https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article Effect of Video Game on School Achievement in School Age Children in Erbil/City ABSTRACT INTRODUCTION With advancement of high-tech devices (e.g. Smartphone, tablets and computers), internet and electronic games have be- come increasingly widespread among people of all ages especially among chil- dren and adolescents [1, 2, 3]. Current estimations have revealed that one in three children under the age of 18 uses Background and objectives: Playing video games is associated with poor academic achieve- ment, Student who got their game systems directly spent less time on homework and, four months later, they got lower reading and writing scores, their teachers were more likely to report academic difficulties. The aim of study is to identify the effect of play video game on school achievement. Methods: A cross sectional descriptive study was carried out at five primary school in Erbil city 50 students was taken as a case group compared with 200 students as control group started from 15 September to 15 November 2020. A Questionnaire format was used as a tool for data collection and consists ,demographic information of the students, parents and some Items about students game, Official permission has been obtained from College of Nursing / Hawler Medical University, Ministry of Education and primary schools. Data was analyzed thorough using frequency, percentage and chi square by using SPSS, 22. Results: The study reveal that 58% of participants were age group between 12-14 years old, 74% of them were boys among playing group, 18% of father were graduated from college, 60% of played children were from middle socio-economic status, 16% of game players have missed school, 66% of played students were missed homework, about 10% of the students have a good school achievement among who played video games and more than half (58%) among non-play students.. There is highly significant association between parent educa- tional levels with their children school achievement. Conclusions: Playing video game was negatively associated with poor school achievement. The study recommended the parent to limit the time of playing less than one hour daily, also limit the number and type of game especially fighting game and replaced with educa- tional game. Key words: Effect; Videogame; School achievement; Children. Nazar Ramadhan Othman; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. (Correspondence: nazar.othman@hmu.edu.krd ) Rozhan Tofiq khedir; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. Gulala Kareem Azeez; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. Kaify Jamil Qadir; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. 86 Erbil Journal of Nursing & Midwifery Received: 29/08/2021 Accepted: 16/11/2021 Published: 30/11/2021 mailto:nazar.othman@hmu.edu.krd?subject=nazar.othman@hmu.edu.krd https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article the internet worldwide, and 75% of adoles- cents play electronic games daily in devel- oped countries [4,5,6]. According to United Nations International Children's Emergency Fund (UNICEF) estimations that one third of Internet users universally are children, with the proportion of internet users likely to be higher in lower income countries where the internet is quickly penetrating all scopes of public life. The International Telecommunication Union (ITU) reports that in developing countries, young people between age 15 and 24 outnumber the overall population by 2 or 3 times [7].In the past few decades, electronic media has grown from virtual non-existence to one of the primary means of entertainment for college students. In more recent years, the Internet has entirely changed the land- scape of electronic media from something personal and static into something with the potential to be interactive and social [8]. Playing video games is often related in our society with poor academic achievement [9]. Some study concludes there is little in- dication to suggest that communicating media improves the learning experience [10]. One study tracked boys’ academic performance, and findings indicate that those kids who got their game systems di- rectly spent less time on homework and data at four months show lower reading and writing scores, and teachers were more likly to report academic difficulties [11]. In one representative sample of American adolescents, aged 10 to 19, those who played video games spent 30% less time reading and 34% less time doing homework [12]. Among video game play- ers, time spent playing time was associated with low school performance [13]. Accord- ing to Anand (2007), the penetration of vid- eo games into the United States alone is huge, with at least 90% of homes having children that have played (rented or owned) video games [14]. This is a record level that continues to increase. Of players over the age of 18, 55% are console play- ers and 66% of online players. However, there is also plenty of research to suggest that interactive video games can actually lead to increased academic performance [15]. The practice of games is often linked to an increase in visual-spatial skills, which often come in handy in the fields of sci- ence, mathematics, technology, and engi- neering [16]. There are many studies a negative relation