h. How to avoid dengue fever 2
1i. Liked to play the game 2
1j. Enjoyed playing the game 7
1k. It gives information about dengue 6
1l. Specific learning about dengue 3
1m. The game is “good” 1
1n. The nature of the game or game content 6
1o. The player answered the game cards correctly 3
1p. Additional comments 8
2. Why one does not like the game
2a. Keep returning to the “hospital” space on the game board 1
a
Total 115
of the experimental study are forthcoming in another publication. Likewise, the con-
trol participants were not included in this debriefing, as they were not exposed to the
game during the experiment.
Because there was a multiple number of debriefers, personal nuances of question-
ing could have interjected biases. Also, some debriefers may have been better probers
than others.
Many students responded to questions in the Visayan language. However, because
the debriefers wrote their responses in English, the accuracy of the responses could
have been diminished by the translation. Also, because the debriefers, instead of the
students, wrote the responses, the debriefers’ interpretations could have been inserted
into the comments.
In school, the students had to contend with a trilingual educational setting.
Although the majority of instruction was in English, the students had to also take
course subjects in Filipino (Tagalog based), the national language. However, Filipino
was not widely spoken in the region where the study took place, unlike the Visayan
language. Consequently, the students’ writing abilities lagged behind their spoken
English. Therefore, in consideration of the factors of the language writing ability of
TABLE 4: Question 3b Responses
1. Attitudes and opinions about the questionnaire

