Investigating the impact of a health game on implicit attitudes towards food and food choice behaviour of young adults

Serious games and eating behaviors: A systematic review of the last 5 years (2018–2022)

Background

Serious game intervention has emerged over the years as a popular strategy for solving the problem of unhealthy eating behavior. This has prompted several scholars to explore its significant impact on eating behaviors, identifying its positive effect on nutritional knowledge and eating behaviors. However, since this research field is yet nascent, an update in knowledge is required to further inform the real-world practice as an alternative intervention for instating healthy eating behavior. Therefore, this current research utilized a systematic review method to reveal the latest state of this concept of a serious game and eating behavior, to identify the position of the literature and shed light on under-researched and emerging areas by recommending future investigations.

Method

To achieve the object of this research, four electronic databases- Science Direct, Web of Science (WoS), APA PsyclNFO, and Emerald- were searched using predefined keywords (search string) relating to the review topic. A total of 15,107 results were retrieved from the databases. After title, abstract, and full-text screening, 15 studies were included following inclusion criteria.

Key findings

The result of this research demonstrated that various designs of serious games comprise an effective intervention for changing eating behavior in both children and adults and addressed the risks of childhood obesity and overweight. The findings also show that the design of the games is co-designed by different specialists such as a nutritionist, psychologist and developer, among others, as either single or multiple players. The effectiveness of the games was attributed to behavior techniques (BT), cognitive theories (CT), and socio-cognitive theories (SCT) of behavior change technique (BCT), incorporating an element of implicit learning in serious games. Feedback and reward were the most reported influencing strategies and self-reporting the evaluation approach.

Conclusion

This research contributed significantly to the body of knowledge in the field of serious games as the most recent review of evidence in the research area. Evidence from 93.33% of the included studies confirmed the effectiveness of serious games in addressing eating behavior. This study concludes that serious games are an effective intervention for improving healthy eating behavior and decreasing unhealthy eating behavior and that various elements of behavior change techniques are essential components of implicit nutritional learning through the games. In addition, it is concluded that the risk of childhood obesity and overweight can be reduced or prevented by leveraging the strength of these games. The need for future research in this field was also pointed out by this study.

Understanding parental vaccine refusal: Implicit and explicit associations about vaccines as potential building blocks of vaccine beliefs and behavior

Objective

A movement of parents refusing vaccines for their children has contributed to increasingly large outbreaks of diseases that are preventable by vaccines. Research has identified multiple factors that relate to parents' vaccination behaviors (i.e., whether not they vaccinate their children), including their beliefs about vaccines' safety and utility and their trust in those who recommend vaccines. Here we examine the role of more fundamental psychological processes that may contribute to multiple vaccine-related beliefs and behaviors: cognitive associations.

Methods

Using a large sample of U.S. parents (pre-COVID-19), we investigated parents' associations between vaccines and helpfulness/harmfulness, as well as between the self and vaccines (vaccine identity), and their relation to parents' beliefs about vaccine safety and utility, trust in authorities' vaccine recommendations, and prior vaccination refusal for their children. To capture a more complete understanding of people's associations, we examined both explicit associations (measured via self-report) and implicit associations (measured by the Implicit Association Test).

Results

Both implicit and explicit associations correlated with beliefs, trust, and vaccination refusal. Results from structural equation models indicated that explicit vaccine-identity and vaccine-helpfulness associations and implicit vaccine helpfulness associations were indirectly related to vaccination refusal via their relation with vaccine beliefs.

Conclusions

Collectively, study findings suggest that vaccine associations—especially those related to helpfulness/harmfulness—may serve as psychological building blocks for parental vaccine beliefs and behaviors.

Serious Gaming for Behaviour Change: A Systematic Review

Over the years, there has been a significant increase in the adoption of game-based interventions for behaviour change associated with many fields such as health, education, and psychology. This is due to the significance of the players’ intrinsic motivation that is naturally generated to play games and the substantial impact they can have on players. Many review papers measure the effectiveness of the use of gaming on changing behaviours; however, these studies neglect the game features involved in the game design process, which have an impact of stimulating behaviour change. Therefore, this paper aimed to identify game design mechanics and features that are reported to commonly influence behaviour change during and/or after the interventions. This paper identified key theories of behaviour change that inform the game design process, providing insights that can be adopted by game designers for informing considerations on the use of game features for moderating behaviour in their own games.

