Design

This study used a quasi-experimental design with pre and post-test with the control group. There are two groups are intervention group and control group. The intervention was held for one month from April until May 2017. The evaluation through posttest was held two weeks after intervention ends.

Setting and Research Participants

This study was conducted in two urban community school districts in Yogyakarta, Indonesia, both of which are endemic areas for dengue. Thus, the two selected schools were: SS in Kotabaru and ST in Wirobrajan. The location is far, so the participants cannot meet each other.

The participants were between the ages of 10-12 years old, enrolled fifth and six grade and had not received educational information on control and prevention of dengue fever in school or from the media. This age group is appropriate to used board game as an educational tool for their cognitive level ¹². Simple random sampling was used for sampling method. There are 92 participants, with each group total 46 participants.

Procedure

Data collection began with pretest for both groups. After that, for the control group received standard Indonesian government dengue fever information through health education which conducted in front the class. This includes brochures and flyers on the importance of dengue fever control and prevention in the community and home. No other information was presented.

For the intervention group, intervention began with health education in front the class, same method and information like control group. And also they received information through brochures and flyers. After that, they played the board game. The game divide into 4 parts, in part one and two they played a board game in easy and moderate level, in part three and four played the moderate to difficult level. There are 3 days for interval for each part.

The game consists of a board, one six-sided dice, a set of 34 game cards with easy to moderate level questions and 19 dengue glossary cards, the second set of 25 game cards with moderate to difficult level questions and 20 dengue glossary cards, and a “Rules and Instructions” pamphlet. The game was played by small groups (4-8 participants) of students in schools. The game played about 40-minute per sessions.

There are 5 research assistants to help to collect the data and to be a facilitator while intervention was run. The research assistants had several qualifications are a nurse, had experience in child education and collecting the research data.

Data Analysis

The instruments in this study were used to evaluate the children’s knowledge about dengue fever and the prevention. The questions were divided into seven categories are: 1) vector characteristics; 2) Dengue fever sign and symptom; 3) Prevention strategy (4M Plus Strategy: based on Indonesia Health Ministry Guidelines); 4) Prevention strategy: chemistry agent; 5) Prevention strategy: biology agent; 6) Prevention strategy: self-protection; 7) Immune system. They had the validity score from 0,385 to 0, 777 and the reliability is 0,864.

To evaluate the statistical significance of differences of the impact of treatments (intervention group and control group) before and after the interventions, McNemar’s chi-square test for dependent samples was used. Paired t-test used to analyze the differences in the impact of treatments between two groups. The significance level was 5%.

Vector Characteristics

In this study, participants were introduced to common dengue vector that is Ae. Aegypty¹⁴. The result shown the highest participants knowledge about vector characteristic is Ae. Aegypty did not put the eggs in the dirty water. In contrast, participants do not know about the time when mosquito actively bite. These findings same like the previous study that the child does not know when mosquito will bite ¹². By knowing when the mosquito will bite, the child can be more vigilant, so they can improve they self-protection such as using the mosquito repellent or using the cloth to protect the body ⁵.

There are 16 cards with information about vector characteristics. After the intervention, the knowledge about vector characteristics is increased, but not significant (p=0.008). Besides that, the improvement of knowledge is important, in control group there is an improvement but not as high as in the intervention group.

Sign and symptom of dengue fever

The result showed that the lowest score about the sign and symptom knowledge is about the first symptom of dengue fever. The previous study finding that child does not know about the first symptom of dengue fever and the severity of the disease ¹²,¹³. In the community, commonly they assume that ‘fever’ in the first day of sick does not sign of dengue fever, they will be more vigilant in the third day, they will take the medicine in the third day of fever ¹⁴.

There are 10 cards with information about sign and symptom of dengue fever. After the intervention, there is a significant improvement of children’s knowledge about sign and symptom of dengue fever (p=0.001).

Dengue Prevention Strategy

Indonesia’s government has a dengue prevention strategy called 4M Plus ¹⁶. There are four strategies (4M) to prevent dengue based on that, first is draining a kind of water storage periodically, then closing the water storage, burying or recycling the secondhand, and monitoring the breeding site. The “Plus” activities are using the larvacide, using the repellent, using the mosquito net while sleeping, keeping the predatory fish larva, planting the plant that can carry out the mosquito, regulating the light and ventilation in the house, avoiding the habits of hanging up clothes.