a. Difficult to answer 8
b. Easy or easy to answer 28
c. Easy to understand 9
d. Understandable 3
e. Challenging 1
f. Good 2
g. Important 7
h. Clear 6
i. Enjoyed them 1
j. Informative 5
k. Liked them 2
l. The directions were understandable 1
m. Interesting 2
n. Not so difficult to answer 2
o. They were “OK” 1
p. “A little bit hard” 2
q. I learned from them 1
r. Some are difficult to answer 1
s. Fun 1
t. Mixed easy and difficult to answer or understand 9
2. Contents of the questionnaire
a. It’s about dengue 11
b. How to prevent dengue 8
c. How to avoid dengue 2
d. About dengue misconceptions 1
e. Action plans 1
f. About whether one likes the GOOD-BYE TO DENGUE GAME 0
g. How dengue is transmitted 1
3. What you learned from the questionnaires
a. About dengue 4
b. How to prevent dengue 0
c. Learned about the mosquito 1
d. Learned how to kill the mosquito 1
e. Learned how to prevent the mosquito 1
4. Specific contents/mentioned/contained in the questionnaire and other comments
a. Aedes aegypti, the name of the dengue-carrying mosquito 1
b. Fever as sign of dengue 1
c. Reason it is easy, based on our own opinion 1
a
Total 126
the students and the limited fixed time for the debriefing in the school setting, it was
decided that an oral debriefing would be used instead of written debriefing.
There were also limitations due to the structure of the debriefings. Students were
debriefed in small groups. However, in this group setting, the students were debriefed
one at a time. This allowed for the potential of biased remarks from exposure to the
1. Yes 75
2. Affirmative but no written response 6
3. No 0
Total 81
a. About dengue (not specific) 19
b. Some aspects of dengue
b.i. Dengue control and prevention (not specific) 39
b.ii. How to avoid dengue (not specific) 3
b.iii. Dengue transmission (not specific) 3
b.iv. Dengue treatment (not specific) 3
b.v. Dengue signs/symptoms (not specific) 3
c. Mosquitoes that transmit dengue (not specific) 1
d. Specific aspects of dengue
d.i. Dengue can harm people—dengue severity 3
e. Specific dengue control and prevention measures
e.i. Covering containers 2
e.ii. Clean containers 1
e.iii. Change water in flower pots 2
e.iv. Clean yard surroundings 4
e.v. Clean yard daily 1
e.vi. Empty containers 2
e.vii. Destroy or remove stagnant water breeding sites such as containers 2
f. Specific aspects about mosquitoes
f.i. Type or name of the dengue-carrying mosquito 5
f.ii. Number of mosquito eggs laid 1
f.iii. Where mosquitoes lay their eggs—stagnant water 7
f.iv. Where mosquitoes lay their eggs—containers 1
g. Specific aspects about dengue treatment
g.i. What to do when sick with dengue (e.g., go to the hospital) 1
g.ii. Pepper is not used in dengue treatment 1
h. Other unique comments
h.i. The game cards gave important dengue information 2
a
Total 106
other students. It was neither a group process, such as a focus group or nominal group
process, nor was it completely individual, without the contact of other students.
The responses of the Grade 5 students were generally briefer than the Grade 6
and High School Year 1 students. However, there was a similarity among all the groups
in the amount of response categories and multiple responses across the academic
grade levels. Academic grade level was not a limitation in the ability to share responses
or in giving a diversity of categories of responses. Nevertheless, the wealth of student
participant debriefings yielded a total of 976 response items, 202 subcategories, and
47 item categories among 81 pages of written debriefing response notes. In spite of any
limitations, the manner of debriefing was fruitful in its response production.
1. Yes 68
2. Yes (implied) 11
3. No 2
If so, what are they?
Total 81
b. Some aspects of dengue
b.i. Dengue control and prevention (not specific) 17
b.ii. How to avoid dengue (not specific) 1
b.iii. Dengue transmission (not specific) 1
b.iv. Dengue treatment (not specific) 0
b.v. Dengue signs/symptoms (not specific) 2
c. Mosquitoes that transmit dengue (not specific) 0
d. Specific aspects of dengue
d.i. Dengue can harm people—dengue severity 0
e.iii. Change water in flower pots 4
e.v. Clean yard daily 0
e.vii. Destroy or remove stagnant water breeding sites 3
e.viii. Destroy or remove mosquito breeding sites such as containers 1
e.ix. The use of tilapia in dengue control via mosquito larvae control 9
e.x. Use of screens 1
e.xi. Clean inside of house 1
e.xii. The interval of days between cleanings 0
e.xiii. Clean mosquito breading sites (types not specific) 3
e.xiv. How to protect one’s self against mosquitoes 1
e.xv. Keep mosquitoes from laying eggs in containers (method was not given) 0
e.xvi. Turn over coconut shells 1
f. Specific aspects about mosquitoes
f.i. Type or name of the dengue-carrying mosquito 30
f.ii. Number of mosquito eggs laid 2
f.iii. Where mosquitoes lay their eggs—stagnant water 5
f.iv. Mosquito life cycle 4
f.v. Dengue-carrying mosquito is a day bitter 4
f.vi. Where mosquitoes lay their eggs—containers 3
f.vii. Mosquitoes breed in water vases 1
f.viii. Mosquito hatching time 1
f.ix. Where mosquitoes lay their eggs—breeding sites 2
f.x. Where mosquitoes live 2
g.ii. Avoid aspirin in dengue treatment and dangers of aspirin 9
(continued)
TABLE 6 (continued)
h. Specific dengue signs/symptoms

h.i. Fever 3
h.ii. Rashes 1
h.iii. Bleeding 2
h.iv. Abdominal discomfort 0
i. Other unique comments
i.i. Pepper is not used in dengue treatment 0
i.ii. The game cards give important dengue information 0
i.iii. Sprays cannot kill all mosquitoes—only the adult form, not the “baby” form 1
i.iv. Dengue does not only affect babies, but everybody 1
j. Response of “no” 2
a
Total 134
Are there some things you would now like to do to better prevent dengue?
b. Some aspects of dengue (not specific) 0
c. Mosquito transmission 0
d. Response of “no” 0
e.iii. Change water in flower pots or vases 10
e.v. Clean yard surroundings daily 5
e.vii. Destroy or remove stagnant water breeding sites 9
e.viii. Destroy or remove mosquito breeding sites such as containers 2
e.ix. The use of tilapia in dengue control via mosquito larvae control 0
e.x. Use of screens 0
e.xi. Clean inside of house 5
e.xii. The interval of days between cleanings 0
e.xiii. Clean or destroy mosquito breeding sites (types not specific) 2
e.xiv. How to protect myself against dengue 0
e.xv. Keep mosquitoes from laying eggs in containers (method was not given) 0
e.xvi. Turn over coconut shells 5
e.xvii. Burning grass 1
e.xviii. Cleaning roof 0
e.xix. Fogging area 1
e.xx. Empty water in containers daily 6
e.xxi. Cover containers in the comfort room 1
e.xxii. Clean house daily 2
(continued)
TABLE 7 (continued)
e.xxiii. Dispose containers 4

