scholarly journals Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Yi-Chin Kato-Lin ◽  
Uttara Bharath Kumar ◽  
Bhargav Sri Prakash ◽  
Bhairavi Prakash ◽  
Vasini Varadan ◽  
...  
Keyword(s):  
Implicit Learning ◽  
Positive Impact ◽  
Controlled Trial ◽  
Food Choices ◽  
Unhealthy Food ◽  
Healthy Foods ◽  
Game Play ◽  
Mobile Games ◽  
Mobile Game ◽  
Randomized Controlled

BACKGROUND Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. OBJECTIVE This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children’s heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players’ food choices. METHODS We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. RESULTS We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; <i>P</i>&lt;.001; Cohen <i>d</i>=1.25) and identified (treatment 7.3, control 6.94; <i>P</i>=.048; Cohen <i>d</i>=.25). A large variation was observed in children’s game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall τ=–.32, <i>P</i>=.04), even after controlling for baseline food preference. CONCLUSIONS A mobile video game embedded with implicit learning components showed a strong positive impact on children’s food choices immediately following the game. Game telemetry captured children’s different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. CLINICALTRIAL ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively.

scholarly journals Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial

10.2196/15717 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e15717
Author(s):  
Yi-Chin Kato-Lin ◽  
Uttara Bharath Kumar ◽  
Bhargav Sri Prakash ◽  
Bhairavi Prakash ◽  
Vasini Varadan ◽  
...  
Keyword(s):  
Implicit Learning ◽  
Positive Impact ◽  
Controlled Trial ◽  
Food Choices ◽  
Unhealthy Food ◽  
Healthy Foods ◽  
Game Play ◽  
Mobile Games ◽  
Mobile Game ◽  
Randomized Controlled

Background Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. Objective This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children’s heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players’ food choices. Methods We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. Results We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; P<.001; Cohen d=1.25) and identified (treatment 7.3, control 6.94; P=.048; Cohen d=.25). A large variation was observed in children’s game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall τ=–.32, P=.04), even after controlling for baseline food preference. Conclusions A mobile video game embedded with implicit learning components showed a strong positive impact on children’s food choices immediately following the game. Game telemetry captured children’s different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. Trial Registration ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively.

scholarly journals Mobile Game�Based Digital Vaccine for Reducing Risk of Lifestyle Diseases (Preprint)

2018 ◽  
Author(s):  
Rema Padman ◽  
Yi-Chin Kato-Lin ◽  
Bhargav SriPrakash ◽  
Sross Gupta ◽  
Palak Narang ◽  
...  
Keyword(s):  
Machine Learning ◽  
Video Games ◽  
Mobile Devices ◽  
Healthy Eating ◽  
Statistical Models ◽  
Food Choices ◽  
Game Play ◽  
Mobile Games ◽  
Mobile Game ◽  
Lifestyle Diseases

