Effectiveness of school- and family-based interventions to prevent gaming addiction among grades 4–5 students in Bangkok, Thailand

Figures & data

Figure 1 Study population at baseline, post-intervention, and 3 months follow-up.

Table 1 Overview of the “Participatory Learning School and Family Based Intervention Program for Preventing Game Addiction by Developing Self-Regulation” modules and instructional activities

Instructional modules	Purpose	Core content	Activities/evaluation
Introduction (week 1)	• To introduce an overview of the program • To gain knowledge about gaming, type of game, consequence of gaming, and gaming addiction behavior • To investigate problem situations for gaming addiction in schools	1. What is gaming? 2. Type of game 3. Rating games and their symbolism in Thailand 4. Consequence of gaming 5. Gaming addiction behavior 6. How to play games while avoiding addiction to gaming? 7. Time limit for playing games per day 8. Education on the healthy gamer	Activities: • Ice-breaking, introduction, test for baseline, VDO, group discussion • Walk rally Evaluation: • Question and answer, pre-test • Participation in classroom
Self-regulation (week 2)	• To gain knowledge about self-regulation	1. What is self-regulation? 2. Why self-regulation is necessary? 3. How can we develop self-regulation by ourselves?	Activities: • Build rapport and provide description of self-regulation • VDO, group discussion Evaluation: • Question and answer • Participation in classroom
Self-determined, goal and standard (week 3)	• Students determine goals to be achieved and standards for behavior • Goal setting and target behavior	1. How to assess yourself? 2. Component of successful test performance 3. How to set goals in the short and long term? 4. Value of goal setting	Activities: • Test: are you addicted to gaming? • Students analyze themselves • Present result of self-assessment in group • Goal setting by groups process • Group presentation in class Evaluation: • Question and answer • Result of self-assessment and goal setting • Participation in classroom
Strategic planning (week 4)	• Searching for options and formulating a plan	• What is the option of planning? • How to formulate a plan? • How to search strategically to achieve their plan?	Activities: • Brainstorming – group discussion • Group presentation in class Evaluation: • Question and answer • Participation in classroom
Self-monitoring (week 5)	• Self-monitoring: students observe and monitor their own performance	• How to systemically develop strategic plans for attempting their own goals? • Provide a model guideline to attempt their goals • Option of self-monitoring	Activities: • Teach students about systemically developing strategic plans for attempting their goal • Group discussion • Group presentation in class Evaluation: • Question and answer • Participation in classroom
Self-instructions (week 6)	• Self-instructions: students give selves instructions (either loudly or quietly) to help guide actions	• What is self-instruction? • What are appropriate rewards and punishment?	Activities: • Teach about self-instructions • Brainstorming • Group discussion • Group presentation in class Evaluation: • Question and answer • Participation in classroom
Self-reflection (week 7)	• Students have to implement the plan and response	• How to implement the plan and response?	Activities: • Students share their experiences and show how to achieve their goal? • Group discussion • Group presentation in class Evaluation: • Question and answer • Participation in classroom
Self-imposed contingencies (week 8)	• Self-imposed contingencies: students impose their own consequences for success or failure	• What is the benefit of self-regulation? • Students response and feedback for their own consequences for success or failure	Activities: • Students share their experiences • Group presentation about their action and evaluate plan in class • Give rewards to all students enrolled in this study • Awarding certificates Evaluation: • Question and answer • Participation in classroom

Note: Activities by Master teachers and RA.

Abbreviation: VDO, virtual data object; RA, research assistants.

Table 2 Baseline characteristics of students (N = 310)

Student characteristics	Intervention (n = 151)	Control (n = 159)	P-value
	n (%)	n (%)
Gender			0.073a
Boys	73 (48.3)	93 (58.5)
Girls	78 (51.7)	66 (41.5)
Age (years)			0.196a
8 and 9	49 (32.5)	41(25.8)
≥10	102 (67.5)	118 (74.2)
Mean (SD)	9.77 (0.79)	10.05 (0.67)
Median (IQR)	10 (1)	10 (2)
Min–max	8–12	8–12
Level of education			0.634a
Grade 4	81 (53.6)	81 (50.9)
Grade 5	70 (46.4)	78 (49.1)
Grade point average
Mean (SD)	3.25 (0.56)	3.63 (0.38)	<0.001b
Median (IQR)	3.31 (0.85)	3.76 (0.50)
Min–max	1.56–4.00	2.45–4.00

Notes: Significant at P-value < 0.05.

a Chi-square test.

b independent t-test.

Abbreviation: IQR, interquartile range.

