Meningioca was designed in partnership with the FIMP, which comprises of over 5300 Italian PCPs (the target audience for Meningioca). Meningioca was designed by a multiprofessional core team comprised of family pediatricians (end-users), professionals with experience and skills in online or remote learning, and professionals with documented scientific expertise in vaccines and vaccinations, through a design-thinking approach [16].

For Meningioca, the design-thinking approach began with understanding the needs of the end-users (ie, PCPs). To ensure all required information was included, a map of topics discussed during health checks was generated (Textbox 1). Unique ideas to communicate this information to end-users in an innovative and engaging way were discussed, and gamification was identified as a potential solution. The map of health check topics was then adapted to suit a serious game, forming the basis of Meningioca’s content.

Meningioca was developed using Storyline 360 (a suite of Articulate 360), an authoring software, SCORM 1.2 (standard format), and TalentLMS, a learning management platform [17-19]. Participants play as an avatar of a goose, inspired by the Game of the Goose (a well-known board game that originated in Italy in the 15th century) and take on the role of a PCP. Using a narrative approach, players participate in a series of activities and mini-games, using and improving vaccination knowledge. Examples of the mini-games include a drag-and-drop activity, where users separate actions they would and would not carry out during health checks, as well as a quick-fire selection game, where users scroll through a video and click on correct answers to questions posed. Participants received points and feedback after each mini-game, with points gained the first time a module is played and players ranked against all other participants. Once each module had been unlocked, it was freely accessible for review or to refresh training. All data included in Meningioca are supported by a reference, either from scientific or gray literature, to ensure all information is confirmed with a reliable source.

A prototype of one module was played by 10 PCPs. Feedback from these testers suggested that the game was enjoyable, and further modules were produced. At launch (March 2023), Meningioca was comprised of 6 modules, with each module focusing on a different age group (0‐2, 2‐3, 4‐6, 12‐15, 24, and 60‐72 mo of age), selected to be in line with the Italian national immunization calendar. In April 2024, a 7th module focusing on adolescents (11‐14 y of age) was added (Figure 1).

All modules within Meningioca are based on a fixed sequence of topics, mirroring discussions that could be expected during health checks for each age group. In brief, the following main themes are covered: health checks in general, child growth or development, vaccination calendar and immunization status check, deepening MenB understanding, communicating with the parent, and Italian general culture. The modules use elements of surprise via quizzes and involve role-playing scenarios where users interact with avatars of colleagues (Figure 2) and caregivers (Figure 3).

At the launch of Meningioca in March 2023, members of the FIMP were invited to play the game via an email link. Members who subscribed to the game were notified of the launch of the module in April 2024. The effectiveness of Meningioca to educate PCPs on the value and proper timing of vaccination with a focus on MenB was measured via feedback questionnaires at the end of each module (Multimedia Appendix 1).

Meningioca was an educational project, not involving a human subject scheme nor collecting human data. Therefore, this project did not require ethics review as per the Linea Guida per la classificazione e conduzione degli studi osservazionali sui farmaci (GU Serie Generale n.76 del 31-03-2008) [20].

To the best of our knowledge, Meningioca is the first gamified educational training tool developed within the field of vaccination, specifically designed for PCPs in Italy. The primary aim of Meningioca is to increase PCPs’ knowledge on the importance of health checks within the context of childhood vaccination and, on a larger scale, boost the below-target MenB vaccination coverage in Italy and decrease general vaccine hesitancy among parents. Early results from the first 14 months of use indicate that Meningioca is not only an enjoyable game but also serves as an effective teaching tool to refresh and strengthen vaccination knowledge.

