Enhancing Engagement, Motivation and Learning through Gamified Digital Tools in Health Education

Enhancing Engagement, Motivation and Learning through Gamified Digital Tools in Health Education

Bhawna Gupta., Akanksha Mahajan., Narinder Kumar., Michael Tong

Department of Public Health, Torrens University, Australia

DOI: https://dx.doi.org/10.47772/IJRISS.2025.909000759

Received: 02 October 2025; Accepted: 12 October 2025; Published: 29 October 2025

ABSTRACT

Introduction: This action research study explores the impact of gamified learning using Kahoot! on student engagement, motivation, and learning outcomes among postgraduate public health students at Torrens University, Australia.

Methods: A total of 397 students participated in the study through an online survey administered via Qualtrics. The sample comprised a diverse student cohort, predominantly international, studying across multiple campuses. Kahoot! was implemented in public health classes as a formative learning strategy. Both quantitative and qualitative data were collected. Quantitative data was collected using Likert-scale responses, and independent samples t-tests were used to assess age-based differences in student perceptions.

Results: The findings demonstrate overwhelmingly positive perceptions of Kahoot!, with students reporting enhanced enjoyment, engagement, and comprehension. Younger students (<30 years) showed significantly greater motivation and learning reinforcement than older peers. Kahoot!’s interactive format, anonymity, and real-time feedback features were cited as major contributors to its effectiveness. Notably, the platform promoted self-reflection, peer interaction, and reduced psychological stress and emphasises the relevance of gamified tools during and post-pandemic hybrid learning environments.

Conclusions: This research supports the broader integration of gamified learning in health education. It calls for thoughtful instructional design to ensure inclusivity across diverse student groups and to leverage Kahoot!’s potential in fostering meaningful, student-centred learning experiences.

INTRODUCTION

In this 21st century, not only the younger generation but also the elderly population spend a lot of time on their cell phones, computers and video games. Moreover, our students today are all “native speakers” of the digital language of computers, video games and the Internet (1). The use of educational digital technology game-based student response systems (GSRS) such as Kahoot! in higher education supports the interactive, effective and efficient learning anytime and anywhere . Furthermore, it also supports learners’ engagement or satisfaction, increased motivation and more positive student attitudes to learning beyond traditional didactic education, which has a facilitator-centred approach (3-6).

These features make it a promising field for using game design elements in non-game contexts, known as gamification (7, 8).  It can be described as ‘the process of game-thinking and game mechanics to engage users and solve problems along with enjoyment’ (9). It is consistently positioned as an instrument that can be used to “facilitate intrinsic and extrinsic motivation to accomplish specific tasks through the selective use of game elements” (10). The use of several audio-visual aids via gamification creates a community of inquiry and practice along with socially sustainable environments and retention with positive health and psychological behaviour outcomes among the students irrespective of the geographical boundary and socio-demographics (7, 11-14).

Game-based learning interventions seek to maintain a positive relationship with failure by creating rapid feedback cycles from the facilitator so that participants can learn immediately while keeping the stakes for individual learning episodes low (15). A systematic review and meta-analysis of thirty randomised controlled trials with 3,634 pre- and post-registration health professionals from high-income countries (excluding Australia) has reported that gamification could result in increased knowledge, skills and satisfaction in contrast with stand-alone traditional methods (16). Siemens (2005) proposed a new theory, closely associated with digital technologies:  Connectivism. Under this theory, students learn collaboratively from each other in an online environment. Students can get immersed in any topic within a subject with the aid of various resources which they can access digitally (17, 18). Furthermore, based on cognitivism theory, human brain is remarkably malleable, and students’ continual interaction with digital technology, has the power to alter the structure of the brain implicating the learning process itself (19).

There is a shred of conceptual evidence to support the use of game-based learning to increase motivation and engagement as it facilitates the ‘flow’ experience (20). ‘Flow’ refers to a person being in a psychological state where they are involved with increased concentration, sense of control in a goal-driven activity to the extent that nothing else seems to matter (21).