The study results found that the child knows about the closing storage activities to reduce the vector’s breeding site, this study finding same like the previous study about the child prevention knowledge ¹². The child should have the knowledge about the variety of water storage that can be the vector’s breeding site, so they can taking action to do the prevention strategies ¹³.

Draining the water storage every three days is the most doing behavior in the community to prevent the mosquito breeding ¹⁴. Same like in this study, found that child has a good knowledge about the way to prevent the mosquito breeding with draining the water storage periodically.

Recycling the secondhand is the newest strategy form the government, this strategy does not consist of the previous government strategy ¹⁵. In this study found that child’s knowledge about recycling is good. In contrast, the previous study found that the knowledge about recycling is bad ¹². With the recycling, the secondhand can be used again and decreasing probability for the vector to breed.

In this study, there are 12 cards with content about dengue prevention strategy that is based on Indonesia’s government program (4M Plus). After the intervention, found that the knowledge is significantly improved (p=0.001).

Dengue Prevention Strategy: Chemistry agent

In this study, there are 7 cards with information about chemistry agent to prevent the dengue fever. The result showed that there is a significant improvement of children’s knowledge about chemistry agent (p=0.000). In the control group also had the knowledge improvement, just for two participants and the result does not a significant improvement (p=0.25).

Based on WHO guidelines for chemistry agent to prevent the dengue fever, there are some strategies that are larvacide, fogging, and the other repellent ⁵. In Indonesia, the most common larvacide that was used is “Abate”. The child does not familiar with that term, they said that the term is very difficult to remember.

Dengue Prevention Strategy: Biology Agent

There are 6 cards with information about biology agent to prevent the dengue fever. The result showed that there is a significant improvement of children know about biology agent (p=0.000). In contrast, in the control group the knowledge is decreasing (p=1.00).

The most often biology agent strategy to prevent the dengue fever is using by the community is the Siamese fighting fish (Betta Splendens) ¹⁴. In this study found that child still cannot understand about several fishes that may eat mosquito larvae, they assume that every fish can eat the larvae. The other biology agent is the plant that can carry out the mosquito. In this study, the child can mention the plant. Children should be provided with knowledge about biology agent to prevent the dengue prevent, the added value is the child will protect the environment ¹².

Dengue Prevention Strategy: Self Protection

In this study, there are 4 cards with information about self-protection. Basically, before the intervention, children have a good knowledge about self-protection. The cards help the child to know more about self-protection to prevent the dengue fever, so in intervention group have a significant improvement (p=0.001) than the control group (p=1.00). The knowledge about self-protection is important, it is also related to mosquito biting time, so they can protect themselves while mosquito biting actively ¹³.

Immune System

There are 4 cards with information about the immune system to prevent the dengue fever. Before the intervention, the child already had a good knowledge of the immune system, and after the intervention, they can recall the knowledge and have a significant improvement knowledge (p=0.001).

Immune system related to endurance, with a good endurance, can reducing the probability the disease ⁵. Same as the previous study is child already know about nutritious can improve the endurance, but in fruit and vegeTable consumption is still low ¹².

The relationship between board game intervention to knowledge

In this study, both groups had a good score for dengue prevention knowledge, same as previous study child already have a good knowledge in dengue prevention, good at the chemical agent, biology agent, but low at environment management ¹². The other study, shown that community had a good knowledge about the prevention strategy, including controlling the breeding site and preventing the mosquito bite ¹⁶.

After the intervention, there are increasing knowledge in both groups, but after doing the further analysis there are a statistically differences for before and after intervention in intervention group and control group. After doing the paired t-test to know different groups, the results showed that the increasing knowledge in the intervention group is significant (p=0,000). It means that the board game can be used as a media for learning the dengue prevention for children. In the previous study, shown that board game can be used for health education ¹⁷.

There are increasing knowledge of the child, indicates that the new knowledge got by the child ¹⁸. The board game as an educational media helps the child understand the difficult terms that are rarely heard by the children. During the learning process, the child can reveal they expression freely because of the enjoyable learning process. The child also can express the difficulty of the new terms that they learned from the cards. At the end of the learning session, the children said that with this media they can enjoy the learning process.