e.xxiv. Use mosquito nets 2
e.xxv. Change water in containers at least weekly 2
e.xxvi. Turn containers upside down 5
e.xxvii. Change water in flower pots daily 2
e.xxviii. Clean canals 3
e.xxix. Throw garbage in a proper place 3
e.xxx. Throw away tires 2
e.xxxi. Remove water in tires 4
e.xxxii. Remove water on roof 1
e.xxxiii. Remove stagnant water in the home 1
e.xxxiv. Remove coconut shells 2
f. Specific aspects about mosquitoes 0
g.ii. Avoid aspirin in dengue treatment 0
h. Specific dengue signs/symptoms 0
i. Other comments
i.i. Tell neighbors to join in clean-up 1
i.ii. Participate in games to prevent dengue 2
i.iii. Join activity to prevent dengue 1
i.iv. Not to throw garbage anywhere 1
i.v. Participate in organized environmental clean-up such as “Environmental
Action Plan” or “4 o’clock habit” 4
i.vi. Avoid areas where dengue mosquitoes are present 2
j. Response of “no” 0
a
Total 161
a. 50 students gave multiple responses.
Question 1. As a review, in your own words, what was the game activity all about?
Please note that the game activity included both the play of the game and the
questionnaires.
Question 1 was designed as a means of recall and clarification of the activity. The
item category with the greatest response to the question “What was the game activity
all about?” was the category “Dengue.” The second greatest number of responses was
observed in the category “Dengue control and prevention.” Most student responses
encompassed the entire activity, both games and questionnaires. Only one person spe-
cifically mentioned the questionnaires. Very few students gave responses about den-
gue treatment or about mosquito aspects. There was no response on dengue signs/
symptoms or on an environmental action plan. The students did not have a wide range
of responses. Question 1 had the least number of response categories and the least
number of multiple responses. Perhaps this was the case because the students were
warming up to the questions and answers, and the debriefing experience in general.
Also, the nature of the first question tended to yield a more limited number of possible
I. Suggested game improvements

A. Improvement of game board
A.1. Add more game board spaces or boxes 7
A.2. Make the game board colorful 2
A.3. Place fewer “Go to the Hospital” spaces 2
A.4. Place only one “Go to the Hospital” space 1
B. Improvement of game cards
B.1. Add more question cards 9
B.2. Add more questions on care of person with dengue 1
B.3. Add more questions on dengue treatment 1
B.4. Add more questions on dengue prevention 1
B.5. Make game cards harder or challenging 4
B.6. Make game cards more interesting 1
B.7. Have a mixture of easy and hard cards 1
C. Game mechanics and play of the game
C.1. More time to play the game 30
C.2. Increase the playing time to 1 hour 3
C.3. Give a reward after each full turn of play around the game board 1
C.4. Give prizes to the winners 3
C.5. Suggested prize for the winner of game of an anti-dengue super hero comic 1
C.6. Change the game chips 1
C.7. No suggested changes for only the game (game board, game cards, and game
mechanics) 1
II. Suggested questionnaire improvements
A. Add more questions 5
B. Make questions simpler or easier 3
C. Make questions harder 1
D. Add more dengue questions 1
E. Make questions more direct 1
F. No suggestions for changes for only questionnaires 5
III. No suggestions for changes for both overall game and questionnaires 24
IV. Not sure 3
a
Total 113
a. 26 Students with multiple responses.
responses. The nature of the question may have caused most students to respond with
answers related to content domains rather than expressions of feelings.
Question 2. How did you feel after the game?

