Escape room-based learning for HPV vaccine education in Japanese female university students: a controlled, three-group study.

Japan's human papillomavirus (HPV) vaccine coverage remains low, highlighting the need for engaging education for young adults. An escape-room intervention, a traditional lecture, and a non-intervention control were compared in Japanese female university students. Questionnaires were completed at baseline, immediately post-intervention, and three months later. Knowledge and vaccination intention were assessed at all time points; satisfaction and perceived comprehension were assessed immediately post-intervention; and HPV vaccination initiation was assessed at three months. Open-ended responses from the escape-room group were analyzed using quantitative content analysis based on Fink's taxonomy. For the 267 students (escape room n = 92; lecture n = 75; control n = 100), the lecture produced greater immediate gains in knowledge and intention. At three months, both intervention groups retained higher knowledge than the control group, with no difference between escape room and lecture. In participants unvaccinated at baseline (0 doses), vaccination intention increased more from baseline to three months in the escape-room group than in the control group, whereas vaccination initiation was significantly higher in the lecture group. Qualitative findings suggested the escape room promoted emotional engagement, intrinsic motivation, and peer collaboration. Escape rooms may complement traditional vaccine education by providing an interactive, low-resource format that supports learning and motivation.