Another three-level gamification framework suggests three levels: gamification, dynamics and motives. Gamification elements include gamification mechanics (e.g. points and badges) and social/interactive elements (e.g. upvoting/downvoting of posts in the discussion forum and ‘follow’ function). These can be linked to each other, for instance by rewarding active participants in discussion forums with points. Together they make up the rules and components of the gamification scheme and encourage specific learner behaviour. The dynamics are the different strategies and learner interactions that emerge based on the gamification elements (e.g. competition, cooperation and progress). These dynamics create a learner experience and this level of motives describes students’ emotional response evoked when interacting with the platform; for example, the learning platform as gripping, unknown territory (discovery) or opportunity for self-expression (autonomy) (22).

Additionally, Baddley and Hitch’s: Working Memory Model describes that the human memory has visual and verbal-acoustic independent subcomponents of the brain, which work simultaneously. The use of digital media to present the information in graphical display as figures, videos, and games allows the human brain to integrate information from both channels of the brain (23).

Therefore, we aimed to assess the use and impact of Kahoot! on learning, motivation and engagement in different public health subjects at Torrens University, Australia. Moreover, this empirical investigation will strengthen the pedagogical and andragogical basis for gamified learning interventions.  The rationale behind the basis of gamifying learning using Kahoot! is that adding elements, such as those found in games, to learning activities will create participant’s immersion in a way similar to what happens in games

Expected Outcome

The expected outcome of this study is that incorporating Kahoot! in learning and as formative assessment will help in providing meta-cognitive support and accelerate the understanding of complex subject matters, thus positively affecting the class dynamics. Formative assessments via Kahoot! will result in a paradigm shift in the teaching and learning experience, transferring the ownership of learning to the students. It may highlight the need to incorporate similar activities as a routine across diverse public health subjects and other health streams.

Study Design and Setting

The study was conducted in a hybrid environment as the participants were from different geographical locations at Torrens University in Australia. This cross-sectional study design adopted a mixed-methods approach. Students were interviewed using a survey administered via Qualtrics in an online environment. This favoured an increase in the response rate as students had the liberty and convenience to participate in our research at any time of the day or night.

Study Participants

Males and females above the age of 18 years studying public health part-time or full-time were included in the study. All the students were well-versed in English. The exclusion criteria were anyone who did not consent in writing to participate in the study.

Sample and Data Collection

The study sample was identified from postgraduate public health students at Torrens University, Australia. A convenience sampling strategy was adopted to enrol the study participants. Based on the past published studies where Kahoot! has been used to estimate the increased motivation and engagement among the students (24-27) and the sample size calculation formula (28) for a cross-sectional study, we enrolled 397 participants.

The teaching class sessions began with an introduction and explanation of the learning objectives, followed by a discussion on the core content for 15-20 minutes. This was followed by Kahoot! as a formative assessment with 10-15 questions after the completion of a topic during the class timings by the Principal Investigator (BG) and by a couple of other lecturers teaching the subject. Lecturers conducting Kahoot! were equally qualified in their subject expertise and research methods. Designing of the questions and training on playing Kahoot! was provided by the Principal Investigator.

Kahoot! was conducted via the screen-share display of questions during the classes. All the questions in Kahoot! were multiple choice with four answer options. Students could join Kahoot! using the game pin in any web browser and respond through their electronic gadgets such as mobile phones, laptops and/or computers for participation and answering the quiz questions. The correct answer option was displayed after each question, which led to addressing the shortcomings in students’ understanding and learning. Moreover, the distribution of incorrect answers allowed precise identification and clarification of student misunderstandings regarding course content. Each student was given points based on their speed in attempting any question (27). Game elements present in Kahoot! quizzes included stimulating music, colourful animations, and a countdown for each question, which maintained participants’ engagement and created a sense of competition. Kahoot! creates a bar graph for each quiz that shows how many participants chose each of the answers provided, which gives feedback for both students and instructors (24). Students were encouraged to join as participants on Kahoot! with their hidden identity. They could use symbols or any cartoon characters to maintain their anonymity.