Table 3 Baseline characteristics of parents (N = 310)

Parent characteristics	Intervention (n = 151)	Control (n = 159)	P-value
	n (%)	n (%)
Parent’s marital status			0.062a
Married	134 (88.7)	129 (81.1)
Widowed/separated/divorced/deceased	17 (11.3)	30 (18.9)
Living arrangement of child			0.137a
With parents, both father and mother	131 (86.8)	125 (78.6)
With father or mother	13 (8.6)	25 (15.7)
With relatives or others	7 (4.6)	9 (5.7)
Father’s education
Primary, secondary, and vocational school	67 (44.4)	84 (49.4)	0.785a
Bachelor’s degree or higher	73 (54.9)	86 (50.6)
Mother’s education			0.072a
Primary, secondary, and vocational school	56 (37.1)	75 (47.2)
Bachelor’s degree or higher	95 (62.9)	84 (52.8)
Father’s occupation			0.664a
Government career	56 (37.1)	51 (32.1)
Farmer, trader, or other	31 (20.5)	27 (17.0)
Professional contractor	15 (9.9)	20 (12.6)
Employee of private company	31 (20.5)	40 (25.2)
Private owners	18 (11.9)	21 (13.2)
Mother’s occupation			0.322a
Government career	59 (39.1)	53 (33.3)
Farmer, trader, or other	38 (45.8)	45 (28.3)
Professional contractor	11 (7.3)	5 (3.1)
Employee of private company	28 (18.5)	37 (23.3)
Private owner	15 (9.9)	19 (11.9)
Family relationship			0.918a
Good relationship	141 (93.4)	148 (93.1)
Conflict	10 (6.6)	11 (6.9)
Parenting style			0.093a
Permissive	47 (29.6)	41 (27.2)
Authoritarian	106 (66.6)	93 (61.6)
Authoritative	3 (1.9)	10 (6.6)
Uninvolved	3 (1.9)	7 (4.6)

Note:

a Chi-square.

Table 4 Baseline characteristics of participants’ gaming behavior (N = 310)

Variables	Intervention (n = 151)	Control (n = 159)	P-value
	n (%)	n (%)
Play games			0.447a
No	2 (1.3)	4 (2.5)
Yes	149 (98.7)	155 (97.5)
Have devices at home			0.064a
Yes	137 (90.7)	153 (96.2)
No	14 (9.3)	6 (3.8)
Area allowed to use devices at home			0.585a
Living room	73 (53.1)	95 (62.1)
Work room	23 (16.8)	23 (15.0)
Bedroom	22 (16.2)	16 (10.5)
Everywhere	19 (13.9)	19 (12.4)
Internet access at home			0.203a
Yes	122 (89.1)	146 (94.3)
No	15 (9.9)	7 (5.7)

Notes: Significant at P-value < 0.05.

a Chi-square test.

Table 5 Baseline characteristics of participant gaming behavior among students who played games (N = 304)

Variables	Intervention (n = 149)	Control (n = 155)	P-value
	n (%)	n (%)
Type of game usually played
Games online	80 (53.7)	96 (61.9)	0.296a
Games offline	26 (17.4)	19 (12.3)
Both online and offline	43 (28.9)	40 (25.8)
Place where games are played
At home	143 (96.0)	155 (100.0)
Outside the home (such as internet cafe, department stores, and school)	6 (4.0)	0 (0)
Type of games played (ranks 1–3) Intervention group
1. Line games	35 (23.2)
2. Fighting games	24 (15.9)
3. Adventure games	20 (13.2)
Control group
1. Line games		74 (46.5)
2. Shooting games		17 (10.7)
3. Adventure games		13 (8.2)

Notes: Significant at P-value < 0.05.

a Chi-square test.

Figure 2 Changes over time of GAST scores between the intervention group and control group.

Abbreviation: GAST, Game Addiction Screening Test.

Figure 3 Change over time of GAPS scores between the intervention group and control group.

Abbreviation: GAPS, Game Addiction Protection Scale.

Table 6 Repeated measures ANOVA of knowledge, attitude toward gaming and its effect, GAST scores, and GAPS scores between the intervention and control groups (N = 307)

Variables	SS	df	MS	F-test	P-value
Knowledge
Between subjects
Intervention	324.674	1	324.674	102.720	<0.001
Error (between-group error)	960.868	304	3.161
Within subjects
Time	4.508	1.950	2.312	1.428	0.241
Intervention × time	47.042	1.950	24.123	14.897	<0.001
Error (within-group error)	959.977	592.831	1.619
Attitude
Between subjects
Intervention	9461.265	1	9461.265	220.667	<0.001
Error (between-group error)	13034.246	304	42.876
Within subjects
Time	57.545	1.823	31.562	1.509	0.223
Intervention × time	297.134	1.823	162.973	7.792	0.001
Error (within-group error)	11593.120	554.256	20.917
GAST scores
Between subjects
Intervention	9461.265	1	9461.265	220.667	<0.001
Error (between-group error)	13034.246	304	42.876
Within subjects
Time	57.545	1.823	31.562	1.509	s0.223
Intervention × time	297.134	1.823	162.973	7.792	0.001
Error (within-group error)	11593.120	554.256	20.917
GAPS scores
Between subjects
Intervention	43152.820	1	43152.820	223.271	<0.001
Error (between-group error)	58755.802	304	193.276
Within subjects
Time	101.718	2	50.859	0.430	0.649
Intervention × time	1871.226	2	935.613	7.914	<0.001
Error (within-group error)	71875.144	608	118.216

Note: Bold values are significant at p<0.001.

