Visual novel game as a new breakthrough in dental health education media for stunted children in Indonesia

Background: Education level is one of the factors that affect children’s oral health status. The research focuses on elementary school-age children due to their limited capacity for formal thought. Educational games are a type of game that not only provides entertainment but also conveys knowledge to their users. Visual novel games offer a new breakthrough to enhance oral health status. The study aimed to evaluate the effectiveness of educational media in the form of a visual novel game as an innovative oral health education tool for stunted children in elementary schools, especially in the Bojongsari area, Indonesia. Methods: This study used a quantitative approach with a quasi-experimental one-group pre-test and post-test design to evaluate the effectiveness of visual novel game educational media on improving oral health knowledge in stunted children in Indonesia, which was then reinforced with in-depth interviews as supporting qualitative data. Results: The research demonstrated a significant increase in knowledge pre- and post-test, and the majority of students retrieved remarkably satisfying knowledge after playing the game. Statistical analysis revealed a significant difference between pre-test and post-test knowledge scores among stunted children at Sekolah Dasar Negeri (SDN; Public Elementary School) Pontir 2 and Madrasah Ibtidaiyah (MI; Islamic Elementary School) Hidayatul Athfal with a p-value < 0.05. Additionally, the game facilitated information and persuasiveness through adaptation of strong stories, attractive characters, and other characteristics. Conclusions: In conclusion, by implementing the strategies, Indonesia is able to increase oral health knowledge, particularly for elementary school-aged stunted children.

Children; Education; Game; Oral health; Stunted

[1] Salsabila N, Kasuma N, Yerizel E. Determination of the number of Porphyromonas Gingivalis ATCC 33277 in Salivaof Stunted Children. e-GiGi. 2023; 12: 26–31. (In Indonesian)

[2] Nelwan SC, Tedjosasongko U, Dewi AM, Ayuningtyas P. Parathyroid hormone-related protein and primary teeth eruption in stunting children. World Journal of Advanced Research and Reviews. 2022; 14: 016–021.

[3] Akbar RR, Kartika W, Khairunnisa M. The effect of stunting on child growth and development. Scientific Journal. 2023; 2: 153–160.

[4] United Nations Children’s Fund (‎UNICEF)‎, World Health Organization & World Bank. The UNICEF-WHO-World Bank joint child malnutrition estimates (JME) standard methodology: tracking progress on SDG indicators 2.2.1 on stunting, 2.2.2 (‎1)‎ on overweight and 2.2.2 (‎2)‎ on wasting. 2024. Available at: https://www.who.int/publications/i/item/9789240100190 (Accessed: 10 August 2025).

[5] Devi YP, Herdayati M, Makful MR, Muthmainnah M, Ekoriano M, Ruwandasari N, et al. Spatial analysis of stunting prevalence according to family data collection indicators in Indonesia. Media Publikasi Promosi Kesehatan Indonesia. 2025; 8: 210–220.

[6] Gunawan E, Puspitawati R. Relationship between Vitamin D deficiency and lipopolysaccharides Porphyromonas gingivalis bacteria in stunting children. Annals of Biomedical Science and Engineering. 2024; 8: 59–65.

[7] Minervini G, Franco R, Marrapodi MM, Fiorillo L, Cervino G, Cicciù M. The association between parent education level, oral health, and oral-related sleep disturbance. An observational crosssectional study. European Journal of Paediatric Dentistry. 2023; 24: 218–223.

[8] Sinchez CJA, Villar BS, Fraiz FC, Lopez RVM, Bavaresco CS, Haddad AE. Association between early admission at school and oral health and nutritional status of children in the city of São Paulo, Brazil. Brazilian Research in Pediatric Dentistry and Integrated Clinic. 2021; 21: 1–10.

[9] Health Development Policy Agency, Ministry of Health of the Republic of Indonesia. SKI 2023 in numbers. 2023. Available at: https://www.badankebijakan.kemkes.go.id/en/ski-2023-dalam-angka/ (Accessed 10 August 2025).

[10] Dewi PK, Aripin D, Suwargiani AA. DMF-T and def-t index among children in Mekarjaya public elementary school, Cimenyan subdistrict, Bandung, Indonesia. Padjadjaran Journal of Dental Researchers and Students. 2017; 1: 123.

[11] Cerovac M, Keane T. Early insights into Piaget’s cognitive development model through the lens of the Technologies curriculum. International Journal of Technology and Design Education. 2024; 35: 61–81.