After completion of learning outcomes of the subject, study participants were invited via class messages and announcements to participate in an online survey. A cover sheet was included along with the research questionnaire. The cover sheet briefly described the study aim and its objectives. Students were requested to give their voluntary written informed consent before the start of the study. The questionnaire took approximately 10-15 min to complete. A pilot study was conducted on 15 postgraduate public health students. The results and feedback of these students were used to refine the questionnaire, and their results were excluded from the results of the final study. The link to the survey was shared with the students’ during their class timings.

Ethical Approval

This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Ethical approvals were obtained from the ethics committee of Torrens University. We included a disclaimer in our cover sheet that participation in the survey was completely voluntary and survey responses were anonymous; thus, confidentiality of all participants was fully respected. Furthermore, electronic informed consent was obtained from each participant before the start of the study and the survey. Participants had the right to withdraw from the study at any stage without any justification.

Survey Questionnaire

The self-reported online survey included nine multiple-choice questions on socio-demographics and nineteen questions on students’ learning, motivation and engagement. Sociodemographic questions included information on gender, age, campus (geographical location), mode of studying (face to face versus online), status of student as domestic or international, nationality, employment (part-time or full time), field of graduation. Questions based on students’ learning, motivation and engagement were predominantly closed ended with one open ended question at the end of the survey. There were Likert scale questions ranging on a five-point scale, itemised from strongly agree (1), agree (2), neutral (3), disagree (4) to strongly disagree (5). In the open-ended question, participants were allowed to express themselves in an unstructured manner. This allowed us to obtain a holistic and comprehensive perspective of the issues being studied and gave the data much more depth and diversity (25).

Statistical analysis

Quantitative data were analyzed using IBM SPSS Statistics (Version XX; IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated to summarize demographic characteristics and Likert-scale survey responses related to learning, engagement, and motivation.

To examine age-based differences in student perceptions of Kahoot!, an independent samples t-test was conducted between two age groups: students under 30 years and those aged 30 years and older. The 20 Likert-scale items (coded 1 = Strongly Agree to 5 = Strongly Disagree) were treated as approximately interval for the purposes of comparison, as supported by previous literature (29). Normality assumptions were evaluated using skewness, kurtosis, and visual inspection of histograms, and Levene’s test was used to assess the homogeneity of variances.

Statistical significance was determined at an alpha level of .05 (two-tailed). Effect sizes (Cohen’s d) were also reported to interpret the practical significance of findings. Qualitative data from open-ended responses were analyzed using thematic analysis to identify recurring patterns and sentiments related to students’ perceptions of Kahoot! as a learning tool.

RESULTS

Table 1 shows the demographic characteristics of students. A total of 397 participants completed the survey. The sample was predominantly female (82.4%), with males comprising 17.6%. The mean age of participants was 29 years. Participants were primarily enrolled across multiple campuses, with the largest proportion studying in Melbourne (39.5%) and 56% were studying epidemiology. Most of students were international (94.2%, mainly from the South-East region), with prior education in health (87.4%). Seventy-eight per cent of students were employed on a part-time basis and more than half of them were studying online.

Table 2 demonstrates that descriptive statistics were used to examine participants’ perceptions of using Kahoot! as a gamified learning tool. Nearly seventy-two percent of the students strongly agreed and 25.9% agreed that they enjoyed themselves when playing Kahoot!. Similarly, 62.5% strongly agreed and 34.3% agreed that playing Kahoot! helped them understand subject content. Regarding reinforcement of learning, 66.5% strongly agreed and 32.0% agreed that Kahoot! helped them revise what they learned in class.

Participants also perceived Kahoot! as effective in promoting engagement and motivation. 63.0% strongly agreed and 34.8% agreed that Kahoot! made their classes more interactive, and 58.2% strongly agreed that playing Kahoot! motivated them to increase their knowledge. Additionally, 59.9% strongly agreed that Kahoot! was an effective means for reflective learning.