Abbreviations: GAST, Game Addiction Screening Test; GAPS, Game Addiction Protection Scale; SS, sum of squares; df, degrees of freedom; MS, mean squares.

Table 7 Pairwise comparisons of the different measurements of knowledge, attitude, GAST, and GAPS scores between the intervention group (n = 148) and control group (n = 159)

Time	Group		Mean difference	SE	P-value	95% confidence interval for differencea
	i	j	i − j			Lower	Upper
Knowledge
Baseline	Intervention	Control	0.425*	0.197	0.032	0.038	0.811
Post-intervention	Intervention	Control	0.745*	0.159	<0.001	0.432	1.058
3 months	Intervention	Control	1.576*	0.176	<0.001	1.230	1.923
Attitude
Baseline	Intervention	Control	−0.390	0.643	0.544	−1.655	0.874
Post-intervention	Intervention	Control	2.507*	0.584	<0.001	1.358	3.656
3 months	Intervention	Control	1.692*	0.681	0.013	0.353	3.032
GAST
Baseline	Intervention	Control	1.462	1.282	0.255	−1.061	3.984
Post-intervention	Intervention	Control	−7.758*	1.127	<0.001	−9.975	−5.541
3 months	Intervention	Control	−9.090*	1.148	<0.001	−11.349	−6.830
GAPS
Baseline	Intervention	Control	1.462	1.282	0.255	−1.061	3.984
Post-intervention	Intervention	Control	−7.758*	1.127	<0.001	−9.975	−5.541
3 months	Intervention	Control	−9.090*	1.148	<0.001	−11.349	−6.830

Notes: Based on estimated marginal means.

* The mean difference is significant at the 0.05 level.

a Adjustment for multiple comparisons: Bonferroni. Bold values are significant at p<0.001.

Abbreviations: GAST, Game Addiction Screening Test; GAPS, Game Addiction Protection Scale; SE, standard error.

Table 8 Differences among students who played games and did not play games among the intervention and the control groups at baseline, post-intervention, and the 3-month follow-up

Time	Intervention, n (%)		Control, n (%)		P-value
	Played games	Did not play games	Played games	Did not play games
Baseline (n = 151, n = 159)	149 (98.7)	2 (1.3)	155 (97.5)	4 (2.5)	0.685
Post-intervention (n = 151, n = 159)	139 (92.1)	12 (7.9)	157 (98.7)	2 (1.3)	0.005*
3-month follow-up (n = 148**, n = 159)	139 (93.9)	9 (6.1)	157 (98.7)	2 (1.3)	0.030*

Notes:

* Significant at P-value < 0.05.

** Dropout, three cases. Analysis by Fisher’s exact test.

Table 9 Comparison of frequency and amount of time spent on gaming at post-intervention and 3-month follow-up between the intervention group and the control group (n = 307)

Variables	Intervention (n = 148)		Control (n = 159)
	Post-intervention	3-month follow-up	Post-intervention	3-month follow-up
Frequency of days used to play games per week
Mean ± SD	2.83 ± 1.123**	3.57 ± 1.674*	3.44 ± 1.644	4.03 ± 2.048
Median (IQR)	3.00 (1)	3.00 (3)	3.00 (3)	3.00 (5)
Min–max	0–7	0–7	1–7	1–7
Gaming time on weekdays (Monday–Friday) (hours/day)
Mean ± SD	0.91 ± 0.698*	1.21 ± 0.808	1.08 ± 0.732	1.41±1.051
Median (IQR)	1.00 (0.50)	1.00 (1.00)	1.00 (1.00)	1.00 (1.50)
Min–max	0–5	0–4	0–4	0–6
Gaming time on weekends (Saturday and Sunday) (hours/day)
Mean ± SD	1.73 ±1.251	2.15 ± 1.359	1.97 ± 1.193	2.44 ± 1.690
Median (IQR)	1.50 (1)	2.00 (2)	2.00 (2)	2.00 (2)
Min–max	0–7.50	0–7	0–5	0–10

Notes:

* Significant at P-value < 0.05.

** Significant at P-value < 0.001. Dropout, three cases.

Abbreviation: IQR, interquartile range.