All I Need Is Two: The Clinical Potential of Adding Evaluative Pairing Procedures to Cognitive Behavioral Therapy for Changing Self-, Body- and Food-Related Evaluations

Pairing procedures are among the most frequently used paradigms for modifying evaluations of target stimuli related to oneself, an object, or a specific situation due to their repeated pairing with evaluative sources, such as positive or negative images or words. Because altered patterns of evaluations can be linked to the emergence and maintenance of disordered cognitions and behaviors, it has been suggested that pairing procedures may provide a simple yet effective means of complementing more complex intervention approaches, such as cognitive behavioral therapy (CBT). Here, we summarize recent studies that explored the clinical potential of pairing procedures for improving self-esteem, body satisfaction, and food and consumption preferences. While no study has yet combined pairing procedures with CBT, there are several successful examples of pairing procedures in clinically relevant domains and clinical populations. We discuss potential sources of heterogeneity among findings, provide methodological recommendations, and conclude that pairing procedures may bear clinical potential as an add-on to classical psychotherapy.

A Systematic Review Of Implicit Attitudes And Their Neural Correlates In Eating Behaviour

An increasing number of studies suggests that implicit attitudes toward food and body shape predict eating behaviour and characterize patients with eating disorders (EDs). However, literature has not been previously analysed, thus differences between patients with EDs and healthy controls and the level of automaticity of the processes involved in implicit attitudes are still matters of debate. The present systematic review aimed to synthetize current evidence from papers investigating implicit attitudes towards food and body in healthy and EDs populations. PubMed, EMBASE (Ovid), PsycINFO, Web of Science and Scopus were systematically screened and 183 studies using different indirect paradigms were included in the qualitative analysis. The majority of studies reported negative attitudes towards overweight/obese body images in healthy and EDs samples and weight bias as a diffuse stereotypical evaluation. Implicit food attitudes are consistently reported as valid predictors of eating behaviour. Few studies on the neurobiological correlates showed neurostimulation effects on implicit attitudes, but the automaticity at brain level of implicit evaluations remains an open area of research. In conclusion, implicit attitudes are relevant measures of eating behaviour in healthy and clinical settings, although evidence about their neural correlates is limited.

A Health Game Targeting Children's Implicit Attitudes and Snack Choices

Objective: The present study investigated whether a health game can be used to affect children's implicit attitudes toward food (IAsTF) and subsequent snack choices. Materials and Methods: The health game used was based on an evaluative conditioning paradigm. The experiment followed a between-subjects design with two conditions (health game vs. control), N = 79 (12.42 years ±1.64, body mass index: 25.06 ± 7.40). IAsTF were assessed at baseline and postintervention using an implicit association test (IAT). Baseline IAT scores were used to categorize IAsTF as healthy (favoring fruits) versus unhealthy IAsTF (favoring chocolates). In addition, three digital snack choices were recorded. Results: No main effect of condition on posttest IAsTF was found. However, baseline IAsTF moderated the effect of condition on posttest IAsTF; participants with less healthy baseline IAsTF playing the health game had healthier posttest IAsTF compared to those playing the control game. Regarding the snack choices, participants playing the health game favored fruit over chocolate in one of the snack choices. Baseline IAsTF did not moderate the effect of condition on snack choices. Conclusion: Tentative support was found that health games can be used to improve IAsTF, in particular among participants with less healthy ones at baseline.

Watching TV Cooking Programs: Effects on Actual Food Intake Among Children

OBJECTIVE

To test the effects of a cooking program on healthy food decisions.

DESIGN

An experimental between-subjects design with 3 conditions: healthy, unhealthy, and control.

SETTING

Class settings in 5 different schools.

PARTICIPANTS

One hundred twenty-five children between 10 and 12 years of age.

INTERVENTIONS

Video clips of cooking program containing healthy foods versus cooking program containing unhealthy foods versus control program.

MAIN OUTCOME MEASURES

Healthy versus unhealthy food choice.

ANALYSIS

Logistic regression analysis, with the control condition as a reference in the first contrast test and the unhealthy food condition as a reference in the second contrast, to examine effects on food choice between conditions.

RESULTS

Children who watched the cooking program with healthy foods had a higher probability of selecting healthy food than children who watched the cooking program with unhealthy foods (P = .027), or with the control condition (P = .039).

CONCLUSIONS AND IMPLICATIONS

These findings indicated a priming effect of the foods the children were exposed to, showing that nutrition education guided by reactivity theory can be promising. Cooking programs may affect the food choices of children and could be an effective method in combination with other methods to improve their dietary intake.