Heath education is an important component of the curriculum for fostering children's correct health knowledge and good daily life habits. However, educators have indicated that most children might fail to realize the importance and meaning of health education content owing to the lack of authentic scenarios and daily life experience. With the advancement of computer technologies, researchers have tried to develop multimedia learning content in order to improve students' learning performance. Among various technology-enhanced learning alternatives, digital game-based learning has been recognized as a highly potential approach to motivating students. However, several previous studies have indicated that, without properly incorporating learning content into game scenarios, the effectiveness of digital game-based learning might not be as good as expected in comparison with conventional technology-enhanced learning. In this study, a contextual digital game was developed for improving students' learning performance in an elementary school health education course. A quasi experiment was conducted to evaluate the effectiveness of the proposed approach by situating the experimental group in the game-based learning scenario and the control group to learn with conventional e-books. The experimental results showed that the proposed approach not only improved the students' learning motivation, but also their learning achievement and problem-solving competences. Moreover, the significant two-way interaction suggested that the contextual game-based learning approach benefited the higher motivation students more than the lower motivation ones in terms of the advanced knowledge, showing the importance and potential of applying contextual games to health education activities. ? 2014 IEEE.