Because Question 2 asked about personal feelings after the play of the game, it may
have produced a greater number of multiple responses and a greater number of
response categories compared to Question 1. With the exception of the two responses,
there was an overwhelmingly positive response after the play of the game. The two
negative student comments listed were centered on dissatisfaction for not winning the
game and for the perceived shortness of time to play the game. However, there were no
negative comments about the design of the GBD, the game’s content, or the play of the
game.
Question 3a. Did you like the game? Why or why not?
Question 3a was designed as a way to probe deeper after the responses to Question
2. It is overwhelming that all but one student gave positive responses as to why they
liked the game. These responses were divided based on two areas: (a) positive affect
after the game and (b) cognitive improvement or learning about dengue.
The greatest total number of responses to Question 3a came from the category
“Learned about dengue,” whereas the second greatest total number of responses came
from the category “It was fun.” A greater number of response categories centered on
learning categories rather than positive emotional affect categories.
These responses from Question 3a generated questions such as does an educational
game need to be both fun and introduce new learning concepts to be effective? Also,
should an educational game be more fun than learning oriented to be effective?
In Question 3a, only one student expressed dislike for the game. That student’s rea-
son for not liking the game was due to multiple landings incurred on the “hospital”
space on the game board. However, in response to Question 2, another student indi-
cated that the game was fun because of returning to the hospital position many times.
The hospital position was a type of penalty, yet landing on the hospital position added
to the surprise and spontaneous laughter. In the future, students can be asked in depth
about the hospital position, such as why is it fun? and what changes, if any, could be
done with the game’s play in relationship to the hospital position?
Question 3b. What are your thoughts about the questionnaires?