BACKGROUND There is a rising epidemic of pediatric obesity in the United States and worldwide. While many factors contribute to pediatric overweight and obesity, dietary decisions are a leading cause. Children spend many hours a day playing video games, mostly on mobile devices. Hence, personalized gamification and learnification on mobile devices have great potential to influence children’s dietary-lifestyle behaviors during the habit formation stage of early childhood. In fact, video games on mobile devices have become a platform through which children learn in a fun and enjoyable way. While there is some early evidence of the positive impact of neuropsychology-based, cartoon-styled, immersive video games on healthy eating behaviors in children, the mechanisms underlying these improved outcomes are yet to be understood. OBJECTIVE To design appropriate interventions in the game environment for children’s behavior formation and change, we need to learn more about the underlying patterns of player behaviors evidenced during gameplay through techniques of machine learning and stochastic optimization. Building on prior descriptive work, this study examines the impact of a diet and lifestyle focused mobile game on children’s game play patterns and associate these patterns with their actual food choices using machine learning and statistical models. METHODS Our dataset was generated from an IRB-approved, informed consent–based randomized controlled trial (RCT) with pre- and post-treatment measurements of almost 100 school children using fooya!, a novel mobile gaming, iOS/Android based App that is being developed as a low-risk and non-invasive “digital vaccine” for lifestyle diseases, for 2 exposures of 20 minutes each. Based on artificial intelligence, neuropsychology and cognitive behavior therapy, fooya! has been shown to deliver positive outcomes with respect to food choices, self-reported dietary choices, and healthy eating intentions. We first model the process of game playing at any level across all students as a discrete, time-homogeneous, first-order Markov chain with multiple states, each representing a status of the game. Process mining identifies distinct patterns in the game sequences and statistical models establish the relationship between game patterns combined with demographic and behavioral data with actual food choices at the end of the game. RESULTS We find strong evidence of the positive effect of the mobile game on actual food choices, just after 40 minutes of intervention exposure (T: 2.46; C: 1.10; P<.001). Analysis of children’s play patterns shows significant variations in game play mechanics among players. Regression analyses further reveal that more engaged, dynamic, and strategic game play patterns are associated with better actual food choices. CONCLUSIONS This study adds to the growing body of evidence that learning about healthy eating in a fun and exciting way via mobile games, acting as Digital Vaccines, can positively impact children’s actual food choices. While promising, additional RCTs in varied settings and deeper analysis of the resulting data are needed to confirm Digital Vaccines’ potential to reduce the long-term risk of nutrition related non-communicable diseases such as diabetes and cardiovascular disease, as well as health risks from the double burden of overweight vs malnutrition and under-nutrition by educating children regarding healthy lifestyle choices using mobile games.

Abstract MP07: Automated, Personalized Feedback and Behavioral Nudges to Improve Workplace Food Choices and Prevent Weight Gain: Choosewell 365 Randomized Controlled Trial

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Anne N Thorndike ◽  
Jessica L McCurley ◽  
Emily D Gelsomin ◽  
Eric B Rimm ◽  
Yuchiao Chang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Weight Gain ◽  
Health Outcomes ◽  
Controlled Trial ◽  
Intervention Group ◽  
Food Choices ◽  
Healthy Food ◽  
Traffic Light ◽  
Randomized Controlled ◽  
Prevent Weight Gain

Importance: Workplace health promotion programs often have limited reach and effectiveness because they are time-intensive and not integrated with the work environment. Objective: Conduct a randomized controlled trial testing an automated intervention combined with workplace cafeteria traffic-light labels to prevent weight gain and increase healthy food choices. Methods: 602 hospital employees who regularly used 6 on-site cafeterias and paid with their ID were randomized in 2016-18. Cafeteria labels identified healthy (green), less healthy (yellow), and unhealthy (red) items. Participants completed visits, surveys, and dietary recalls at baseline and 12 months (end of intervention). The intervention group received personalized emails (2/week) and letters (1/month) that were automatically generated by a software platform that integrated cafeteria sales, health, and survey data. Emails included a log of weekly purchases (item, traffic light label, and calories) and health tips. Letters included social norm comparisons and small incentives for healthy purchases. The control group received standard lifestyle advice in monthly letters. A Healthy Purchasing Score was calculated by weighting purchased items by traffic light labels (red=0; yellow=0.5; green=1) using 12 mo of purchases during both baseline (pre-intervention) and intervention. Differences in differences in health outcomes, purchases, and dietary quality were compared, with missing values imputed. Results: Participants were 43.6 years (mean), 79% female, and 81% white. The intervention group increased healthy purchases compared to control, but changes in BMI and health outcomes were not different (see Table). Conclusion: An automated intervention linked to the workplace food environment increased healthy food choices but did not prevent weight gain. To improve health, this scalable healthy eating intervention could be augmented with additional technology to improve other health behaviors, such as physical activity, both at work and home.

