This scoping review was conducted in line with PRISMA guidelines [22], and the protocol was submitted to the Open Science Framework Platform (https://doi.org/10.17605/OSF.IO/HVNYA). A systematic electronic search was conducted twice within 6 months (May–October 2024) to identify and collect all published papers on current edutainment approaches for controlling various parasitic diseases, without restrictions on publication date. Databases consulted included PubMed, Science Direct, and Scopus. Additionally, the database Google Scholar was also consulted to collect gray literature. Search keywords included ‘health education’, ‘edutainment’, ‘entertainment education’, ‘participatory methods’, ‘school-age children’, ‘prevention’, ‘parasites’, ‘parasitic zoonosis’, ‘soil-transmitted helminths’, ‘schistosomiasis’, ‘Cystic Echinococcosis’, ‘animated cartoons’, ‘comic books’, ‘games’, ‘videos’, ‘posters’, ‘illustrations’, ‘puppet shows’, and ‘mobile health applications’. A full list of keywords is provided in S1 Table. Keywords were inserted in the search string in various combinations using the Boolean operators “AND” and “OR” (S1 Table).

Initial title/abstract screening was conducted by two authors (MFA and IA) to identify relevant articles. To assess their eligibility for inclusion in the present review, articles that passed the first screening were subjected to a second round of screening of their full texts by three authors (MFA, IA, and AR). Inclusion criteria were: studies that used any edutainment approach to increase awareness of parasitic diseases in school-age children or other groups, articles available in full text, research articles, and articles published in English. Exclusion criteria were: articles describing edutainment approaches for controlling non-parasitic diseases (e.g., viruses, bacteria, and nutritional deficiencies), articles available in abstracts only, and non-original contributions (e.g., review articles and books). Results obtained by each author tasked with screening were compared, and any discrepancies were resolved by discussion and consensus or by consultation with the senior author (AV). Cohen’s Kappa coefficient (k), calculated in Excel, was employed to estimate the degree of agreement between screeners. The values obtained were interpreted as follows: no agreement (k < 0.0), slight (0.1–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80), and almost perfect (k > 0.80). Data from all eligible studies were extracted by three authors (MFA, IA, and AR) and discussed with CT, CC, and AV. The following data were extracted where possible: study design, target parasite(s), country of origin, audience (e.g., school-age children), edutainment approach used, methods of pre- and post-intervention testing. No statistical methods were used in the present scoping review.

Randomized intervention-type studies (controlled or uncontrolled) are often employed to assess the effectiveness of various edutainment approaches in controlling parasitic diseases, particularly STH and schistosomiasis [23]. However, previous controlled intervention trials compared outcomes between two groups only, thus introducing potential selection biases, that are minimized when several groups are compared. Therefore, cluster-randomized intervention-controlled trials are designed to compare the effectiveness of edutainment among several intervention and control groups [24–26]. Most of these randomized trials target school-age children in schools, although community-based studies can also be conducted [27]. Any disparity in age distribution between intervention and control groups represent another potential source of bias [26].

Edutainment is defined as the process of purposefully designing and implementing a media message to entertain and educate, in order to increase audience knowledge of educational issue(s), create favorable attitudes, shift social norms, and encourage behavioral change [28]. There is a fundamental difference between teaching children (= pedagogy) and teaching adults (= andragogy) [29]. Key learning differences between children and adults are highlighted in Fig 2. Nowadays, children grow up as digital natives, and thus may highly benefit from edutainment approaches as they coincide with their developmental behaviors, that includes shorter attention spans and a natural preference for engaging, interactive learning experiences [30]. Edutainment engages emotions as well as the intellect [31]. Edutainment aims to ‘be there’, to ‘participate in the experience of knowledge’ and ‘be oneself inside the situation’, while encouraging playing and active involvement [9].

Compared to traditional education methods, edutainment connects fun with learning, making even complex ideas more attractive and digestible [32]. The emotional component of communication plays an important role in learning, both in children and in adults. Human cognitive processes, including attention, learning, and memory, are influenced by emotions [14]. Emotional experiences are remembered vividly and accurately, with great resilience over time. This phenomenon occurs because the brain stimulates an emotional mechanism that activates the learning process. By integrating multimedia, games, and storytelling, learning can be aligned with the mechanisms by which children process and absorb new information, thus resulting in improved retention and comprehension [33]. Furthermore, flexibility is key to ensure wider participation of students with varying attention spans. Active engagement boosts creativity, problem-solving abilities, and social interaction, all pivotal components of a holistic learning experience [34].