[12] Djannah SN, Trisnowati H, Tukiyo IW, Solikhah S. Dental and oral health education media: effectiveness in improving health students’ knowledge and attitudes. Disease Prevention and Public Health Journal. 2025; 19: 11–19.

[13] Bakhtiar M, Hosseini SM, Behbahanirad A, Kamyab A, Khani Jeihooni A. Preparation and evaluation of a multimedia oral health education software for teenagers. BMC Oral Health. 2025; 25: 712.

[14] Johnston K. Engagement and immersion in digital play: supporting young children’s digital wellbeing. International Journal of Enviromental Research and Public Health. 2021; 18: 10179.

[15] Kaźmierczak R, Skowroński R, Kowalczyk C, Grunwald G. Creating interactive scenes in 3D educational games: using narrative and technology to explore history and culture. Applied Sciences. 2024; 14: 4795.

[16] Li Z. An analysis of the effect of educational games on cultivating students’ interest in subjects. Lecture Notes in Education Psychology and Public Media. 2024; 42: 27–31.

[17] Khoiruddin MH, Bahari ZHZ, Kaka MS, Saenpich S. Development of visual novel games as learning media for the history of Indonesia’s independence. Journal of Educational Technology and Learning Creativity. 2023; 1: 33–41.

[18] Moreira R, Silveira A, Sequeira T, Durão N, Lourenço J, Cascais I, et al. Gamification and oral health in children and adolescents: scoping review. Interactive Journal of Medical Research. 2024; 13: e35132.

[19] Almalki SA, Adil AH, Mustafa M, Karobari MI. Assessing oral health knowledge among public school children in Saudi Arabian subpopulation. Journal of Health, Population and Nutrition. 2024; 43: 126.

[20] Ram Surath Kumar K, Deshpande AP, Ankola AV, Sankeshwari RM, Jalihal S, Hampiholi V, et al. Effectiveness of a visual interactive game on oral hygiene knowledge, practices, and clinical parameters among adolescents: a randomized controlled trial. Children. 2022; 9: 1828.

[21] Ezzat R. Gamification to increase engagement and impact on students through education process. International Design Journal. 2024; 14: 375–386.

[22] Li Y, Chen D, Deng X. The impact of digital educational games on student’s motivation for learning: the mediating effect of learning engagement and the moderating effect of the digital environment. PLOS ONE. 2024; 19: e0294350.

[23] Parthasarathy PK, Mittal A, Aggarwal A. Literature review: learning through game-based technology enhances cognitive skills. International Journal of Professional Business Review. 2023; 8: 1–33.

[24] Zaror C, Mariño R, Atala-Acevedo C. Current state of serious games in dentistry: a scoping review. Games for Health Journal. 2021; 10: 95–108.

[25] Rasmus K, Toratti A, Karki S, Pesonen P, Laitala ML, Anttonen V. Acceptability of a mobile application in children’s oral health promotion—a pilot study. International Journal of Environmental Research and Public Health. 2021; 18: 1–9.

[26] Wardani NEP, Putri AW, Ramadhanintyas KN. Dental and oral health counseling efforts on students’ knowledge levels (SDN 02 Tiron Madiun). International Journal of Health Literacy and Science. 2023; 1: 35–40.

[27] Gurav KM, Shetty V, Vinay V, Bhor K, Jain C, Divekar P. Effectiveness of oral health educational methods among school children aged 5–16 years in improving their oral health status: a meta-analysis. International Journal of Clinical Pediatric Dentistry. 2022; 15: 338–349.

[28] Saidah A, Isni K. The effect of dental and oral health education on children’s knowledge level in Rejowinangun village, Yogyakarta. Media Publikasi Promosi Kesehatan Indonesia. 2022; 5: 205–210. (In Indonesian)

[29] Aljafari A, Elkarmi R, Nasser O, Atef A, Hosey MT. A video-game-based oral health intervention in primary schools—a randomised controlled trial. Dentistry Journal. 2022; 10: 1–11.

[30] Aprilia K, Yudiernawati A, Rachman MZ. Board game-based education to improve knowledge and skills in dental caries prevention among school-aged children. Journal of Health Research Science. 2024; 4: 328–335. (In Indonesian)

[31] Cascaes AM, Da Silva NRJ, Fernandez MDS, Bomfim RA, Vaz JDS. Ultra-processed food consumption and dental caries in children and adolescents: a systematic review and meta-analysis. British Journal of Nutrition. 2023; 129: 1370–1379.