between addiction of vid- eo games and homework preparation and decreased academic performance [17, 18] At the same time educational games are, considered an effective alternative to sup- porting traditional teaching methods in terms of educators’ responsibility, such as inspiring students to learn, teaching them to love learning, and making learning fun [19]. There is a great deal of research showing the effect of educational games on learning are positive in encouraging the learning. Educational games, incorporated at the opening or end of a lesson, of con- cepts, and that they allow students to dis- cuss target concepts [20]. For this reason, they can foster students’ interest and mo- tivation towards lessons, or review, strengthen and assess the learned topics. Therefore, educational games promote students’ active contribution in lessons and thus assist with their learning [21]. The aim of this study is to examine the effect of video game on school achievement in school age children. A case control study design was conducted at five primary school in Erbil city accord- ing to geographical designations (East, West North ,South and center). The study was carried out from 15 September to 15 November 2020. A convenience sample of (50) students were taken- as a case group with (200) students as a control group. 87 Erbil Journal of Nursing & Midwifery METHODS https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article achievement. Among the playing group, about 18% of fathers graduated from col- lege, and 33% reported low socio- economic status. There was a highly sig- nificant association between parent educa- tional level and their children's’ school achievement. Regarding parent occupation There was a significant association be- tween mothers’ of playing children with school achievement, but no significant as- sociation with parent of non-playing chil- dren and school achievement. No signifi- cant association between parent socio- economic status and children school achievement was observed (Table 2). Both genders and students from fourth, fifth and sixth stage were included Handi- caps students and those who refused to participate were excluded from the study. A questionnaire tool was used to collect data by face to face interview which com- posed of four parts, students’ socio- demographic characteristics (age , gender and education level) , and sociodemo- graphic characteristics of students' parents ( age, level of education ,occupation and socio-economic status). Questions related to game playing, and questions regarding academic performance. A written official scientific approval was obtained from Col- lege of Nursing / Hawler Medical University No. 7.26/7/2020 . Verbal permission was obtained from participations and partici- pants were informed privacy and confiden- tiality. Statistical analyses: Data were ana- lyzed using the statistical package for social sciences (SPSS) version 21. Frequency and percentages were used for categorical da- ta, and the chi-square test was used to find out the association between variables, with P-value ≤ 0.05 being considered as statisti- cally significant. In present study 58.0% of video games players were 12-14 year's old, , 74% were boys and 46% video game players were stage six. There was no significant associa- tion between age and academic achieve- ment in both groups. Among game players, around 4% of children failed school for 3 years. There is a highly significant associa- tion between years of failure and academic achievement among the not-played group (Table 1). Among the playing group, 42 % of fathers belonged to the 41-45 years old age group and among the non-playing group, 31.5% of mothers belonged to the 41-45 years old age group. There is no sig- nificant association between parents in case group with their children school 88 Erbil Journal of Nursing & Midwifery RESULTS Table 1: Association between child’s demographical characteristics and game players of the Student Not Playing Play Catego- ry Variable (%) F. (%) F. (54) 108 (42) 21 9-11 Age/ years (46) 92 (58) 29 12-14 0.115 S 0.743 NS X2 (42.5) 85 (74) 37 Male Gender (57.5) 115 (26) 13 Female 0.004 HS 0.194 NS X2 (28.5) 57 (26) 13 Four Stage (31) 62 (28) 14 Five (40.5) 81 (46) 23 Six 0.948 NS 0.018 S X2 (80.5) 161 (68) 34 No fail- ure Number of years Failure (12) 24 (14) 7 1 years (6) 12 (14) 7 2 years (1.5) 3 (4) 2 3 years < 0.001 HS 0.153 NS X2 https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article 89 Table 2: Parent socio demographic characteristics Not Playing Play Category Variable (% ) F. (%) F. (2) 4 (2) 1 26-30 Fathers age/years (15) 30 (6) 3 31-35 (28) 56 (30) 15 36-40 (35.5) 71 (42) 21 41-45 (6.5) 13 (12) 6 46-50 (13) 26 (8) 4 <50 0.265 NS 0.662 NS (11) 22 (6) 3 26-30 Mothers age/years (19) 38 (16) 8 31-35 (31.5) 63 (46) 23 36-40 (23.5) 47 (20) 10 41-45 (15) 30 (12) 6 46-50 0.297 NS 0.620 NS X2 (29.5) 59 (14) 7 Illiterate Fathers level of education (13.5) 27 (20) 10 Can read and write (26) 52 (32) 16 Primary school graduate (16.5) 33 (16) 8 Secondary school graduate (14.5) 29 (18) 9 Institute and college grad- uate 0.002 HS 0.004 HS X2 (52) 104 (44) 22 Illiterate Mothers level of education (11.5) 23 (22) 11 Can read and write (18) 36 (22) 11 Primary school graduate (9.5) 19 (8) 4 Secondary school graduate (9) 18 (48) 24 Institute and college grad- uate 0.018 S 0.000 HS X2 (30.5) 61 (34) 17 Employed Fathers occupation (2) 4 (2) 1 Nonemployee (1.5) 3 (64) 32 Retired (66) 132 (34) 17 Free work 0.264 NS 0.324 NS X2 (12) 24 (6) 3 Employed Mothers occupation (88) 176 (94) 47 House wife 0.141 NS 0.040 S X2 (18.5) 37 (8) 4 High Socio-economic status (48.5) 97 (60) 30 Middle (33) 66 (32) 16 Low 0.207 NS 0.356 NS X2 https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article games reported poor duration of study at home and 2.5% of those that did not play video games reported duration of study. Only 10% of students who play video games reported good school achievement while 58% of non-playing students report good achievement (Table 4). 