Serious game 'Duld geen schuld' teaches future healthcare providers about assisting people in poverty.

People living in poverty face immense stress. They are in survival mode. How can we support them and enhance their vitality? That's what the game "Duld geen schuld" is about. Peter Paulus, one of the creators, explains how the game works, why it was developed, and how the development process unfolded.

Peter Paulus works at Leiden University of Applied Sciences. Four days a week, he serves as a faculty manager. One day a week, he works as a work package leader in the Vital Delta program: Medical Delta’s journey towards vitality and health within the research program Social Vitality. He speaks passionately about the topic of poverty and the game. "With this game, we teach students from programs like Social Work what people living in poverty face and how to approach this in a stress-sensitive way."

This article was previously published on the Vital Delta website.

You work as a work package leader for the Social Vitality research line. What exactly do you do?

“Vitale Delta is a collaboration between four universities of applied sciences in South Holland, aiming to enhance the vitality of residents in the delta region. One component of this is the Social Vitality program. Within this program, I act as a facilitator. Each of the four universities conducts research and wants to implement programs to support this. That’s where I come in. I prepare initiatives and coordinate them with the universities.”

Did the game 'Duld geen schuld' come about in a similar way?

“Yes. The Social Vitality research line focuses on people’s vitality. People living in poverty are not vital—they are stressed, in survival mode, and primarily focused on paying their bills. We wanted to address this. What challenges do these people face, and how can we enhance their vitality? I discussed this with the universities. We wanted to find a compelling way to educate our students about this urgent issue. That’s how we arrived at the idea of a game. As universities, we had previously written a book on the subject. Additionally, we had gained new insights from practical research. We transformed all of that into a game that allows Social Work students to acquire knowledge and skills.”

A game is quite innovative, isn’t it, especially in education? How did you come up with that idea?

“Students often find lessons about poverty dull, even though they care about the issues and may know people living in poverty. That’s why teachers sometimes bring in people with lived experiences to talk about the topic. How did they end up in poverty, and how did they get out? The students are captivated! Because it’s real—it’s the outside world. We wanted more of that. We wanted to challenge students with cases, presented in a 21st-century format. I discussed this with the professor leading the initiative. She mentioned that we had previously created a game and suggested doing it again. It was a success because the students absolutely love the game.”

What kind of game is it, and how does it work?

“It’s a board game with a nice layout and appropriate street names, such as Debt Street. You play in groups, and you can finish it in about two hours. But to do well, you need knowledge and skills. So, you can really only play if you’ve paid attention during lectures. We ask knowledge and skills questions. If you answer a question correctly—though ‘correct’ is often relative with this topic—you get to move one step forward.

When it’s your turn, you roll the dice. You land on a square and pick the corresponding card with a QR code on it. When you scan the code with your phone, a video plays. For example, you might see someone sitting on a bench, saying: “I’m in debt. My life is shrinking. There’s tension and domestic violence at home. That’s why I’m fleeing my house.” Well, dear student, it’s your turn now! You’re working with this person and you encounter them now. What do you do? Each group chooses a different path, and that’s interesting to see. This way, students also learn from each other. Also, fun fact: the actors in the videos are our own students.

I think it’s great that we’ve focused so much on stress-sensitive work. In this field, it’s crucial to know how to approach people living in poverty. It’s not easy, because many people feel ashamed. So, how do you build trust, make contact, and start a conversation? What should you do, and what shouldn’t you do? This aspect is well represented in the game, and I’m proud of that.”

The game was launched in February 2024. How did that go, and how is the game being used now?

“The game was created based on input from teachers at the four universities of applied sciences in the Randstad region. They have a good understanding of what is taught about poverty within their institution. We brought their perspectives together and created a game in which everyone could recognize themselves. After the launch, I visited the universities and explained to a larger group of Social Work teachers how the game works. I provided instructions on how to use the game in their lessons. One university used the game with second-year students. You can’t use all the questions, as some are too difficult. The game contains sixty questions, so you can easily work with a selection. Another university uses it with third-year students, who can use all the questions.”

And the teachers, how do they experience teaching with the game?

“For teachers, it can take some getting used to. With this game, you’re not offering traditional teaching. The teacher suddenly becomes a game leader who has to guide and challenge students. ‘Come on, give an answer or reaction!’ Or: ‘What does the other group think about this?’ What’s also fantastic is that the students’ enthusiasm is contagious. The teachers get excited about it too. The students enjoy it so much that we even wondered: is this okay? After all, it’s about poverty, a serious topic! The playing almost felt like Monopoly, everyone was so enthusiastic. That was, of course, the intention. That activator aspect is embedded in the format—in playing together, earning points, using wildcards, and real-life examples. That’s what makes it so engaging.”

Could the game also be used in other environments?

“Recently, I was at a knowledge festival. I got into a conversation with people who work in HR at a hospital. They told me they struggle to approach employees who are facing financial difficulties. The HR department only finds out that colleagues are struggling financially when there’s a wage garnishment. Their question was: could the game be useful for us? I definitely think so. You can adapt the game to their situation, but that’s not enough. Implementation takes time and effort. Before you can truly integrate such a game…”

You developed the game with four universities of applied sciences. How did that collaboration go?

“First of all, it’s truly amazing that we were able to do this, especially because we worked with incredibly passionate people. Teachers who know a lot about this topic and are genuinely invested in it. The collaboration with researcher Catelijne Akkermans was also fantastic. However, I found the process challenging because the logistics were not easy. People in education are so busy, and we asked a lot of them. It was sometimes really difficult to figure out the schedules and get everyone together.

All in all, it took much longer than I expected. We were working on it for a total of fourteen months. We started by gathering all the insights and reaching consensus on what we wanted. Then we created a design and came up with questions. That was a huge task. I think we spent seven months working on questions that we could all agree on. In the meantime, we coordinated with the game developer Salsaparilla. Then we tested the questions with students. They would say, “We don’t recognize this from the course material.” So we had to adjust things again. Once we had the questions, we started designing the game, working on the execution, the layout, creating a dummy version, testing that, making adjustments where needed, printing the game, and finally providing training sessions.

A long process, but I look back on it with satisfaction, especially thanks to the collaboration with Salsaparilla. They have so much experience, and they brought us new ideas and provided great guidance. We were regularly steered in the right direction. The questions had to be shorter, clearer, more concrete, or have more activation. They also made sure there was enough variety in the questions, balancing dilemmas, knowledge questions, and skills-based questions.

And now?

“Now, I hope this game becomes a permanent part of the curriculum at the four universities of applied sciences. I’m personally excited, and many others share that enthusiasm. Poverty is a current issue, and more and more people are dealing with it. With this game, we ensure that future healthcare providers give the topic the intensive attention it deserves, and that works well. Thanks to this game, our students will be better equipped to work with people living in poverty. And that is, of course, incredibly valuable.”