The responses to Question 3b were broken down to areas of attitudes and opinions
about the questionnaires, and cognitive areas of content and learning related to the
questionnaires. In the response area of attitudes and opinions, all but two students
expressed positive feelings toward the questionnaires. Unlike the leading response
category about the game for Question 3a, which was learning oriented, the leading
response category for Question 3b was attitude or emotional affect oriented. Perhaps
this was so because the students spent less time with the questionnaires than the game.
Because students spent less time with the questionnaires, they were less likely to give
content responses. Positive affect responses to Question 3b centered more on the
aspect of ease rather than fun. It should be noted that 17 students in Question 3a re-
sponded that the game was fun compared with no responses to Question 3b that the
questionnaires were fun. Could perceived fun of enjoyable questionnaires enhance the
interest in the game? That possible relationship should be explored.
Question 4. Did the game cover anything about dengue that is important to you? If
so, please explain.
In response to Question 4, all students indicated that the game covered something
important. The category with the greatest number of responses from the students was
the general category of dengue control and prevention. There were seven specific
dengue control and prevention areas identified. No specific control measures related to
screening of houses were mentioned in spite of their importance as dengue control
measures. Four dengue categories addressed aspects to the potential problems of water
containers. A small number of responses also identified mosquito characteristics, such
as mosquitoes laying their eggs in stagnant water, and also dengue treatment as impor-
tant. However, there was no predominant area among the specific content responses.
No specific indoor control and prevention measures were identified in response to
Question 4. The perception that the interior of the house is not a transmission site of
dengue may have resulted from the lack of listing of specific indoor dengue control
measures. The literature suggested that perceptions of household cleanliness caused
some residents in dengue endemic areas to view indoor dengue control as less a prior-
ity than outside dengue control (Winch, Lloyd, Hoemeke, & Leontsini, 1994).
For Question 4, only three students responded to learning something about dengue
severity. This was in spite of students’ landing on the popular hospital game board
space. Students mentioned nothing about dengue susceptibility as a response to Ques-
tion 4. Perhaps these topics could be expanded in a future game revision. Both per-
ceived susceptibility and severity are important constructs on the Health Belief Model
(Rosenstock, Strecher, & Becker, 1988).
The majority of the game board topics were in the category of dengue control,
whereas the majority of the game cards were in the topic of mosquito characteristics
(Lennon, 2001). The visual aspect of the game board may have influenced the students
toward the response of dengue control.
Question 5. Did you learn some new things about dengue? If so, what are they?
The greatest number of total responses to Question 5 was in the content area cate-
gory related to mosquitoes. This was unlike the responses to Question 4, which
focused on dengue control. Therefore, the GBD should stress the relationship of
dengue control to mosquito control. However, there was a greater number of dengue
control-related response categories for Question 5 than for Question 4. Yet the
responses to Question 5 were not concentrated in a few specific response item catego-
ries. The responses were spread among 16 categories related to specific dengue con-
trol and prevention measures. Of note, only one student indicated the use of screens as
a dengue prevention. The number of multiple responses and the number of total
response categories were the second greatest among all the debriefing questions. This
may have been suggestive that indeed students learned new information about dengue.
For further exploration, the relationship between the importance of a topic and also
learning something new in relation to a health educational game should be examined.
Question 6. Are there some things you would now like to do to better prevent
dengue?
Because Question 6 covered what the students would “like to do better to prevent
dengue,” it was expected that the greatest number of response categories would be
specific dengue prevention issues. The students responded with 28 specific dengue
prevention categories. In spite of the question’s topic of prevention, one student gave a
response to Question 6 under dengue treatment.
A small number of students gave responses in categories that spoke about involve-
ment in group activities related to dengue prevention. This issue of group or commu-
nity response is necessary for improved dengue control and prevention. The group
aspect of dengue control and prevention ought to be expanded in a future game in edu-
cational sessions related to the game.
The greatest category response to Question 6 was the category “Clean yard sur-
roundings.” However, only a small number of students (2) indicated the importance of
cleaning the inside of the house. Because many indicated that they learned new things
about the dengue-carrying mosquito in Question 5, it may have been possible that stu-
dents were not aware that clean-up inside the house and covering containers inside the
house were as important as outside clean-up. Or, were the students already performing
sufficiently well at indoors clean-up and mosquito breeding site control? Any future
game revisions should emphasize the importance of inside-the-house dengue control
and prevention as well as outside the house. A future study should examine the activi-