90 Erbil Journal of Nursing & Midwifery Among players, 46% of their parent agreed to playing, 14 % of them played daily and 48% of used a mobile device to play. Used mobile for play game.46% of children en- joyed fighting games and 86 % reported their father bought the gaming device (Table 3). Among students who played video games, 16% did not attend school daily and among non-playing students14.5% did not attend school daily. Among playing students, 66% did not bring their homework to school while only 10.5% of non-playing student did not bring their homework to school. About 22% of those tht played video Table 3: Distribution of played Children Item Category F. (%) Parents agree to play. Yes 46 (92) No 4.0 (8) Encouraging par- ents to play Yes 39 (78) No 11 (22) Who bought the device for children Father 43 (86) Mother 5 (10) Brother 2 (4) Type of device us- ing by children Mobile 24 (48) Computer 3 (6) I pad 18 (36) Play sta- 5 (10) type of play chil- dren like it Ball 14 (28) Fighting 23 (46) Crushing 4 (8) Education 3 (6) Music 1 (2) Playing daily No 43 (86) Yes 7 (14) Duration of using play game / hours per day 1 hours 23 (46) 2 hours 13 (26) 3 hours 13 (26) 4 hours 1 (2) bring device to school for playing No 12 (24) Yes 38 (76) Time of playing After- 8 (16) Evening 26 (52) Night 16 (32) Table 4: Assessment of children school achievement among case and control group. Item Category Case Control F. (%) F. (%) Attending daily to school Yes 42 (84) 171 (85.5) No 8 (16) 29 (14.5) Attending to all class session Yes 45 (90) 178 (89) No 5 (10) 22 (11) Bringing home work to school Yes 17 (34) 179 (89.5) No 33 (66) 21 (10.5) Thinking that play video game affect school achieve- ment Yes 25 (50) 151 (75.5) No 25 (50) 49 (24.5) Duration of study at home 1 hours 24 (48) 47 (23.5) 2 hours 20 (40) 77 (38.5) 3 hours 6 (12) 48 (24) 4 hours 0 (0) 26 (13) 5 hours 0 (0) 2 (1) School Achieve- ments Poor 11 (22) 5 (2.5) Fair 34 (68) 79 (39.5) Good 5 (10) 116 (58) https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article The main purpose of this research study was to explore the effect of playing video game on primary school students’ achieve- ment. Our study came in line with a previ- ous study by Hakan Tuzun et al. which ex- amined primary school students’ achieve- ment and motivation in learning geography through an educational computer game [22]. (Table1). We reported that 58% of children who played video games in pre- sent study their age group belonged to 12- 14 years old agreeing with Islam et.al which found that average children age were 15.38% among player [23]. Concern- ing gender about 74% among played chil- dren were boys agreeing with studies sug- gesting that there are gender differences in time spent playing video games and pre- ferred content [24, 25]. Boys tend to play video games more frequently than girls [26]. Girls had more addictive tendency towards internet/game-play in comparison to boys [23]. Unfortunately, this may be due to our culture of gifting playing devices to. boys more than girls. (Table 2). Our study found that 18% of fathers graduated from college agreeing with Islam et al., re- porting 33.2% primary career's highest lev- el of education [23]. Concerning family in- come, 66% of played children family were from low socio-economic status agreeing with Hasting et al., which reported that most of the family income in middle-class (annual family income) [27].Concerning parent educational level the present study showed a highly significant association be- tween parent educational levels with their children school achievement. This result completely agrees with Matilov et al., which reported an educational level of chil- dren in the family depends more on the level of the parent’s education. This factor strongly affects family relationships and the successful development of children [28]. Similarly, Hoover et al., found that parental involvement broadly includes home-based activities (e.g., helping with homework, discussing school events or courses) and school-based activities (e.g., volunteering at school, coming to school events). They argued that parental involve- ment is a function of a parent's beliefs about parental roles and responsibilities, a parent's sense that they can help their chil- dren succeed in school, and the opportuni- ties for involvement provided by the school or teacher [29]. Likewise Garg et al., showed that the impact of family factors on influencing students’ educational aspi- rations through their impact on extracur- ricular reading, attitudes towards school and homework and students’ perceptions of their