The edutainment approach can be effectively implemented in various environments, including schools, community gatherings, science festivals, and broader public settings [35,36]. In schools, students engage with interactive tools like storytelling, games, and role-playing activities, that make lessons on hygiene, sanitation, and disease prevention more enjoyable [37]. Digital resources like animated videos and mobile applications can visually demonstrate how diseases spread. Activities like puppet shows and competitions can reinforce the lessons on the importance of, e.g., handwashing, safe interaction with animals, and wearing footwear [27].

In community gatherings, edutainment can include street performances and interactive open workshops covering prevention measures in culturally relevant ways. Local radio and television programs can facilitate the dissemination of information, particularly in rural areas, and make information accessible in local languages [28,38]. In workplaces and during public health campaigns, the use of infographics, safety videos, and live demonstrations on the prevention of parasitic and zoonotic disease, sanitation, and hygiene, are a powerful tool to spread awareness [39].

The effective implementation of edutainment strictly depends on well-defined strategies, dedicated facilitators, and the availability of adequate resources. In schools, teachers, health educators, and NGOs play a key role in coordinating edutainment initiatives, utilizing printed materials, digital tools, and interactive teaching methods [40]. Successful implementation may include competitions and quizzes to assess knowledge retention and behavioral change. In community gatherings, healthcare professionals, volunteers, and NGOs drive edutainment efforts, utilizing mobile outreach units and appropriate edutainment strategies tailored to specific contexts [41]. Wherever implemented, continuous assessment of knowledge retention is essential to ensure long-term impact of edutainment approaches.

By identifying the appropriate health needs of a community, priorities for community health programmes can be established, resources can be identified, and community participants can become involved [42]. This process may involve schools and teachers, including questionnaires, to achieve a better understanding of the specific health needs of a given community. Teachers play a key role in health education for their students, and based on their practical experience, they can contribute significantly to the design and development of appropriate educational materials. Collaboration between teachers and researchers ensures that these materials (e.g., illustrated storybooks, animated videos, interactive games, and educational posters) are both pedagogically effective and scientifically accurate, enhancing their impact on student learning and health awareness [43]. Teachers also exert a fundamental role in follow-up strategies, by regularly updating student knowledge of hygiene- and health-related practices [44].

Enhancing teacher knowledge of the target parasite(s) is crucial to the success of the edutainment strategy. For this purpose, several approaches can be implemented; these include the teacher guide, a simple illustrative booklet that includes information on the biology and epidemiology of the target parasite, including routes of zoonotic transmission, as well as risk factors for infection and available control strategies [23,25,35]. The booklets should summarize relevant information on the target parasite(s) using lay language accessible by the general public. In addition, seminars and workshops have been shown to effectively enhance teacher knowledge and encourage their engagement with edutainment programmes [23–25,45]. Similar to the teacher guide, seminars should cover the basic knowledge of the target parasite including the transmission patterns and its prevention [23].

Incorporating new elements into an existing teacher guide can be a complex task, influenced by various factors depending on specific contexts. These challenges often stem from administrative and bureaucratic hurdles, such as obtaining approvals or adhering to institutional protocols. Additionally, the rigid time standards and pre-established schedules within educational systems can further complicate the process, leaving limited flexibility for integrating new content. Moreover, additional classes for health education may represent a burden for teachers and interfere with other forms of schooling. Nevertheless, these classes may be integrated into the school curriculum and regular activities. School health nurses or responsible officers for school health may also participate in health education [46].

