Training Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test

A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study

BACKGROUND

Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists.

OBJECTIVE

This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices.

METHODS

To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country's capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use.

RESULTS

Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001).

CONCLUSIONS

This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria.

The Adoption Factors of Mobile Games in the Wireless Environment

The factors that influence how people play mobile games have been studied from a variety of perspectives in the wireless broadband environment. The original data in the background of the game, such as user operation records, consumption records, and social behavior records, are converted into user attributes, user tags are generated, and data sets are constructed in this study, which primarily uses data mining technology to study user behavior and form user portraits. By incorporating the similarity of players’ subspace interests into the CFR (collaborative filtering recommendation) algorithm, a personalized game recommendation model, as well as the relationship management level of mobile game players, is created. The final fusion model’s ROC-AUC value is 0.921, which has a percentile enhancement effect, according to the results. The findings show that using a personalized game recommendation model can help to improve the scalability of the CFR algorithm and the impact of data scarcity on the quality of mobile games recommended by players.

Use of educational technologies in the promotion of children's cardiovascular health: a systematic review

OBJECTIVE

The aim of this study was to investigate the effectiveness of educational technologies for cardiovascular health promotion in children.

METHODS

A systematic review was carried out through a search in Biblioteca Virtual de Saúde, Comissão de Aperfeiçoamento de Pessoal do Nível Superior, EBSCOHot Information Services, and US National Library of Medicine National Institutes of Health databases, using the descriptors: play and plaything, cardiovascular diseases, child, and health promotion, between 2012 and 2019.

RESULTS

Eight articles were selected for this review. The identified technologies were based on low-tech interventions, such as play workshops, using tools such as CARDIOKIDS, the SI! program, MOVI-2, and activities with wide-ranging digital tools such as Fooya!, Fit2Play^TM, and the exergame cycling program.

CONCLUSIONS

It is noteworthy that all of the analyzed interventions were effective and those that involved playing were better accepted by the children.

Feasibility and Acceptability of a Culturally Tailored Website to Increase Fruit and Vegetable Intake and Physical Activity Levels in African American Mother-Child Dyads: Observational Study

BACKGROUND

African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population.

OBJECTIVE

This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads.

METHODS

Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska's Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes.

RESULTS

A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children's open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos.

CONCLUSIONS

Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions.

Breaking Health Insurance Knowledge Barriers Through Games: Pilot Test of Health Care America

BACKGROUND

Having health insurance is associated with a number of beneficial health outcomes. However, previous research suggests that patients tend to avoid health insurance information and often misunderstand or lack knowledge about many health insurance terms. Health insurance knowledge is particularly low among young adults.

OBJECTIVE

The purpose of this study was to design and test an interactive newsgame (newsgames are games that apply journalistic principles in their creation, for example, gathering stories to immerse the player in narratives) about health insurance. This game included entry-level information through scenarios and was designed through the collation of national news stories, local personal accounts, and health insurance company information.

METHODS

A total of 72 (N=72) participants completed in-person, individual gaming sessions. Participants completed a survey before and after game play.

RESULTS

Participants indicated a greater self-reported understanding of how to use health insurance from pre- (mean=3.38, SD=0.98) to postgame play (mean=3.76, SD=0.76); t₇₁=-3.56, P=.001. For all health insurance terms, participants self-reported a greater understanding following game play. Finally, participants provided a greater number of correct definitions for terms after playing the game, (mean=3.91, SD=2.15) than they did before game play (mean=2.59, SD=1.68); t₃₁=-3.61, P=.001. Significant differences from pre- to postgame play differed by health insurance term.

CONCLUSIONS

A game is a practical solution to a difficult health issue-the game can be played anywhere, including on a mobile device, is interactive and will thus engage an apathetic audience, and is cost-efficient in its execution.

Parent packs, child eats: Surprising results of Lunch is in the Bag's efficacy trial

Early care and education (ECE) centers that require lunch brought from home provide an uncluttered view of parent-child dietary interactions in early childhood. Children's eating from parent-provided bag lunches was observed at 30 ECE centers in Texas, with 15 randomly assigned to the Lunch is in the Bag intervention to improve the lunch meal and 15 to a wait-list control condition. Study participants were parent and child aged 3-5 years (N = 633 dyads). Data were collected at baseline (pre-intervention) and follow-ups at weeks 6 (post-intervention), 22 (pre-booster), and 28 (post-booster). Changes effected in the children's lunch eating-e.g., increase of 14 percent in prevalence of children eating vegetables (SE = 5, P = 0.0063)-reciprocated changes in parent lunch-packing. Irrespective of intervention, however, the children consumed one-half to two-thirds of the amounts of whatever foods the parents packed, and the eat-to-pack ratio did not change across time. Thus, children's lunch eating at the ECE centers appeared to be regulated by perceptual cues of food availability rather than food preferences or internal cues of hunger and satiety.

Mommio's Recipe Box: Assessment of the Cooking Habits of Mothers of Preschoolers and Their Perceptions of Recipes for a Video Game

BACKGROUND

Vegetables are an important part of a healthy diet because they help prevent several chronic diseases. Mothers of preschoolers reported difficulty getting their young children to eat vegetables, and many did not know how to cook child-pleasing recipes.