In terms of fun and competitiveness, 64.5% strongly agreed that they had fun while playing Kahoot!, and 55.7% strongly agreed that they enjoyed the competitive element. A slightly lower proportion (50.4% strongly agreed) indicated that playing Kahoot! increased their motivation to attend classes, although an additional 40.1% agreed with this statement.

Overall, the results suggest that Kahoot! was perceived very positively by the participants, with strong endorsements for its ability to enhance enjoyment, engagement, retention, and understanding of course content

An independent samples t-test was conducted to compare perceptions of Kahoot!-based learning activities between participants under 30 years and those 30 years and older (Table 3). The dependent variables included 20 Likert-scale items evaluating enjoyment, understanding, motivation, engagement, and learning reinforcement.

Significant differences were observed across most survey items. Participants under 30 years consistently reported lower mean scores compared to participants aged 30 and above across various items, indicating more positive perceptions of Kahoot! activities (given that lower scores reflect stronger agreement).

Specifically, participants under 30 reported significantly greater enjoyment (M = 1.24, SD = 0.49) than those 30 and above (M = 1.43, SD = 0.58), t = -3.10, p = .002. Similarly, younger participants reported greater perceived understanding (M=1.34, SD=0.541), t = -3.78, p < .001), better knowledge retention (M=1.33, SD=0.598 t = -2.66, p = .008), and higher motivation (M=1.39, SD=0.546 t = -3.47, p = .001) through Kahoot!. The most substantial difference was observed for the item “Playing Kahoot! has helped me improve my academic performance,” where participants under 30 reported significantly stronger agreement (M = 1.45, SD = 0.65) compared to those 30 and above (M = 1.99, SD = 1.09), t = -5.17, p < .001. Notably, no statistically significant difference was found for a questions, such as “Playing Kahoot! made class more interactive” (p = .245) and “I prefer learning subject material using both lecture and Kahoot!” (p = .056), suggesting similar perceptions across age groups for these aspects.

Thematic analysis of open-ended responses indicated that the majority of students (95.5%) perceived Kahoot! as a complementary learning strategy, which was a beneficial and enjoyable learning experience. Many commented that the platform facilitated revision, clarified concepts, and contributed to a more relaxed and motivating classroom environment. For example, “one of the students said that even though she had not done her reading and revision, Kahoot! helped her to focus and learn the concepts while having fun and being an environment that made her felt supported and comfortable”. Another student said,  “every time I saw myself on top of the scoreboard, I was thrilled and excited for the next question, I felt confident that I was making progress and could achieve good scores in the subject and this motivated me to keep going with the course”.

Students reported that the competitive and game-like nature of Kahoot! kept them engaged, attentive and encouraged participation, particularly through real-time feedback and visual elements like music and leaderboards. A sense of social connection and enjoyment was also highlighted, especially during collaborative or large-group sessions. For instance, a student said that “he felt engaged in learning as he was not alone and was surrounded by other students as a team, so the hurdles and assessments did not seem a burden for his commitment to study”.

Negligible responses (4.5%) raised concerns about the format, noting that time-limited questions could hinder deeper reflection or discussion.

DISCUSSION

This is the first study that has been conducted among the postgraduate public health students to assess the impact on learning, engagement and motivation by implementing Kahoot! in class. The novel finding of this study is the comparison between students aged <30 years and those who are 30 years or above. To the best of our knowledge, only few studies have established that using GSRS like Kahoot! improves the motivation and engagement among the higher education health students (24-26, 30-37).

