Co-designing and evaluating a gamified e-resource to promote healthcare decarbonisation competencies in pre-registration health profession students : a mixed-methods study protocol

Climate change continues to intensify pressures on global health, with healthcare systems contributing approximately 5% of global greenhouse gas emissions. Decarbonising healthcare is therefore a critical priority, yet many health profession students feel underprepared to understand or address the carbon impacts of clinical care. Strengthening the decarbonisation knowledge and capabilities of the future workforce is essential to achieving low-carbon, sustainable healthcare delivery. This protocol outlines a mixed-methods study that will co-design and evaluate a gamified e-learning resource intended to build students’ knowledge, attitudes, self-efficacy, and behaviour related to healthcare decarbonisation. The study will follow a sequential explanatory design across three interconnected phases. Phase 1 involves a scoping review to synthesise current evidence on educational approaches to sustainable and low-carbon healthcare. Phase 2 consists of four co-design workshops with pre-registration health profession students (n=20), supported by focused ethnographic post-workshop focus groups to explore participants’ perspectives on the co-design process, learning needs, and design features that support engagement. Phase 3 will assess the impact of the e-resource using pre- and post-test questionnaires (n=200) measuring knowledge, attitudes, self-efficacy, behaviours, willingness to act, and perceptions of usability, followed by focus groups (n=30) to explore behavioural change and user experience in greater depth after interacting with the resource. This research will generate empirical evidence on the development and evaluation of a co-designed gamified e-resource centred on healthcare decarbonisation. The findings will offer important insights into how game-based digital education can support meaningful learning, influence decarbonisation behaviours, and enhance the integration of sustainability competencies within health professions curricula. Ultimately, this work aims to support the preparation of a workforce capable of contributing to a low-carbon, climate resilient health system.