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However, little is known about the nature of emotions in game-based learning. We extended previous game-based learning research by examining epistemic emotions and their relations to flow experience and situational interest. Sixty-eight 15\u201318-year-old students played the Antidote COVID-19 game for 25 min. Epistemic emotions, flow, and situational interest were measured after the playing session. These measures indicated that the game engaged students. Students reported significantly higher intensity levels of positive epistemic emotions (excitement, surprise, and curiosity) than negative epistemic emotions (boredom, anxiety, frustration, and confusion). The co-occurrence network analyses provided insights into the relationship between flow and situational interest. We found an asymmetrical pattern of the \u201csituational interest-flow\u201d co-occurrence. When situational interest occurred, the flow was always co-occurring. This co-occurrence suggests that situational interest could be a prerequisite or a potential trigger for flow experience but not an adequate state ensuring a high flow experience. Further, flow and situational interest co-occurred mainly with positive epistemic emotions. The findings imply that flow and situational interest are similar constructs and share several characteristics. The study also demonstrated that epistemic emotions, flow, and situational interest can be used as proxies of engagement. Implications of the findings are discussed.<\/jats:p>","DOI":"10.1007\/978-3-031-22124-8_15","type":"book-chapter","created":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T05:13:43Z","timestamp":1669094023000},"page":"149-159","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Motivation and Emotions in a Health Literacy Game: Insights from Co-occurrence Network Analysis"],"prefix":"10.1007","author":[{"given":"Kristian","family":"Kiili","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juho","family":"Siuko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Cloude","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhterem","family":"Dindar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"15_CR1","first-page":"111","volume-title":"Handbook of Game-Based Learning","author":"K Loderer","year":"2020","unstructured":"Loderer, K., Pekrun, R., Plass, J.L.: Emotional foundations of game-based learning. 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