Gamified Adult Basic Life Support Training for Schoolchildren Using Minecraft Education Edition: Cross-Sectional Program Evaluation

Abstract Background Early bystander cardiopulmonary resuscitation (CPR) and prompt defibrillation are key determinants of survival after out-of-hospital cardiac arrest, and school-based adult basic life support (BLS) education is a high-impact public health strategy. However, scalability and standardized assessment remain challenging. Gamified digital environments may sustain engagement while enabling comparable, rubric-based evaluation of learning artifacts. Few evaluations have examined whether a fully online gamified platform can support large-scale school-based adult BLS participation while generating standardized class-level artifacts for structured assessment. Objective This study aims to assess the implementation of a fully online, school-oriented, gamified adult BLS initiative delivered through Minecraft Education Edition by quantifying program reach, rubric-based class-level project performance, and provider-side costs. Methods We conducted a cross-sectional program evaluation of the 2025 Build & Save: CPR Museum Challenge during a 21-day window. Participation followed open, voluntary, convenience-based, self-selected sampling in schools. Teachers facilitated a self-directed online adult BLS course and a structured in-game building task with rooms representing key adult BLS actions (checking responsiveness, calling 112, compressing, defibrillating). Each class submitted one project (diary and world file), the unit of analysis; teacher and student counts were recorded only as reach indicators. Eligible submissions included the required PDF diary and an accessible world file; incomplete or nonassessable submissions were excluded before scoring. A 4-member jury assessed projects using a predefined 5-domain rubric (score of 1‐4 per domain; base score 0‐20; total 0‐21, capped at 20). Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests, Spearman correlations, item-total reliability, and Cronbach α were computed using a 2-sided α of .05. Inferential tests were interpreted as exploratory. A cost-consequence analysis reported provider-side costs. Results Thirty class-level projects were submitted; 27 were evaluated after excluding incomplete or nonassessable submissions. The initiative reached 23 teachers and 850 students across 11 regions (Spain, United States, Colombia, Malaysia). The median base and total scores were 7 (IQR 2‐10; range 0‐20). Rubric internal consistency was high (Cronbach α=0.95, 95% CI 0.89-0.97), with corrected item-total correlations of 0.81‐0.89. Projects including an explanatory video scored higher than those without a video (Mann-Whitney U =134.5; P =.006; Cliff delta=0.66, 95% CI 0.37‐0.92), and secondary-level projects outperformed primary-level submissions (Kruskal-Wallis H =7.46; P =.006). Domain correlations were strong (all P <.001; highest ρ=0.94). Direct implementation costs were €4500 (US $5126), rising to €6000 (US $6835) including awards; the cost per student ranged from €5.29 (US $6.03) to €7.06 (US $8.04). Conclusions This single-edition program evaluation suggests that a teacher-facilitated, low-cost, Minecraft-based school initiative may support wide reach and scalable, standardized assessment through class-level artifacts, but it does not demonstrate educational effectiveness in CPR knowledge or skills. Stronger instructional scaffolding is needed, particularly in primary education. Future controlled studies should evaluate knowledge and skill acquisition, retention, and transfer to real-world bystander behavior. Digital gamified activities should complement, not replace, hands-on CPR training.