{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T03:26:07Z","timestamp":1793935567196,"version":"4.8.0"},"reference-count":42,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Creative Nursing"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Game-based learning has become a successful method for encouraging nursing students\u2019 active participation, critical thinking, and conceptual understanding, while building comfort and helping with information recall. It is a creative and interactive approach for talking about sexual and reproductive health and rights (SRHR), especially in countries like Pakistan where this subject is still culturally sensitive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study explored undergraduate public health nursing students\u2019 learning about cause-and-effect relationships in sexual health using the Problem Tree Game as a teaching\/learning tool. Through experiential learning, the goal was to improve comprehension, memory, and application of SRHR knowledge in the public health domain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A design-based research approach was used, including: (1) co-design and conceptualization; (2) prototype development and testing; (3) implementation and evaluation (through focus group discussions); and (4) reflection and refinement. Data analysis was conducted through reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four major themes were identified: (1) Game-based Learning as Cognitive Architecture for SRHR Learning; (2) Learning as a Social, Dialogic, and Reflective Process; (3) Facilitation, Learning Climate, and the Pedagogical Conditions of Participation; (4) Cognitive Friction in SRHR Game Play.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Problem Tree Game effectively linked theoretical SRHR concepts with practical reasoning skills in public health nursing. By promoting dialogue, reflection, and empathy, this gamified approach holds significant potential to bridge the knowledge-to-practice gap in SRHR education in Pakistan, preparing future nurses for culturally competent community engagement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10784535261486392","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:35:06Z","timestamp":1789997706000},"page":"532-544","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["From Silence to Solutions: Learning Through the \u201cProblem Tree Game\u201d to Explore Public Health-Oriented Sexual and Reproductive Health Issues"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6183-3116","authenticated-orcid":false,"given":"Sarmad","family":"Muhammad Soomar","sequence":"first","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Qasim Ali","sequence":"additional","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8611-3910","authenticated-orcid":false,"given":"Simel","family":"Masood","sequence":"additional","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jatender","family":"Lal","sequence":"additional","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0744-4489","authenticated-orcid":false,"given":"Rameen","family":"Faisal","sequence":"additional","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syeda Naghma","family":"Rizvi","sequence":"additional","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Abir","sequence":"additional","affiliation":[{"name":"Aga Khan University"},{"name":"Ras Al Khaimah Medical and Health Sciences University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tazeen Saeed","family":"Ali","sequence":"additional","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.3163\/1536-5050.103.3.010"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/01421590903473969"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/15710882.2015.1081246"},{"key":"e_1_3_3_5_1","volume-title":"A taxonomy for learning, teaching, and assessing: A revision of Bloom\u2019s taxonomy of educational objectives","author":"Anderson L. 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