In the present study, the students’ motivation influenced by psychosocial factors and social environment in learning, ranges from intrinsic to extrinsic motivation, based on self-determination theory, which promotes positive efforts, persistence, and goal-directed behaviour (38). Students were motivated intrinsically by interest, excitement, confidence, and the learning activity itself. On the other hand, they were motivated extrinsically by several factors, such as feedback, competition, rewards, recognition of people and other interactive features (38, 39). reported similar results from his study on physiotherapy students in Spain. Our results are also in line with some other studies from health and engineering students  (24, 25, 33, 40-45). Kahoot! is a user-friendly interface that promotes an active, engaging and student-centred learning environment with social connectedness and fun that increases students’ achievement, provides permanent learning and academic success (25, 27, 43-46). Students get good feedback with audio-visual stimuli in an anonymous environment, which facilitates self-reflection and open dialogues between peers and the teacher. The fun element in learning with Kahoot has also shown to reduce psychological distress in a study conducted on medical students (25, 33), these features strengthen students’ capacity to regulate their own performance as mentioned by (47).  In a study conducted on medical students, Kahoot! was perceived as a learning booster and enhanced academic performance (34). Participants reported that Kahoot! helped them revise, clarify misunderstandings, and retain content learned in class. This aligns with findings of a literature review conducted on ninety-three studies on the use of Kahoot! In educational settings, looking at the positive learning performance, classroom dynamics and students’ and teachers’ attitudes, anxiety and the support provided for cognitive engagement and deeper learning (48, 49). The competitive elements of Kahoot!, when designed thoughtfully, encourage repeated retrieval practice — a well-documented mechanism for enhancing memory and comprehension (50, 51).

Our findings also align with more recent studies conducted during and post-pandemic, which highlight the importance of gamified digital tools in maintaining student motivation and engagement in hybrid and online learning environments (52-54). The flexibility and adaptability of Kahoot! allowed students to remain connected and motivated, even in less traditional learning setups.

The qualitative responses demonstrate overwhelmingly positive experiences among students, with 95.5% expressing promising and productive views. The most frequently reported benefit was enhanced learning and enjoyment (46.6%). Students described how Kahoot! supported the clarification of complex concepts and facilitated active revision through engaging formats. These findings are consistent with prior research in medical education. For instance, a phenomenological study by (55) Ismail et al. (2019) in his study with undergraduate medical students identified themes of “attractive learning tool” and “learning guidance,” indicating that Kahoot! was not only enjoyable but also functioned as an effective formative assessment mechanism. Similarly, in the context of histology, (56) reported improved comprehension and academic performance among medical and dental students when Kahoot! was integrated into the curriculum.

Student engagement was another dominant theme (39.0%). The interactive and competitive nature of the tool promoted active participation and collaborative learning. These results align with (43), who noted that game-based student response systems improved classroom dynamics and maintained learner attention. Additionally, (45) conceptual framework of student engagement emphasizes behavioral and emotional investment, both of which were reflected in student comments from this study.

Students (9.8%) highlighted the motivational aspects of Kahoot!’s competitive features, such as real-time leaderboards, music, and screen effects. These design elements foster a sense of competence and autonomy, which are central to (57) Self-Determination Theory (1985). Supporting this, a systematic review which concluded that the use of Kahoot! in nursing education was associated with increased intrinsic motivation and higher levels of learner satisfaction (58).

Despite these positive outcomes, a small subset of students (4.5%) expressed concerns regarding the limitations of the platform. Specifically, the brevity of questions constrained deeper discussion, and the fast-paced nature of competitive play occasionally led to restlessness. Dicheva et al. (2015), in his study support similar findings (59) and express concerns for superficial engagement when gamification prioritizes speed and points over reflective learning. Hanus and Fox (2015) similarly cautioned that gamification, if poorly aligned with pedagogical goals, may result in decreased satisfaction and performance over time (60).

Despite the overwhelmingly positive perceptions, it is important to recognize potential limitations in the effectiveness of gamification. Not all students may respond equally well to competitive game mechanics; for some, competitive stress may reduce engagement or motivation (60). Furthermore, poor alignment between game design and pedagogical objectives can result in superficial engagement, where students participate actively but learn little meaningfully (61, 62). Also, the essential requirement of technology and at times, the elements of competition can hinder motivation among the mature students (63, 64).