ties related to inside-the-house dengue control.
The study did not explore who was involved in dengue control and prevention. For
example, was indoors clean-up gender related? Winch et al. (1994) suggested that the
acknowledgment of the need for improvement of indoor clean-up might be an affront
to some women’s domestic activities. Therefore, the relationship of gender to dengue
control and prevention should be further explored.
No student mentioned the need for the “use of screens” as a means for improved
dengue prevention. Studies in Taiwan (Ko, Chen, & Yeh, 1992) and in Australia
(Murray-Smith, Weinstein, & Skelly, 1996) have demonstrated the value of screens in
dengue control and prevention. Yet, in spite of the value of screening, many houses
around Dumaguete City of both lower and upper social classes revealed no window
screens. At the time of this study, the students’ classrooms at the high school, elemen-
tary school, and their school snack shop did not have screens. The students should be
probed as to their view of the importance of screens as a protective function against
dengue. Also, the factors that inhibit people from screening should be explored.
Question 7. Is there anything you can suggest to make the game or questionnaire
better?
The greatest number of responses to Question 7 was found in the category “More
time to play the game.” This could be an expression of students’ sincere interest in
wanting to play the game or it could be an excuse to avoid formal class work. Even if it
were the latter, many students responded to learning new things, as in earlier men-
tioned responses to Question 5. Perhaps a future study should examine learning in
relation to multiple sessions of play for the GBD.
For improvements of the game’s material components, “adding more game board
spaces” and “adding more question cards” were the students’greatest responses on the
topics of improvement of game board and improvement of game cards, respectively.
No specific detail as to what topics should be added or specific detail as to suggestions
for changes to existing material were given. In the future, perhaps after asking the
debriefing questions and receiving the responses, the students could look again at the
game board and the cards. Then, the students could be asked again for suggestions for
changes or improvements.
One very novel suggestion for improving the play of the game involved giving the
winner an “anti-dengue super hero comic.”
Concerning the improvement of the questionnaires, the students responded in
Question 7 that more questions should be added. In the future, the students could be
further probed as to what types of questions should be added.
The second largest category with total responses to Question 7 was “No sugges-
tions.” In the future, students could be further probed as to why they had no further
suggestions. Perhaps the students needed refreshing of detail as in seeing a copy of the
game, or perhaps they really enjoyed the game.
In viewing all the responses to the debriefing questions together, the researchers
saw that there was a large number of response items. The informal, nonthreatening set-
ting and the mode of questioning allowed students to open up and reveal what they
learned as well as their opinions about the game. These were strengths of the debrief-
ing session.
Summary
The use of a debriefing form with open-ended questions was an efficient way to
debrief three grade levels of students after the play of the GBD in less than a class
period. Students were able to express their individual thoughts and opinions in the lan-
guage of their preference. A large volume of response categories was developed from
the student responses.
In general, the students expressed positive feelings about the game. Most students
shared that they enjoyed the game. All students indicated that the game covered impor-
tant issues related to dengue. The debriefing also stimulated a host of comments on
how the students could personally better prevent dengue. The students also suggested
game and questionnaire improvements. These improvements primarily centered on
increasing the number of game cards and the number of questionnaire items.
The debriefing generated questions on such topics as the importance of indoor den-
gue control and prevention, the relationship of mosquitoes to dengue control and pre-
vention, the importance of group activities in dengue control and prevention, and the
gender relationship to dengue control and prevention.
Finally, the study is suggestive of further exploration of the manner of post-
educational game debriefing in schools.
APPENDIX A
GOOD-BYE TO DENGUE GAME Debriefing Questionnaire
Grade_________________
Please list the responses of the students to the following series of questions of the debriefing
session.
1. As a review, in your own words, what was the game activity all about? Please note that
the game activity included both the play of the game and the questionnaires.
2. How did you feel after the game?
3a. Did you like the game? Why or why not?
3b. What are your thoughts about the questionnaires?
4. Did the game cover anything about dengue that is important to you? If so, please explain.
5. Did you learn some new things about dengue? If so, what are they?
6. Are there some things you would now like to do to better prevent dengue?
7. Is there anything you can suggest to make the game or questionnaires better?
APPENDIX B
Student Transcripts
Question 1:
Grade 5: “The game is about dengue fever and how to control it from spreading to other
people.”
Grade 6: “All about dengue, what type of mosquito that carries dengue disease, the preven-
tion, how it spreads and where they breed.”
High School Year 1 (HS 1): “The game and questionnaires were all about knowing and how
to prevent dengue.”
Question 2:
Grade 5: “I feel happy and excited.”

