The Effect of Health Education on Digital Game Addiction and Health Promotion Behavior in Adolescents

Plain-language summary

Nowadays, among adolescents who are frequently exposed to digital technologies, problematic behaviors resulting from misuse such as problematic internet use, video game addiction, and online gaming disorder are commonly observed (Young, 2017). In the literature, the prevalence of digital game addiction among adolescents has been reported to range between 0.7% and 15.6% (Arifin et al., 2022; Karadağ \& Noyan, 2023; Miezaha et al., 2020; Yudes et al., 2021). Promoting health-enhancing behaviors plays a key role in combating digital game addiction in adolescent health (Daysal \& Yılmazel, 2020). Previous studies have found that adolescents generally exhibit a moderate level of health-promoting behaviors (Özdemir \& Bülbül, 2023). When behaviors such as regular sleep, stress management, exercise, and adequate and balanced nutrition are adopted by adolescents with the aim of improving health, the need for technology tends to decrease (Bebiş et al., 2015; Özcan et al., 2023; Hysing et al., 2021). When the existing literature is reviewed, it appears that there is a lack of randomized controlled trials that explain behavior change as a process through health education aimed at promoting healthy behaviors among individuals affected by digital game addiction, which is considered a significant problem in adolescents (Shinde et al., 2020; Yang, 2020). In this context, the aim of this study is to determine the effect of health education provided to adolescents on digital game addiction and health-promoting behaviors. The population of the study consisted of 5th, 6th, 7th, and 8th grade students (n = 825) enrolled at Etimesgut 15 July Martyrs Secondary School located in the city center of Ankara. When the study was completed with 136 participants, a post hoc power analysis indicated that with an effect size of f = 0.25, the study achieved 80% power and 95% confidence (1-α) based on a four-group experimental design with repeated measures ANOVA, with a minimum of 34 participants per group (Cohen, 1992). Considering potential participant loss, the sample size was increased by 15%, and the study was initiated with 160 participants, allocating 40 to each group. The study will begin after obtaining permission from the Ankara Provincial Directorate of National Education and approval from the Ethics Committee. Following the identification of voluntary adolescents who meet the inclusion criteria, information about the study will be provided to both the adolescents and their parents, and written informed consent will be obtained. In this randomized controlled study based on the Solomon four-group design, participants will be assigned to groups using the block randomization method (Group 1: Intervention Group 1, Group 2: Intervention Group 2, Group 3: Control Group 1, Group 4: Control Group 2). Research data will be collected through a pretest administered to Group 1 (intervention 1) and Group 3 (control 1) immediately after randomization and prior to training, and a post-test administered to all groups at the end of the third month following the completion of the four training sessions. The intervention groups will receive a standardized health education program delivered over four sessions spanning three months. The timing of the training sessions will be coordinated with the school administration to fit within the school schedule. The data collection tools used in the study include the Descriptive Information Form (20 items), the Digital Game Addiction Scale for Children (24 items), and the Adolescent Health Promotion Scale (40 items). If the data do not follow a normal distribution, non-parametric methods will be used, and analyses will be conducted using the Walrus package in the JAMOVI software. For analyzing the relationships between scales, Pearson or Spearman correlation coefficients will be used depending on the normality of the data. For categorical data, if the expected frequency is greater than 25, Pearson's chi-square test will be applied; if it is between 5 and 25, Yates' correction will be used; and if it is less than 5, Fisher's exact test will be employed. For the analysis of numerical demographic data, one-way ANOVA will be used if the data are normally distributed, and the Kruskal-Wallis test will be used if not. IBM SPSS Statistics version 23 will be used for statistical evaluations. A significance level of p \< 0.05 will be considered statistically significant in this study.

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