Abstract P329: Perceptions of Neighborhood Level Stressors in Native Hawaiian Communities: A Descriptive Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Claire T Ing ◽  
Hyeong Jun Ahn ◽  
Tricia Mabellos ◽  
Mapuana de Silva ◽  
Adrienne Dillard ◽  
...  
Keyword(s):  
Social Cohesion ◽  
Native Hawaiian ◽  
Controlled Trial ◽  
Intervention Group ◽  
Native Hawaiians ◽  
Healthy Foods ◽  
Aesthetic Quality ◽  
Randomized Controlled ◽  
Trial Testing ◽  
Neighborhood Level

HTN (HTN) is an important and modifiable risk factor for cardiovascular disease, the leading cause of death. Native Hawaiians, the indigenous people of Hawai‘i, experience a prevalence of HTN (i.e., systolic blood pressure (SBP) of ≥140mmHg or diastolic blood pressure of ≥90mmHg) of over 50%. Factors that contribute to HTN control are multilevel and include neighborhood or community level determinants such as walkability, availability of healthy foods, safety, and social cohesion. However, these factors and their potential relationship to HTN have yet to be examined in Native Hawaiian communities. Identifying important neighborhood factors in Native Hawaiian communities can inform HTN control interventions. The purpose of this study is to describe the perceptions of neighborhood level stressors among Native Hawaiians participating in a randomized controlled trial testing a culturally-grounded, hula-based HTN intervention. This study was comprised of a subset of participants (N=124) from an NIH-funded, randomized controlled trial testing the effectiveness of a hula-based intervention at improving SBP in Native Hawaiians with uncontrolled HTN compared to an education only group. Neighborhood Level Stressors Scale was used to assess seven neighborhood dimensions: walkability, availability of healthy foods, safety, social cohesion, aesthetic quality, violence, and activities with neighbors. Scores ranged from 1 to 5 with lower scores indicating more positive perceptions their neighborhoods (e.g., greater safety). Demographic variables included age, gender, marital status, education. Descriptive and summary statistics are presented. Two-sample t-test was done to compare neighborhood level stressor by intervention group. Mean scores for the seven dimensions were as follows: aesthetic quality 2.54 (SD=0.61) walkability 2.48 (SD=0.72), availability of healthy foods 2.59 (SD=1.10), safety 2.63 (SD=0.97), violence 3.44 (SD=0.54), social cohesion 2.17 (SD=0.76), and activities with neighbors 2.09 (SD=0.75). The hula-based intervention group had a significantly lower (i.e., better) mean neighborhood aesthetic quality score compared to the education only group (p=0.02). The intervention group also had marginally better perceived activities with neighbors (p=0.09). This study describes perceived neighborhood dimensions in a Native Hawaiian population engaged in a HTN control intervention trial. Mean scores on walkability, availability of healthy foods, safety, social cohesion, aesthetic quality, violence, and activities with neighbors were similar to those reported in larger, multiethnic cohort studies. Perceptions of greater walkability, availability of healthy foods, safety, and social cohesion have been associate with HTN in other populations. Analysis to examine the potential associations between neighborhood level stressors and SBP is planned.

scholarly journals A Mobile Gaming Intervention for Persons on Pre-Exposure Prophylaxis: Protocol for Intervention Development and Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Laura Whiteley ◽  
Elizabeth Olsen ◽  
Leandro Mena ◽  
Kayla Haubrick ◽  
Lacey Craker ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Positive Impact ◽  
Controlled Trial ◽  
The United States ◽  
Developmental Phase ◽  
Randomized Controlled ◽  
Research Activities ◽  
Young Msm ◽  
Exposure Prophylaxis ◽  
Gaming Intervention