Pre-intervention testing aims to identify risk factors for parasitic infections, and underpins the selection of the key messages provided to the participants through the education materials [44]. To this end, several approaches have been applied, including Knowledge, Attitude, and Practices (KAP) questionnaires that evaluate participants in relation to the target parasite [35,45]. These structured questionnaires are characterized by a “True False Don’t Know” (TFD) design, with questions posed in layman terms and participants having little to no prior knowledge of the target parasite. Indeed, prior knowledge of the target parasite amongst participants may affect the overall effectiveness of the interventions, and thus it may represent a potential limitation. Questions should cover basic knowledge of the parasite (types of parasitic worms, routes of transmission, symptoms, treatment, and prevention) and hygiene practices (e.g., latrine use, washing hands after defecation and prior to eating, hand-to-mouth contamination, handling food, washing food and/or cooking it thoroughly and wearing footwear). Questions covering sources of information and preferred entertainment media (e.g., favorite television show and/or most appreciated cartoon) can also be included as these may assist the selection of appropriate intervention tools [27]. The pre-intervention questionnaire is developed and piloted in collaboration with other researchers and educators, based on experiences gained over the course of previous edutainment trials [24]. In several previous studies, cross-sectional investigations were conducted to screen the participants to detect prevalence and intensity of the target parasites (e.g., STHs) [23,43], followed by mass anthelmintic (e.g., albendazole or mebendazole) treatment of the participating cohort to exclude potential biases [23,25,45]. Additional testing of soil samples in the participant environment is occasionally conducted. Data collected from such screenings may lead to adaptation of pre-questionnaires to test knowledge of participants regarding specific STH infections and their routes of transmission [i.e., oro-fecal (e.g., whipworms and ascarids) versus skin-penetration of infective stages (e.g., hookworms and schistosomes)]. In addition, other means of pre-intervention testing include group discussions [26,44], and drawing activities, in which the participants are asked to draw an illustration of the target parasite, followed by a brief discussion [24,32,47].

Introduction and applications of various edutainment approaches to address parasitic diseases are summarized in Table 1.

Studies detailing edutainment interventions, target parasites or parasitic diseases, and their quantitative outcomes are presented in Table 2.

Post-intervention aims to evaluate edutainment outcomes, including knowledge gain, cognitive advancement, and behavioral changes of the participants. Post-intervention testing approaches include TFD questionnaires, that should be delivered as soon as possible following completion of intervention and be identical to pre-intervention assessments [35,44,59]. Both pre- and post-intervention questionnaires are assessed using a scoring system that enumerates correct answers [27], and comparisons between pre- and post-intervention answers should be conducted using appropriate statistical tools. In addition, post-intervention screening of both participants and environment may be required in some instances (e.g., STHs) to evaluate any reduction in prevalence and intensity of the target parasites post-intervention [23–25,45,46].

Furthermore, a sheet containing illustrations depicting hygiene habits to control parasitic diseases can also serve as a post-intervention strategy to evaluate edutainment outcomes. In this approach, participants indicate whether any of the represented activities constitute (or not) appropriate preventative measures by drawing happy or sad faces next to each illustration [47]. Conversely, changes in participant behavior (e.g., washing hands after using the toilet at school) are usually observed by research staff and occasionally by trained students [24]. However, in studies characterized by large sample sizes, any behavioral changes rely on participant self-reporting, that may introduce measurement errors [25].

Surveys can provide valuable insights into perceptions and behaviors [81]. Pre- and post-intervention quizzes, as well as satisfaction questionnaires, represent useful tools to acquire data aimed to evaluate the effectiveness of structured edutainment-style projects in comparison to mainstream models, and to assess the acquisition of KAP competences of students at all levels and the involvement of both the teaching staff and the community. Questions must be structured in collaboration with teams of pedagogues, parasitologists, and biologists and formulated appropriately, in order to ensure the reliability of any information supplied to decision-makers [81].

By combining educational content with engaging formats, multiple studies have reported significant improvements in knowledge retention and positive behavioral change. Key approaches, including interactive games, animated videos, mobile applications, and educational posters have been successfully applied in various settings. While edutainment offers innovative methods for addressing parasitic diseases, it is essential to acknowledge the potential constraints of each approach.

Despite their effectiveness, the production and distribution of educational cartoons require significant resources and/or creative skills, both of which are not readily available (particularly in low-income countries were parasitoses are often endemic); in addition, the impact of this approach may be limited unless fully integrated with other educational and health initiatives such as deworming programs. On the other hand, potential limitations to the use of gamification and computer-based educational tools include the need to access digital devices and the challenge of maintaining children attention in the long term. Additionally, digital games require frequent updates and validation to remain relevant and accurate.

Songs, videos, and music-based approaches rely substantially on the quality of the content, and ensuring access to high-quality content in resource-limited settings may prove challenging. Moreover, such approaches are considered ‘passive’ and thus should be integrated with other edutainment methods. In the post-Covid era, educationally useful videos in relation to hand hygiene are widely available; however, such videos are most effective when aligned with social media best practice principles to avoid miscommunication [7]. The application of mobile health applications for the dissemination of information is an effective strategy; however, barriers such as access to smartphones and literacy levels in low-income countries may severely limit the reach and effectiveness of health educational initiatives.

