Introduction:

Introduction: Indonesian youth face a converging syndemic crisis, with 87.8% demonstrating insufficient physical activity and elevated NCD risk intertwined with environmental degradation. Current traditional education does not provide an integrated response to these multiple and intertwined threats. So, this study develops, designs, and tests a new transformative pedagogy called Game-As-Reality (GAR) Education, which integrates planetary health education through the use of a hybrid reality for Indonesian youth.

Methods

We conducted a randomized pilot study, which consisted of forty university students who were randomly assigned (block randomization) to either an experimental (n = 20) or a control group (n = 20). Experimental group participants completed the Game-As-Reality intervention, which included a mobile VR/AR metaverse with AI-driven motion sensors to create the narrative of "Planetary Health Heroes." The control group received standard health education materials without gamified or immersive elements. Three measures of the syndemic effects were assessed: the Integrated Planetary Health Behavior Scale (IPHBS), physical activity (IPAQ) to represent active mobility, and affective engagement (PANAS), at Week 1 as the baseline and Week 5 as endpoint of the intervention.

Results and Conclusion

The experimental group demonstrated significant improvements across all syndemic outcomes (p < 0.05). Specifically, the experimental group showed significant improvement in all seven domains of the IPHBS, including active transportation and waste reduction. The experimental group also reported physical activity levels comparable to the WHO and exhibited a decrease in sedentary behavior. Affective engagement was 60 percent greater among the experimental group than the control group (p < 0.05).

This pilot study demonstrates that GAR pedagogy effectively enhances active mobility, planetary health behaviors, and educational engagement simultaneously. The hybrid reality aspect of this approach provides a culturally relevant and scalable solution for creating "Planetary Health Citizens" that support SDGs 3, 4, and 13 in Indonesia.