CONCLUSIONS

In conclusion, the results of this study reinforce the growing evidence that gamification — and specifically tools like Kahoot! — positively influence student engagement, motivation, and learning reinforcement in health education contexts. Importantly, these benefits appear to be most pronounced among younger, digitally fluent students. However, careful instructional design is critical to maximise learning outcomes and ensure that game-based elements complement, rather than distract from, pedagogical goals. Finally, future studies with a control group and longitudinal follow-up could explore integrating multiple gamification platforms or adaptive technologies to enhance inclusivity and assess how specific gamified elements influence learning behaviours across diverse student cohorts.

Conflict of interest: None

Funding: None

Acknowledgement: We are sincerely thankful to the students for their voluntary participation in the study. We are also grateful to Torrens University for providing us with support for the use of Qualtrics.

Availability of data and materials

The datasets used and analysed during the current study are available from the corresponding author upon a reasonable request.

REFERENCES

1. Costa C, Hammond M, Younie S. Theorising technology in education: an introduction. Technology, Pedagogy and Education. 2019;28(4):395-9.
2. Gunderman RB, Kang YP, Fraley RE, Williamson KB. Instructional technology and radiologic education. Radiology. 2001;221(1):1-4; discussion 5.
3. Underwood JD. The impact of digital technology: A review of the evidence of the impact of digital technologies on formal education. 2009.
4. Underwood JD, Farrington-Flint L. Learning and the E-Generation: John Wiley & Sons; 2015.
5. Barrio CM, Muñoz-Organero M, Soriano JS. Can gamification improve the benefits of student response systems in learning? An experimental study. IEEE Transactions on Emerging Topics in Computing. 2015;4(3):429-38.
6. Licorish S, George J, Owen,, HE D, B “Go Kahoot!” enriching classroom engagement, 6. motivation and learning experience with games. In Proceedings of the 25th International Conference on Computers in Education, (ICCE ).  Asia-Pacific Society for Computers in Education; Christchurch, New Zealand2017. p. 755–64.
7. Deterding S, Dixon D, Khaled R, Nacke L. From game design elements to gamefulness: defining “gamification”. Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments; Tampere, Finland: Association for Computing Machinery; 2011. p. 9–15.
8. Caponetto I, Earp J, Ott M, editors. Gamification and Education : A Literature.
9. Zichermann G, Cunningham C. Gamification by design: Implementing game mechanics in web and mobile apps: ” O’Reilly Media, Inc.”; 2011.
10. Seaborn K, Fels DI. Gamification in theory and action: A survey. International Journal of Human-Computer Studies. 2015;74:14-31.
11. Gefen D, Karahanna E, Straub DW. Inexperience and experience with online stores: The importance of TAM and trust. IEEE Transactions on engineering management. 2003;50(3):307-21.
12. Yadav PK, Bera TK, Mukharjee P, Yadav S, Sah SK, Kar SK. Audio-visual aids in teaching-learning process of health science students and professionals. Journal of Universal College of Medical Sciences. 2015;3(4):50-2.
13. Hamari J, Koivisto J, Sarsa H, editors. Does gamification work?–a literature review of empirical studies on gamification. 2014 47th Hawaii international conference on system sciences; 2014: Ieee.
14. Looyestyn J, Kernot J, Boshoff K, Ryan J, Edney S, Maher C. Does gamification increase engagement with online programs? A systematic review. PLoS One. 2017;12(3):e0173403.
15. Lee J, Hammer J. Gamification in Education: What, How, Why Bother? Academic Exchange Quarterly. 2011;15:1-5.
16. Gentry SV, Gauthier A, Ehrstrom BLE, Wortley D, Lilienthal A, Car LT, et al. Serious gaming and gamification education in health professions: systematic review. Journal of medical Internet research. 2019;21(3):e12994.
