Effect of a Theory-Informed, Six-Week Gamified Educational Intervention on Hydration Knowledge, Behavior, and Status in School Children: A Randomized Controlled Trial

Aim: This study assessed the effects of a six-week educational intervention using an adapted “Snakes and Ladders” board game on hydration knowledge, behavior, and status among Tunisian elementary school children during physical education (PE) lessons. Method: A randomized controlled trial involving 207 children was conducted, with participants assigned to either the educational group (EG, n = 99) or the control group (CG, n = 108). The EG participated in six weekly 30-min board game sessions, while the CG continued regular activities. Knowledge of hydration was assessed using a validated questionnaire. Hydration status was monitored indirectly by the percentage change in body mass from pre- to post-PE session. Perceived thirst was evaluated using a 9-point scale, and hydration behavior was evaluated based on water consumption during PE lessons. Results: Following the intervention, the EG demonstrated a significant improvement in overall hydration knowledge (ΔMean = +0.30 ± 0.11 vs. −0.05 ± 0.08 in CG; p < 0.001). Water intake during PE sessions increased progressively from week 2 (83.6 ± 127.2 mL) to week 6 (311.2 ± 204 mL) in the EG, whereas it remained unchanged in the CG (p < 0.001). Body mass loss after PE sessions decreased significantly in the EG (−0.03 kg) compared with the CG (−0.16 kg; p < 0.001), and perceived thirst before and after PE sessions was markedly lower (Cohen’s d = 0.75–1.32). Conclusions. The six-week board-game intervention appeared effective in increasing hydration knowledge, promoting healthier drinking behaviors during PE, and improving indirect indicators of hydration status. These findings provide preliminary evidence for the feasibility and educational value of a gamified, low-cost approach to hydration promotion in schools. Further research should examine long-term retention, include objective hydration biomarkers, and evaluate applicability across diverse school settings and environmental conditions. Trial Registration: This study is registered with Pan African Clinical Trial Registry (PACTR) under the unique identifier (PACTR202510771129829).