parents’ educational aspirations [30].Regarding parental occupation there are significant associations between par- ents with played children and school achievement while no significant associat- ed with parents with non-played children and school achievement. Our result agrees with result of the study done by Usaini and Abubakar indicating that students from a parent with formal occupation performed well than those from parents with informal occupation[31].Concerning socio-economic status there are non-significant associa- tions between parent socio-economic sta- tus and children school achievement. Our finding is in line with Ripple and Luthar who found that socio-economic status has little to no relevance for academic achieve- ment [32]. Likewise a meta-analysis per- formed by Sirin of more than 70 studies published from 1990 to 2000 reported that there was no significant correlation be- tween socio-economic status and academ- ic achievement [33].Our study illustrated that about 16% of children who played vid- eo games have missed school (Table 3). This finding totally agrees with Terry and Malik who found a significant association regarding missing school among children 91 Erbil Journal of Nursing & Midwifery DISCUSSION https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article by Jackson et.al, which reported that inter- net use is positively associated with im- proved reading skills and higher scores on standardized tests [38].About 22% of stu- dents in our study who played video game have poor school achievement while only 2.5% had poor achievement among non- play students. Our finding strongly agrees with Islam et al., which found that adoles- cents who played no electronic games at all have better scores in writing compared to those who played electronic games. Ad- diction tendency to internet and electronic -gaming is found to be adversely associat- ed with academic achievement [23]. Simi- larly, evidence argues that the use of the internet and electronic games have nega- tive effects such as reduced sleeping time, behavioral problems (e.g. low self-esteem, anxiety, depression), attention problems and poor academic performance in adoles- cents [1,5,39]. Academic performance is negatively associated with internet use and electronic games, particularly when the internet is used for non-academic pur- pose [34]. Studies also found that playing electronic games develops cognitive skills (e.g. mental rotation abilities, dexterity), which can be attributable to better aca- demic achievement [40,41]. These varied consequences require an urgent need of understanding the effect of the internet use and electronic gaming on the develop- ment of children and adolescents, mainly on their school achievement. Most of boys were among played children, most of player missed homework, Majority of parent was agree to play, most of chil- dren were use the mobile for playing, play- ing daily and bringing the device to school. There are significant association between mother of case group with school achieve- ment while no significant with parent with control group in school achievement, that played video games (Spearman rho coefficient 0.003)[34]. The present study showed that 46.0% of students played video games dailt for 1 hour which agrees with Islam et al., reported 46.6% of stu- dent playing 1-2 hours daily. This could be attributed to the increased availability of computers/smart-phones and the in- ternet use among under-12 years old [23]. Similarly, 48.0 % of children used mobile devices to play games which may be due to availability and easy access. Hastings et al., reported that over half (56%) owned and played some type of hand-held game system [27].In our study we found that 46% of children played fighting games which may due to the continuous war environment for more than decade, TV programs, movies and film with fighting. This result disagrees with Hastings et al., which reported chil- dren’s gaming consists mostly 61% of ed- ucational games [27]. Hastings et.al., stat- ed that over a fifth (21.4%) of parents responded that they did not know the rating level of their children’s video and computer games, suggesting a lack of pa- rental monitoring [27]. Our finding also showed that 14% of children played daily in contrast with Aaron Boyce et al., which reported that 48.2% of children play per week [35]. About 66% of played student in our study missed homework which is consistent with Gentile et al., and Sharif and Sargent’s findings that video gaming creates time conflicts that reduce the amount of time that gamers devote to homework. The results of this study clearly evaluated that the non-academic use of internet during weekdays, particu- larly, spending more than four hours on internet is harmful for academic perfor- mance, whereas, internet use on the weekends is likely to incur a positive effect on academic performance [36,37]. This result is consistent with a USA study 92 Erbil Journal of Nursing & Midwifery CONCLUSIONS https://doi.org/10.15218/ejnm.2021.10 Erbil j. nurs. midwifery, Vol. 4, No. (2), Nov 2021 Original Article [7] ITU (International Telecommunication Un- ion). Measuring the Information Socie- ty. Geneva: ITU. (2013). [8] Luis Concepcion, Marilyn Nales-Torres, Ana Rodriguez-Zubiaurre. 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