OBJECTIVE

The cooking habits of mothers of preschoolers, their perceptions of recipes designed for their children, and the involvement of their children in food preparation were assessed to inform a food parenting video game called Mommio.

METHODS

A cross-sectional survey design was used. Eligibility criteria included mothers of 3- to 5-year-old children who reported difficulty getting their children to eat vegetables. Participants completed a demographic questionnaire with questions about their food preparation practices. They were asked to select up to 4 of the 10 provided recipes they wanted to try and to prepare and report back on their experiences.

RESULTS

Most (46) of the 50 recipes included in Mommio's in-game recipe box were evaluated at least once and some up to 5 times with a total of 85 evaluations. This well-educated, mostly employed, sample of 27 mothers of preschoolers preferred simple, quick recipes. They ate primarily at home, made dinners from scratch, and indicated that the 46 recipes were generally simple, quick, and easy to prepare. Involvement in preparation enhanced their child's acceptance of the food. Prior food and preparation preferences influenced the children's acceptance of the dish at the ensuing meal.

CONCLUSIONS

The high rate of home recipe preparation indicated that including a recipe selection and preparation component in a food parenting video game could be attractive and may enhance effectiveness. Mothers reported that the recipes provided were generally easy to prepare, tasted good, and the instructions were easy to understand, suggesting they could be helpful to the mothers when playing a vegetable parenting game. Some mothers reported that involving their children in recipe preparation influenced their children's willingness to eat the vegetables. The highest rated recipes are being included in the game, and mothers will be encouraged to involve their children in recipe preparation.

Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review

Smartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings.

Mobile Technology for Vegetable Consumption: A Randomized Controlled Pilot Study in Overweight Adults

Background

Mobile apps present a potentially cost-effective tool for delivering behavior change interventions at scale, but no known studies have tested the efficacy of apps as a tool to specifically increase vegetable consumption among overweight adults.

Objective

The purpose of this pilot study was to assess the initial efficacy and user acceptability of a theory-driven mobile app to increase vegetable consumption.

Methods

A total of 17 overweight adults aged 42.0 (SD 7.3) years with a body mass index (BMI) of 32.0 (SD 3.5) kg/m² were randomized to the use of Vegethon (a fully automated theory-driven mobile app enabling self-monitoring of vegetable consumption, goal setting, feedback, and social comparison) or a wait-listed control condition. All participants were recruited from an ongoing 12-month weight loss trial (parent trial). Researchers who performed data analysis were blinded to condition assignment. The primary outcome measure was daily vegetable consumption, assessed using an adapted version of the validated Harvard Food Frequency Questionnaire administered at baseline and 12 weeks after randomization. An analysis of covariance was used to assess differences in 12-week vegetable consumption between intervention and control conditions, controlling for baseline. App usability and satisfaction were measured via a 21-item post-intervention questionnaire.

Results

Using intention-to-treat analyses, all enrolled participants (intervention: 8; control: 9) were analyzed. Of the 8 participants randomized to the intervention, 5 downloaded the app and logged their vegetable consumption a mean of 0.7 (SD 0.9) times per day, 2 downloaded the app but did not use it, and 1 never downloaded it. Consumption of vegetables was significantly greater among the intervention versus control condition at the end of the 12-week pilot study (adjusted mean difference: 7.4 servings; 95% CI 1.4-13.5; P=.02). Among secondary outcomes defined a priori, there was significantly greater consumption of green leafy vegetables, cruciferous vegetables, and dark yellow vegetables (adjusted mean difference: 2.6, 1.6, and 0.8 servings; 95% CI 0.1-5.0, 0.1-3.2, and 0.3-1.4; P=.04, P=.04, and P=.004, respectively). Participants reported positive experiences with the app, including strong agreement with the statements “I have found Vegethon easy to use” and “I would recommend Vegethon to a friend” (mean 4.6 (SD 0.6) and 4.2 (SD 0.8), respectively, (on a 5-point scale).

Conclusions

Vegethon demonstrated initial efficacy and user acceptability. A mobile app intervention may be useful for increasing vegetable consumption among overweight adults. The small sample size prevented precise estimates of effect sizes. Given the improved health outcomes associated with increases in vegetable consumption, these findings indicate the need for larger, longer-term evaluations of Vegethon and similar technologies among overweight adults and other suitable target groups.

Trial Registration

ClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591 (Archived by WebCite at http://www.webcitation.org/6hYDw2AOB)

Assessing Feedback in a Mobile Videogame

BACKGROUND

Player feedback is an important part of serious games, although there is no consensus regarding its delivery or optimal content. "Mommio" is a serious game designed to help mothers motivate their preschoolers to eat vegetables. The purpose of this study was to assess optimal format and content of player feedback for use in "Mommio."

MATERIALS AND METHODS

The current study posed 36 potential "Mommio" gameplay feedback statements to 20 mothers using a Web survey and interview. Mothers were asked about the meaning and helpfulness of each feedback statement.

RESULTS

Several themes emerged upon thematic analysis, including identifying an effective alternative in the case of corrective feedback, avoiding vague wording, using succinct and correct grammar, avoiding provocation of guilt, and clearly identifying why players' game choice was correct or incorrect.

CONCLUSIONS

Guidelines are proposed for future feedback statements.