Escape Room vs. Traditional Lecture for HPV Vaccine Education: Mixed-Methods Study With Japanese University Students

Japan’s human papillomavirus (HPV) vaccine coverage remains low, highlighting the need for engaging education for young adults. We conducted a mixed-methods study among Japanese female university students to compare an escape-room intervention, a traditional lecture, and a non-intervention control. Participants completed questionnaires before, immediately after, and three months after the intervention to assess HPV-related knowledge, satisfaction, comprehension, vaccination intention, and vaccine uptake; qualitative data from the escape-room group were analyzed using Fink’s taxonomy. Among 267 students (escape room, n = 92; lecture, n = 75; control, n = 100), the lecture produced greater immediate gains in knowledge and vaccination intention and the highest vaccination uptake (48.2%). At three months, however, both the escape-room and lecture groups maintained significantly higher knowledge scores than the control group, with no difference between the two active interventions. Qualitative findings indicated that the escape room fostered strong emotional engagement, intrinsic motivation, peer collaboration, and reduced psychological barriers to learning. Overall, lectures may be superior for short-term behavior change, whereas escape rooms offer comparable medium-term knowledge retention while uniquely enhancing affective and collaborative aspects of learning. Escape rooms may therefore serve as a low-resource, scalable complement to traditional vaccine education in settings with low HPV vaccine coverage.