BACKGROUND In the United States, young minority men who have sex with men (MSM) are the most likely to become infected with HIV. Pre-exposure prophylaxis (PrEP) is an efficacious and promising prevention strategy. However, PrEP’s safety and effectiveness can be greatly compromised by suboptimal adherence to treatment. To maximize the positive impact of PrEP, it is necessary to combine its prescription with cost-effective behavioral interventions that promote adherence and decrease HIV risk behaviors. In this project, we developed a theoretically informed app/gaming intervention to engage young MSM in learning information, practicing behaviors, and improving motivation for HIV preventative behaviors and PrEP adherence. OBJECTIVE The goal of this project was to develop and test a cutting-edge, engaging, and entertaining app/gaming intervention for improving adherence to PrEP and building HIV prevention knowledge, skills, and behavior. METHODS This study was conducted in two phases. In the developmental phase, we conducted qualitative interviews with young MSM (n=20) to guide the development of the gaming intervention. In the randomized controlled trial, we tested the preliminary efficacy of the gaming intervention compared to a comparison condition among young MSM. Subjects were recruited from the University of Mississippi Medical Center HIV/STI testing clinics (n=60). RESULTS Institutional review board approval was received in February 2015. Research activities began in June 2015 and are still ongoing. CONCLUSIONS This app/gaming intervention aimed to improve PrEP adherence and HIV preventative behaviors in young MSM. Engaging young MSM in learning information, practicing behaviors, and improving motivation for increased adherence to PrEP has the potential to decrease HIV seroconversion. It is important to develop interventions that are enjoyable, engaging, and easily incorporated into clinical settings. CLINICALTRIAL ClinicalTrials.gov RCT02611362; https://tinyurl.com/y65gkuwr INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18640

scholarly journals The use of food swaps to encourage healthier online food choices: a randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Laura Jansen ◽  
Ellen van Kleef ◽  
Ellen J. Van Loo
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Food Choices ◽  
Purchase Behavior ◽  
Grocery Stores ◽  
Consumer Health ◽  
Randomized Controlled ◽  
Product Choices ◽  
The Difference ◽  
Store Environment

Abstract Background Online grocery stores offer opportunities to encourage healthier food choices at the moment that consumers place a product of their choice in their basket. This study assessed the effect of a swap offer, Nutri-Score labeling, and a descriptive norm message on the nutrient profiling (NP) score of food choices in an online food basket. Additionally explored was whether these interventions made it more motivating and easier for consumers to select healthier foods and whether potential effects were moderated by consumer health interest. Methods Hypotheses were tested with a randomized controlled trial (RCT) in a simulated online supermarket. Dutch participants (n = 550) chose their preferred product out of six product options for four different categories (breakfast cereals, crackers, pizza, and muesli bars). Participants were randomly allocated to one of eight groups based on the interventions in a 2 (Nutri-Score: present, not present) X 2 (swap offer: present, not present) X 2 (norm message: present, not present) between subject design. The primary outcome was the difference in combined NP score of product choices, for which a lower score represented a healthier product. Results Swap offer (B = − 9.58, 95% CI: [− 12.026; − 7.132], Ƞ2 = 0.098) and Nutri-Score labeling (B = − 3.28, 95% CI: [− 5.724; −.829], Ƞ2 = 0.013) significantly improved the combined NP score compared to the control condition (NP score M = 18.03, SD = 14.02), whereas a norm message did not have a significant effect (B = − 1.378, 95% CI [− 3.825; 1.070], Ƞ2 = 0.002). No evidence was found that interventions made it more motivating or easier for consumers to select healthier food, but situational motivation significantly influenced the healthiness score of food choices for both swap offer (b = − 3.40, p < .001) and Nutri-Score (b = − 3.25, p < .001). Consumer health interest only significantly moderated the influence of Nutri-Score on ease of identifying the healthy food option (b = .23, p = .04). Conclusions Swap offer and Nutri-Score labeling were effective in enhancing healthy purchase behavior in the online store environment. Trial registration This study was retrospectively registered in the ISRCTN database on 02-09-2021 (ISRCTN80519674).

