Six-Week Board Game Intervention to Improve Hydration in Tunisian School Children

Adequate hydration is a critical determinant of children's physical health, cognitive functioning, and participation in daily school activities. Despite the well-documented benefits of maintaining optimal hydration, evidence consistently demonstrates that many school-aged children consume insufficient amounts of water during the school day. This inadequacy may compromise physical performance, learning capacity, and general well-being. Consequently, effective and engaging strategies are required to promote hydration-related knowledge and foster sustainable drinking behaviors in school settings.

This study employed a cluster-randomized controlled trial design to evaluate the effectiveness of a six-week board game-based educational intervention in enhancing hydration knowledge, hydration status, and fluid consumption among Tunisian primary school children. The intervention was conceived as an innovative, developmentally appropriate approach that integrates health education within a playful learning format.

Participating schools were randomly allocated at the class level to either the intervention group or the control group. The intervention consisted of weekly sessions in which children played an adapted version of the traditional "Snakes and Ladders" board game. The game was modified to incorporate hydration-related messages: ladders symbolized appropriate hydration practices, while snakes represented missed opportunities to drink water. Each session lasted approximately 30 minutes and was conducted immediately prior to scheduled physical education lessons. Teachers facilitated gameplay, guided discussion, and reinforced key messages. Children assigned to the control group continued their usual educational activities without exposure to the intervention.

Primary outcomes focused on cognitive, behavioral, and physiological aspects of hydration. Specifically, researchers examined changes in children's hydration knowledge, hydration status during physical education, perceived thirst, and water intake across the intervention period. Baseline and post-intervention assessments were conducted to evaluate program impact.

By embedding health-related messages into a culturally adapted, game-based learning tool, this study seeks to assess the feasibility and effectiveness of playful education in fostering positive hydration behaviors. The findings are expected to contribute to the evidence base for innovative school-based health promotion strategies and may provide valuable insights for educators and public health practitioners aiming to enhance children's well-being through accessible, low-cost interventions.

Inclusion criteria

• First-grade students aged 6-7 years
• Normal BMI according to Cole criteria (2007)
• Parental consent provided

Exclusion criteria

• Exempted from PE due to injury, allergy, or medical condition
• Absent during data collection