Grade 6: “I am happy but not satisfied because the time was not enough.”
HS 1: “I feel proud because I have gone one round in the whole game board and I was happy.”
Question 3a:
Grade 5: “Yes, because it was exciting.”

Grade 6: “Yes, because I like the questions found in the dengue cards.”
HS 1: “Yes, it’s fun and I learned how to prevent dengue.”
Question 3b:
Grade 5: “The questionnaires were easy to answer and it’s also clear.”
“Some are hard to answer but some are easy.”
Grade 6: “The questionnaires are clear and gives me an idea about dengue.”
HS 1: “They give these questions to let us know more about dengue.”
Question 4:
Grade 5: “Yes, because the game gave me an idea on how to prevent dengue.”
“Yes, I learned that stagnant water is a place where dengue mosquito breed, and pepper
can’t cure dengue.”
Grade 6: “Yes, because it shows that when we have dengue we need to go to hospital, and we
need to keep the surroundings clean to avoid mosquito.”
HS 1: “Yes, cleaning the yard everyday and change the water in the flower vase, too.”
“Yes, about if we don’t cover the containers of water, there’s a tendency that dengue
carrier mosquitoes lay their eggs in there.”
Question 5:
Grade 5: “Yes, how dengue affects us. And, I learned that tilapia can help prevent dengue
mosquito by eating their larva.”
Grade 6: “Yes, if we get dengue, we need to go to the hospital, keep the surroundings clean.
Cover the containers also.”
HS 1: “Yes, the water containers should be covered, and the coconut shells should be turned
upside down.”
“Yes, I learned what type of mosquito carries dengue. I learned that persons having
dengue should not be given aspirin, instead, paracetamol. I also learned that tilapia eats
the larvae of the mosquitoes.”
Question 6:
Grade 5: “Yes, and I will tell my neighbors that we have to clean the surroundings, and we
have to change the water in the containers daily, and also with the flower vases.”
Grade 6: “I would like to destroy the places that mosquitoes might live in like removing the
containers that have water and cleaning the surroundings.”
HS 1: “Yes, keep the environment clean always, remove old cans, old tires, coconut shells,
and dispose them properly.”
Question 7:
Grade 5: “In game—It is better if we put more boxes on the gameboard. In questionnaires—
Much better if we add more questions to the questionnaires.”
Grade 6: “I need more time to play the game because during the game the time was limited
for about 35 minutes, only, and I want to play again.”
HS 1: “I want to suggest that the winners of the game be given an award.”
References
Crookall, D. (1992). Editorial debriefing. Simulation & Gaming: An International Journal, 23, 141-142.
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transmission by mosquito vector. American Journal of Epidemiology, 136, 214-220.
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Gaming: An International Journal, 23, 145-160.
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ties. Unpublished manuscript.
Lennon, J. L. (2001). The utility of a board game for dengue hemorrhagic fever health education. Unpub-
lished doctoral dissertation, University of Alabama at Birmingham.
Lennon, J. L., & Coombs, D. W. (1992). An application of the LePSA methodology for health education and
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Microbes and Infections, 2, 1041-1050.
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Charters Towers, Queensland: Are insect screens protective? Australian and New Zealand Journal of
Public Health, 20, 545-547.
Parlett, D. (1990). The Oxford guide to card games. Oxford, UK: Oxford University Press.
Rosenstock, I. V., Strecher, J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model.
Health Education Quarterly, 15, 175-183.
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186-195.
Steward, L. P. (1992). Ethical issues in postexperimental and postexperiential debriefing. Simulation and
Gaming: An International Journal, 23, 196-211.
Swaddiwudhipong, W., Chaovakiratipong, C., Nguntra, P., Khunchote, S., Khumklan, P., &
Lerdlukanavonge, P. (1992). Effect of health education on community participation in control of dengue
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161-173.
Thiagarajan, S. (1994). How I designed a game and discovered the meaning of life. Simulation & Gaming:
An International Journal, 25, 529-536.
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Jeffrey L. Lennon, PhD, MD, MPH, is a visiting professor at Foundation University, Dumaguete City, Philip-
pines. His specialty area is health education. He focuses on nonformal educational methods for health top-
ics. Educational games have been integrated into the courses he has taught for more than a decade. He has
served in public health work in Latin America and Asia. Currently, he is also associated with the Interna-
tional Technical Assistance Group, Seattle, Washington.
David W. Coombs, PhD, MPH, is an associate professor emeritus at the University of Alabama at Birming-
ham, School of Public Health, Department of Health Behavior. He has a major interest in community health.
He has participated in public health projects in Asia and Latin America.
ADDRESSES: JLL: 217 Hibbard Avenue, 6200 Dumaguete City, Negros Oriental, Philippines; telephone:
+63 (0)35-422-9823; e-mail: jeffchona2@yahoo.com. DWC: University of Alabama at
Birmingham, School of Public Health, Department of Health Behavior, Birmingham, AL
35294-0022, USA; telephone: +1 205-934-6020; e-mail: dcoombs@uab.edu.

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SIMULATION

The GOOD-BYE TO DENGUE GAME:

KEYWORDS: board game; debriefing; dengue fever; Philippines; students

Dengue fever has increasingly become a worldwide health problem especially

Materials and methods

Details of student responses

The responses to Questions 1, 2, 3a, 3b, 4, 5, 6, and 7 were categorized in summa-

TABLE 1: Question 1 Responses

Response Item Category Total

TABLE 2: Question 2 Responses

Response Item Category Total

a. Positive affect responses

TABLE 3: Question 3a Responses

Response Item Category Total

TABLE 4: Question 3b Responses

Response Item Category Total

1. Attitudes and opinions about the questionnaire

TABLE 5: Question 4 Responses

Response Item Category Total

TABLE 6: Question 5 Responses

Response Item Category Total

Response Item Category Total

h. Specific dengue signs/symptoms

TABLE 7: Question 6 Responses

Response Item Category Total

Response Item Category Total

e.xxiii. Dispose containers 4

TABLE 8: Question 7 Responses

Response Item Category Total

I. Suggested game improvements

Question 2. How did you feel after the game?

Question 3b. What are your thoughts about the questionnaires?

Grade 5: “I feel happy and excited.”

Grade 5: “Yes, because it was exciting.”

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