Advancing PrEP Delivery: A Randomized Controlled Trial for Use of ePrEP to Expand PrEP Access to Non-Urban Young Black MSM (Preprint)

2019 ◽  
Author(s):  
Aaron J Siegler ◽  
James B Brock ◽  
Christopher B Hurt ◽  
Lauren Ahlschlager ◽  
Karen Dominguez ◽  
...  
Keyword(s):  
United States ◽  
North Carolina ◽  
Randomized Controlled Trial ◽  
Interactive Video ◽  
Small Town ◽  
Positive Impact ◽  
Controlled Trial ◽  
Scale Up ◽  
The United States ◽  
Randomized Controlled

BACKGROUND Pre-exposure prophylaxis (PrEP) is highly efficacious for preventing HIV but has not yet been brought to scale among at-risk persons. In several clinical trials in urban areas, technology-based interventions have shown a positive impact on PrEP adherence. In rural and small-town areas in the United States, which often do not have geographically proximal access to PrEP providers, additional support may be needed. This may be particularly true for younger persons, who are more likely to face multiple barriers to accessing PrEP services. Home-based care, accomplished through a tailored smartphone application (app), specimen self-collection (SSC), and interactive video consultations, could increase both PrEP initiation and persistence in care. OBJECTIVE Our goal is to assess the initiation and persistence in PrEP care for those randomized to a home-care intervention (ePrEP) relative to those assigned to the standard of care (control) condition. We will conduct additional assessments, including quantitative and qualitative analyses, to contextualize trial results and facilitate scale-up. METHODS This two-arm, randomized controlled trial will enroll young men who have sex with men (YMSM) aged 18-24 from rural areas of Georgia, Mississippi, and North Carolina. The trial will seek to recruit a diverse sample, targeting 50% participation among highly impacted groups of Black or Latino MSM. Intervention participants will receive a study app that incorporates a messaging platform, a scheduling and milestone-based tracking system for PrEP care progress, electronic behavioral surveys, and interactive video consultations with a clinician. Complemented by SSC kits mailed to laboratories for standard PrEP-related monitoring, the ePrEP system will allow participants to access PrEP care without leaving their homes. YMSM randomized to the control condition will receive a listing of nearest local PrEP providers to receive standard PrEP care. Both groups will complete quarterly electronic surveys. The primary outcome, assessed at 6 and 12 months after randomization, will be the difference in the proportion of intervention versus control participants that achieve protective levels of the active metabolite of oral PrEP (tenofovir diphosphate). RESULTS Enrollment is anticipated to begin in March 2019, with study completion in 2022. CONCLUSIONS This trial will determine whether home PrEP care provided through an app-based platform is an efficacious means of expanding access to PrEP care for a diverse group of YMSM in rural and small town areas of the United States. CLINICALTRIAL University of North Carolina Institutional Review Board (#18-0107); ClinicalTrials.gov NCT03729570

Does an Eczema Action Plan Improve Atopic Dermatitis? A Single-Site Randomized Controlled Trial

2018 ◽  
Vol 57 (14) ◽  
pp. 1624-1629 ◽  
Author(s):  
Julia Brown ◽  
Nicole W. Weitz ◽  
Amy Liang ◽  
Melissa S. Stockwell ◽  
Suzanne Friedman
Keyword(s):  
Randomized Controlled Trial ◽  
Atopic Dermatitis ◽  
Positive Impact ◽  
Action Plan ◽  
Controlled Trial ◽  
Treatment Options ◽  
Single Site ◽  
Care Group ◽  
Randomized Controlled ◽  
The Impact

The multitude of treatment options for atopic dermatitis (AD) makes management frustrating for providers and patients. Eczema action plans (EAPs) have been proposed to improve parental and provider management. We developed a single-site randomized controlled trial to evaluate the impact of an EAP on quality of life (QOL), provider knowledge, and comfort with AD management. Providers were randomized into an EAP-use group and a traditional care group. All patients completed validated AD QOL surveys, and those with AD were verbally administered the survey 1 month later. Providers’ perceptions on managing AD were compared in the EAP and usual use groups. Parents in the EAP group demonstrated a significantly increased understanding of AD treatment, and providers in the EAP group had a significantly increased understanding and management of AD. The EAP is a feasible tool that can be integrated into a busy clinic practice with a positive impact on physicians and patients.

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