17. Nanjappa A, Grant MM. Constructing on constructivism: The role of technology. Electronic Journal for the integration of Technology in Education. 2003;2(1):38-56.
18. Wolf M, Stoodley CJ. Proust and the squid: The story and science of the reading brain: Harper Perennial New York; 2008.
19. Cavanaugh JM, Giapponi CC, Golden TD. Digital technology and student cognitive development: The neuroscience of the university classroom. Journal of Management Education. 2016;40(4):374-97.
20. Csikszentmihalyi M. Beyond boredom and anxiety. 1975.
21. Privette G, Bundrick CM. Measurement of Experience: Construct and Content Validity of the Experience Questionnaire. Perceptual and Motor Skills. 1987;65(1):315-32.
22. Hansch A, Newman C, Schildhauer T. Fostering engagement with gamification: Review of current practices on online learning platforms. 2015.
23. Baddeley AD, Hitch G, Bower GH. The psychology of learning and motivation. 1974.
24. Aktekin NÇ, Celebi H, Aktekin M. Let’s Kahoot! Anatomy. International Journal of Morphology. 2018;36(2).
25. Ismail MA-A, Mohammad JA-M. Kahoot: A promising tool for formative assessment in medical education. Education in Medicine Journal. 2017;9(2).
26. Jamil Z, Fatima SS, Saeed AA. Preclinical medical students’ perspective on technology enhanced assessment for learning. J Pak Med Assoc. 2018;68(6):898-903.
27. Felszeghy S, Pasonen-Seppänen S, Koskela A, Nieminen P, Härkönen K, Paldanius KMA, et al. Using online game-based platforms to improve student performance and engagement in histology teaching. BMC Medical Education. 2019;19(1):273.
28. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121-6.
29. Carifio J, Perla R. Resolving the 50-year debate around using and misusing Likert scales. Medical Education. 2008;42(12):1150-2.
30. Daniel S, Bangalore-Krishna K. FRI016 Utilizing Game-based Learning In Medical Education. Journal of the Endocrine Society. 2023;7(Supplement_1):bvad114. 1493.
31. Hsu Y-H, Tsou C-Y, Li W-J, Shen P-J, Hsu H-T, Yu S-I. Using Game-Based Learning to Engage Learners in Lung Basic Sciences. Respiratory Care; 2023.
32. Sandoval-Hernández I, Molina-Torres G, León-Morillas F, Ropero-Padilla C, González-Sánchez M, Martínez-Cal J. Analysis of different gamification-based teaching resources for physiotherapy students: a comparative study. BMC Medical Education. 2023;23(1):675.
33. Youhasan P, Raheem S. Technology enabled formative assessment in medical education: A pilot study through Kahoot. Education in Medicine Journal. 2019;11(3):23-9.
34. Elkhamisy FAA, Wassef RM. Innovating pathology learning via Kahoot! game-based tool: a quantitative study of studentsperceptions and academic performance. Alexandria Journal of Medicine. 2021;57(1):215-23.
35. Krause M, Mogalle M, Pohl H, Williams JJ, editors. A playful game changer: Fostering student retention in online education with social gamification. Proceedings of the Second (2015) ACM conference on Learning@ Scale; 2015.
36. Jang J, Park JJ, Yi MY, editors. Gamification of online learning. Artificial Intelligence in Education: 17th International Conference, AIED 2015, Madrid, Spain, June 22-26, 2015 Proceedings 17; 2015: Springer.Cechanowicz J, Gutwin C, Brownell B, Goodfellow L, editors. Effects of gamification on participation and data quality in a real-world market research domain. Proceedings of the first international conference on gameful design, research, and applications; 2013.
37. Deci EL, Ryan RM. The importance of universal psychological needs for understanding motivation in the workplace. 2014.
38. Neureiter D, Klieser E, Neumayer B, Winkelmann P, Urbas R, Kiesslich T. Feasibility of Kahoot! as a Real-Time Assessment Tool in (Histo-)pathology Classroom Teaching. Adv Med Educ Pract. 2020;11:695-705.
39. Mullen GE, Tallent-Runnels MK. Student outcomes and perceptions of instructors’ demands and support in online and traditional classrooms. The Internet and higher education. 2006;9(4):257-66.
40. Lashari TA, Fiayaz R, Lashari SA, Khan I, Sultana S, Afzal T. Kahoot: A game‐based web tool to assess motivation, engagement fun, and learning outcomes among engineers. Computer Applications in Engineering Education. 2024;32(2):e22684.
