Effectiveness of Life-skills Board Game Innovation to Enhance Attitudes and Intention of Alcohol Consumption Prevention in Female Middle School Students

Abstract

Introduction Alcohol consumption among children and adolescents is a significant public health problem in Thailand and globally. Recent trends indicate an increasing prevalence of alcohol initiation among female middle school students, which may increase risks of behavioral problems and alcohol dependence in adulthood. Despite the implementation of legal measures, the integration of alcohol-related harm education into school curricula, and the provision of health services through school health programs aimed at preventing risky behaviors among adolescents, these strategies have not proven sufficiently effective in curbing youth alcohol consumption. The use of innovative tools, such as board games, may offer a promising approach to enhancing life skills and preventing alcohol consumption among young people. 

Objectives This study aims to compare attitudes and intention to prevent alcohol consumption between the experimental and comparison groups across three phases: baseline, the post-life skills development activity with board games, and the post-group discussion activity. 

Design This study employed an experimental, two-group repeated measures design, focusing on the development of life skills based on Ajzen’s Theory of Planned Behavior (TPB), integrated with a social engineering process using an innovative board game intervention. According to the TPB, behavioral intention is the primary determinant of behavior, influenced by three key factors: (1) attitudes toward alcohol consumption, (2) social norms in alcohol consumption, and (3) perceived ability to control alcohol consumption behaviors. Enhancing these three components is expected to strengthen participants’ intentions to prevent alcohol consumption. Drawing on this theoretical framework, the researchers designed a 12-week life-skills board game innovation to enhance attitudes and intention of alcohol consumption prevention among adolescents. The program consisted of five structured activities: four board game sessions and one group discussion. Activity 1, “Know the Truth about Alcohol” provided foundational knowledge about alcoholic beverages. Activity 2, “Think Good, Choose Right for a Bright Future” aimed to promote positive attitudes and social norms through cartoon-based scenarios. Activities 3 and 4, titled “Say No without Losing Friends” focused on practicing refusal and avoidance skills to reinforce behavioral intentions to abstain from alcohol. Finally, Activity 5 involved a group discussion on self-management strategies for avoiding alcohol consumption and offered guidance on overcoming potential barriers.

Methodology The participants consisted of 70 female middle school students from two schools in Surat Thani Province, selected through multistage random sampling. Participants were randomly assigned to either the experimental group or the comparison group, with 35 students in each group. Inclusion criteria were as follows: (1) aged between 11 and 15 years, (2) able to communicate verbally, read, and comprehend the Thai language, (3) no history of alcohol consumption, and (4) willingness to participate in the study. The sample size was determined using power analysis via the G*Power program. Research instruments included: (1) an innovative board game to develop life skills to prevent alcohol consumption, (2) a game manual, (3) a general information questionnaire, (4) an attitude toward alcohol consumption scale, and (5) a behavioral intention scale for alcohol prevention. Data collection was conducted from November 2024 to January 2025. Descriptive statistics were used to analyze general data, while attitudes and behavioral intention scores were compared using Two-way repeated measures ANOVA. Pairwise comparisons were conducted using Bonferroni.

Results The participants were female middle school students aged between 12 and 15 years. Among the experimental and comparison groups, 42.86% and 45.71%, respectively, lived with their families. Additionally, 51.43% of participants in the experimental group and 34.29% in the comparison group reported having no family members who consumed alcohol. Results from the two-way repeated measures ANOVA revealed a statistically significant difference in attitudes toward alcohol consumption within the experimental group across the three time points: baseline, post-life skills development activity with board games, and post-group discussion (F = 14.870, p < .001), with an effect size of 0.18. However, the interaction effect between time and group was not statistically significant (F = 0.090, p = .760), with an effect size of 0.00. Between-group analysis showed a statistically significant difference in attitudes toward alcohol consumption between the experimental and comparison groups (F = 174.750, p < .001), with an effect size of 0.72. Pairwise comparisons indicated that the mean attitude scores differed significantly between baseline and post-board game activity (MD = 1.99, p = .003), and between baseline and post-group discussion (MD = 3.24, p < .001). However, no significant difference was found between the post-board game activity and post-group discussion phases (MD = 1.26, p = .270). Regarding behavioral intention to prevent alcohol consumption, a statistically significant difference was observed within the experimental group across the three time points (F = 6.230, p = .020), with an effect size of 0.09. The interaction effect between time and group was not statistically significant (F = 1.870, p = .180), with an effect size of 0.03. Between-group analysis revealed a statistically significant difference in behavioral intention between the experimental and comparison groups (F = 149.440, p < .001), with an effect size of 0.69. Pairwise comparisons showed no significant difference between baseline and post-board game activity (MD = 1.34, p = .350), but a significant difference was found between baseline and post-group discussion (MD = 1.34, p < .001), as well as between post-board game activity and post-group discussion (MD = 2.71, p = .009).

Recommendation Community nurse practitioners and public health personnel can apply this board game innovation for use in health service activities aimed at enhancing life skills in female middle school students. This approach is intended to improve attitudes and behavioral intentions toward alcohol prevention, thereby increasing their likelihood of engaging in preventive behaviors. Additionally, the board game can be utilized in activities designed to support and guide health education teachers in integrating this tool into their instructional practices.