Posters attract passive engagement with limited depth of information, and thus may be relatively ineffective in areas of the world characterized by low literacy rates as they rely on visual appeal and literacy. Compared with other interactive or hands on approaches, comic books may not fully address diverse learning preferences. Challenges such as varying cultural contexts and literacy levels may limit their accessibility and reduce their overall impact. Health information professionals play a key role in identifying, cataloguing, indexing and promoting educational health comics, thus contributing to improved knowledge and access to health information in a comics format. It could also contribute to changing perceptions and encouraging both patients and family members, as well as health care workers, to appreciate comics as a credible and potentially valuable form of health information [71].

The application of puppet shows as an edutainment strategy is effective, although potential challenges include the need for continuous content updates to reflect the latest scientific knowledge and for ensuring cultural relevance to different populations. Additionally, on their own, puppet shows may prove insufficient and should be complemented with other educational interventions. Drawing activities and use of cardboard props are effective educational interventions, although they depend on the artistic skills of learners and their ability to accurately depict scientific concepts, that may rely on the availability of skilled facilitators.

Group discussions require skilled facilitators to ensure focused and informative discussions and avoid misinformation. In educational settings with large class sizes, active participation of all children may prove challenging. If booklets/lectures are used, it is important to ensure that they are culturally pertinent and age appropriate, and that the questionnaires are designed to accurately assess comprehension while avoiding frustration or disengagement. The effectiveness of this approach may be constrained by variations in literacy levels among the child population.

Artificial intelligence (AI) has successfully modernized the educational system and contributed to the evolution of society 5.0 by embracing innovative practices [82]. Globally, the use of AI-based automated systems in education is accelerating due to effectiveness and the growing demand for personalized learning. The advantages of integrating such systems with edutainment approaches include various cognitive benefits [83]. The idea of leveraging the benefits of AI to enhance the effectiveness of edutainment approaches is in its infancy, and it is likely that this will lead to a paradigm shift in the field of education by enhancing engagement, personalization, and knowledge retention.

Digital game-based learning represents an effective approach to knowledge acquisition, with various examples already in practice, e.g., ‘Parasite Patrol’ and ‘ZooTrivia’ [84,85]. AI integration in these games is forthcoming, and will allow users to interact with the life cycles and transmission routes of a range of pathogens in realistic environments, thus facilitating a deeper understanding of their effects on humans and animals [86,87]. The personalization capability of machine learning supports content tailored to the specific needs of each learner, adjusting levels of difficulty, and providing feedback on user performance [88]. Moreover, its adaptive learning systems allow to regularly refine contents based on the identifications of knowledge gaps. Conversational agents powered by natural language processing can simulate interactive dialogs, allowing children and community members to engage in real-time discussions on disease prevention. These AI chatbots can answer queries, provide scenario-based learning experiences, and reinforce key messages in an engaging manner [89].

With AI-driven virtual and augmented reality, immersive environments can be created where students can work with high-resolution models of parasites [90]. AI-powered intelligent tutoring systems are being applied in real-time support, thus helping to achieve sustainable education [91]. By integrating AI in edutainment, educators will create interactive and engaging learning environments that will substantially facilitate the acquisition of knowledge and raise student awareness of parasitic and zoonotic infections, thus providing support toward better public health outcomes.

The incorporation of participatory approaches in University curricula will have a long-term impact on the veterinary profession, among others [92]. Universities, as primary channel for academic knowledge dissemination, are amongst the frontline interlocutors for science communication communities via, for instance, institutional communication and the dissemination of research projects. Thus, a virtuous circle of social media supporting the dissemination of Science Communication (SC) may be created, with wider public outreach. In addition, academic training should include pathways or educational activities that promote the concept of SC and associated skills [93].

The integration of edutainment tools in the school curriculum and the assessment of student achievement is also crucial. Schools represent formal educational institutions that offer facilities to support or counteract successful health education and health promotion processes. The edutainment-style approach allows to effectively convey key health information, even with limited resource availability and/or in economically and socially challenging settings. Social factors collected by ISTAT (micro-criminality, homicide rate, cultural demand) confirmed the association between zoonosis disease risk (e.g., CE) and critical rural conditions [94]. Targeted One Health interventions are crucial in high-risk areas. Furthermore, interventions must be envisaged as long-term programmes, structured and fully integrated within the school curriculum and subjected to formal assessment. This long and complex process must be (conceptually and financially) supported by relevant government and higher-education institution stakeholders, such as Ministry of Health, Universities and local municipalities.