41. Castro M-J, Lopez M, Cao M-J, Fernandez-Castro M, Garcia S, Frutos M, et al. Impact of educational games on academic outcomes of students in the Degree in Nursing. PloS one. 2019;14(7):e0220388.
42. Wang AI. The wear out effect of a game-based student response system. Computers & Education. 2015;82:217-27.
43. Jamil Z, Fatima SS, Saeed AA. Preclinical medical students’ perspective on technology enhanced assessment for learning. JPMA. 2018;68(898):903.
44. Kahu ER. Framing student engagement in higher education. Studies in Higher Education. 2013;38(5):758-73.
45. Subhash S, Cudney EA. Gamified learning in higher education: A systematic review of the literature. Computers in Human Behavior. 2018;87:192-206.
46. Nicol DJ, Macfarlane‐Dick D. Formative assessment and self‐regulated learning: A model and seven principles of good feedback practice. Studies in higher education. 2006;31(2):199-218.
47. Wang AI, Tahir R. The effect of using Kahoot! for learning – A literature review. Computers & Education. 2020;149:103818.
48. Licorish SA, Owen HE, Daniel B, George JL. Students’ perception of Kahoot!’s influence on teaching and learning. Research and Practice in Technology Enhanced Learning. 2018;13(1):9.
49. Roediger HL, Butler AC. The critical role of retrieval practice in long-term retention. Trends in cognitive sciences. 2011;15(1):20-7.
50. Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public interest. 2013;14(1):4-58.
51. Zainuddin Z, Chu SKW, Shujahat M, Perera CJ. The impact of gamification on learning and instruction: A systematic review of empirical evidence. Educational research review. 2020;30:100326.
52. Lee JJ, Hammer J. Gamification in education: What, how, why bother? Academic exchange quarterly. 2011;15(2):146.
53. Chang SJ, Kim GM, Kim JA. The effects of flipped learning and gamification on nursing students’ patient safety education: A mixed method study. Heliyon. 2024;10(8).
54. Ismail SN, Halim A, Ahmad Z. A phenomenological study on student experiences of using Kahoot! as a formative assessment tool in medical education. BMC Medical Education. 2019;19:245.
55. Fonseca LM, Fernandes LM, da Silva MAS, Conceição CM. Gamification as a learning strategy for histology in medical and dental students. BMC Medical Education. 2020;20:47.
56. Deci EL, Ryan RM. Intrinsic Motivation and Self-Determination in Human Behavior: Springer; 1985.
57. Al Said F. Effectiveness of Kahoot! as a digital game-based learning tool in nursing education: A systematic review. International Journal of Science and Healthcare Research. 2022;7(3):23-9.
58. Dicheva D, Dichev C, Agre G, Angelova G. Gamification in education: A systematic mapping study. Educational Technology & Society. 2015;18(3):75-88.
59. Hanus MD, Fox J. Assessing the effects of gamification in the classroom: A longitudinal study on intrinsic motivation, social comparison, satisfaction, effort, and academic performance. Computers & Education. 2015;80:152-61.
60. Dicheva D, Dichev C, Agre G, Angelova G. Gamification in education: A systematic mapping study. Journal of educational technology & society. 2015;18(3):75-88.
61. Landers RN. Gamification misunderstood: How badly executed and rhetorical gamification obscures its transformative potential. Journal of Management inquiry. 2019;28(2):137-40.
62. Özdemir O. Kahoot! Game‐based digital learning platform: A comprehensive meta‐analysis. Journal of Computer Assisted Learning. 2025;41(1):e13084.
63. Holmes JB, Gee ER. A framework for understanding game-based teaching and learning. On the horizon. 2016;24(1):1-16.

Table 1: Demographic data of study participants

Table 2: Descriptive statistics which assessed students’ anonymous and voluntary responses of all questions on Kahoot!

Table 3: Descriptive statistics and results from the Independent t-test on questions on Kahoot!

Table 4: Main themes that emerged from open-ended questions about learning, engagement and motivation