Abstract
BACKGROUND: The metaverse provides an immersive, interactive medium for health education, but most studies evaluate immersion and gamification together. Randomized evidence disentangling their separate effects on immediate learning and short-term retention in breast health education is lacking. OBJECTIVE: This study aimed to isolate the effects of gamification, over and above an identical immersive metaverse environment, on immediate gains and 4-week retention of women's breast health knowledge. METHODS: This 2-arm, parallel, individually randomized controlled trial was conducted in Hangzhou, China. Eligible participants were women aged ≥18 years who were interested in breast health and able to use a personal computer with internet access. A total of 80 women were recruited via the Xiaohongshu social media platform; 8 withdrew before randomization or did not complete the baseline assessment, and the remaining 72 women were randomized to a gamified metaverse (GM) group or a nongamified metaverse (NGM) group using a computer-generated 1:1 sequence. Both groups used the Mammoverse platform with identical educational content and exposure time. Breast health knowledge was assessed at baseline (T1), immediately postintervention (T2), and 4-week follow-up (T3) using the same questionnaire. The primary outcome was a change in knowledge score. Linear mixed-effects models were used, with age, education, family history of breast cancer, prior training, and baseline knowledge as covariates. Participants and investigators were not blinded. RESULTS: All randomized participants completed follow-up and were included in the analysis (GM group: n=36; NGM group: n=36), with no loss to follow-up. Knowledge scores improved in both groups, but gains from T1 to T2 were larger in the GM group than in the NGM group (Hedges g=0.65, 95% CI 0.18-1.12; P=.007). From T2 to T3, there was no between-group difference in change scores (P=.91). However, at 4 weeks, the GM group retained higher absolute knowledge than the NGM group (estimated marginal means 15.7 vs 13.0). No intervention-related adverse events were reported. CONCLUSIONS: This study marks the first application of gamification in breast self-examination education for ordinary Chinese women within a 3D desktop metaverse. By comparing gamified and nongamified versions under identical metaverse platform conditions, it expands the application boundaries of the GM group in breast health education. Gamification significantly enhanced immediate acquisition of breast health knowledge but did not provide additional advantages for short-term retention. However, the gamified group maintained higher absolute knowledge levels at the 4-week follow-up. Overall, in the 3D desktop metaverse, immersive experiences provide foundational effects, while gamification delivers immediate gains. To further optimize long-term retention, memory consolidation strategies should be integrated into the gamified framework.