Meningioca adds to the rapidly expanding field of digital vaccination-based serious gamification tools. Over the past 10 years, digital learning methods aimed at enhancing vaccination knowledge and programs have transitioned from being limited in use to becoming well established, with this evolution evidenced by the increasing number of these games available [14,15,21]. Meningioca, like many vaccine-based digital gamification tools, was aimed at a specific population [22,23]. Understanding the needs of the end-user is key for an engaging learning tool, and by focusing on one target group, the effectiveness of digital gamification tools can be maximized. PCPs were closely involved in the development of Meningioca, both as part of the initial multiprofessional design team and as testers of the pilot module. Involving the end-user from an early stage of development is a valuable strategy for tailoring the needs of a game and may have contributed to players’ enjoyment of Meningioca [15]. Furthermore, Meningioca reinforces the idea that digital gamification tools can be effective even in cohorts with a high level of base knowledge, as demonstrated in a previous study involving antibiotics and vaccination games, where senior students’ knowledge improved despite already possessing high baseline knowledge in these areas [22]. At present, the majority of vaccine-based digital gamification tools focus on one type of disease, such as influenza or human papillomavirus [15]. While Meningioca focuses on MenB vaccination, it also includes information on other childhood vaccinations, topics discussed during health checks, and general Italian culture. By including information on multiple childhood vaccinations, Meningioca ensures PCPs gain interconnected knowledge between different vaccinations, which may lead to a more comprehensive understanding and an increased ability to apply this knowledge more broadly. The web-based nature of Meningioca enhances its ease of use, as no downloadable content or additional devices are required to participate. While the impact of the type of platform used to deliver the tools, eg, web-based, mobile, or virtual reality has not currently been evaluated in terms of user preference, this web-based approach aligns with the majority of vaccine-related digital gamified tools [15].

Feedback from Meningioca’s first year indicated that the game is well-rated among players and enjoyable, as evidenced by Meningioca’s mean rating of 4.4/5. The even split between players’ favorite topics within modules suggests that the game offers a balanced experience, with each aspect developed to a high quality throughout. Enjoyment has been shown to have a positive effect on learning and memory, suggesting that Meningioca may be more effective at increasing knowledge if players enjoy it [24]. “Communicating with parents,” consistently one of the PCPs’ favorite topics, was voted as one of the least difficult, suggesting enjoyment and difficulty may be linked. As no single topic received an overwhelming majority of votes as the most difficult, it could be implied that players of a digital gamification tool need to experience a balanced level of challenge. This balance is crucial for effective learning, as players should feel challenged enough to engage in the game’s content, but not too much that it becomes overwhelming. Overall, early results suggest Meningioca was well received and is an effective tool to increase vaccination knowledge.

In Italy, regular health checks from birth to the age of 14 years are recommended to monitor the physiological development of children and inform parents about preventable diseases, including raising awareness of these diseases and encouraging caregivers to ensure their children receive available vaccinations. Nonetheless, many PCPs do not proactively schedule these appointments, potentially leading to gaps in preventive care and lapses in vaccination schedule adherence, ultimately impacting the child’s overall immunization profile [10]. Enhancing PCPs’ knowledge on the importance of vaccination may not only encourage them to proactively arrange future health checks but also improve their ability to effectively communicate this information to parents, thereby reducing parental vaccine hesitancy, fostering increased vaccine adherence, and helping to prevent the spread of disease. While it is not possible to measure this directly, by encouraging both PCPs to carry out more health checks and parents to take their children to receive vaccinations, Meningioca could boost childhood vaccination uptake, potentially leading to Italy meeting its national MenB vaccination coverage target.

The ability of Meningioca to act as an effective teaching tool was strengthened by the inclusion of PCPs in its development. A large number of Italian PCPs were invited to play the game, improving the game’s generalizability and aiming to ensure that the players accurately represent PCPs overall. Despite these strengths, Meningioca was associated with limitations. First, feedback questionnaires were not consistent across modules, leading to data gaps when synthesizing responses. Consistent questions across modules may help in building a more comprehensive view of the perceptions of end-users. Second, the impact of Meningioca, in terms of its ability to reduce caregiver vaccine hesitancy and increase vaccine uptake, cannot be directly measured. Surrogate measures such as enjoyment and Meningioca’s use as a learning tool could instead be used as proxies.

Further feedback from users will be essential for the improvement of Meningioca as a tool to increase vaccine knowledge among Italian PCPs. Meningioca will continue to be a live game for PCPs to access, in order to increase their knowledge on health check activities as well as their knowledge on vaccinations. Specific questions that test PCPs’ vaccine knowledge before and after using the training tool may help to quantify the effectiveness of Meningioca as a resource for increasing PCPs’ knowledge. Further validation will need to be carried out to assess whether Meningioca could be effective in reducing caregiver vaccine hesitancy and increasing MenB vaccine uptake.

Digital gamification tools are an innovative and promising option for developing vaccination-related learning tools. Meningioca is an enjoyable and potentially effective educational resource for increasing PCP knowledge on the value and proper timing of vaccination, particularly MenB vaccination.