From Silence to Solutions: Learning Through the “Problem Tree Game” to Explore Public Health-Oriented Sexual and Reproductive Health Issues

BackgroundGame-based learning has become a successful method for encouraging nursing students' active participation, critical thinking, and conceptual understanding, while building comfort and helping with information recall. It is a creative and interactive approach for talking about sexual and reproductive health and rights (SRHR), especially in countries like Pakistan where this subject is still culturally sensitive.ObjectiveThis study explored undergraduate public health nursing students' learning about cause-and-effect relationships in sexual health using the Problem Tree Game as a teaching/learning tool. Through experiential learning, the goal was to improve comprehension, memory, and application of SRHR knowledge in the public health domain.MethodsA design-based research approach was used, including: (1) co-design and conceptualization; (2) prototype development and testing; (3) implementation and evaluation (through focus group discussions); and (4) reflection and refinement. Data analysis was conducted through reflexive thematic analysis.ResultsFour major themes were identified: (1) Game-based Learning as Cognitive Architecture for SRHR Learning; (2) Learning as a Social, Dialogic, and Reflective Process; (3) Facilitation, Learning Climate, and the Pedagogical Conditions of Participation; (4) Cognitive Friction in SRHR Game Play.ConclusionThe Problem Tree Game effectively linked theoretical SRHR concepts with practical reasoning skills in public health nursing. By promoting dialogue, reflection, and empathy, this gamified approach holds significant potential to bridge the knowledge-to-practice gap in SRHR education in Pakistan, preparing future nurses for culturally competent community engagement.