The Effects of Students' Learning Anxiety and Motivation on the Learning Achievement in the Activity Theory Based Gamified Learning Environment

The advancement of mobile game-based learning has encouraged many related studies, which has enabled students to learn more and faster. To enhance the clinical path of cardiac catheterization learning, this paper has developed a mobile 3D-CCGBLS (3D Cardiac Catheterization Game-Based Learning System) with a learning assessment for cardiac catheterization, and which also evaluates the learning effectiveness, based on ARCS (Attention, Relevance, Confidence and Satisfaction) theory. This study implemented a quasi-experimental design, using 102 students with the relevant medical background, divided into three groups. The learning achievements of this study show that the experimental group achieved higher scores than both control groups. The statistical analysis of the learning motivation and learning achievement shows ARCS-R (Relevance) as the most important factor, followed by of ARCS-C (Confidence). The results show that the learning content was relevant to the learner's level, and that it brought more confidence and increased the effectiveness of learning.