Debbe Thompson

Serious Video Games for Health: How Behavioral Science Guided the Development of a Serious Video Game

Serious video games for health are designed to entertain players while attempting to modify some aspect of their health behavior. Behavior is a complex process influenced by multiple factors, often making it difficult to change. Behavioral science provides insight into factors that influence specific actions that can be used to guide key game design decisions. This article reports how behavioral science guided the design of a serious video game to prevent Type 2 diabetes and obesity among youth, two health problems increasing in prevalence. It demonstrates how video game designers and behavioral scientists can combine their unique talents to create a highly focused serious video game that entertains while promoting behavior change.

Impact of an Active Video Game on Healthy Children’s Physical Activity

OBJECTIVE: This naturalistic study tests whether children receiving a new (to them) active video game spontaneously engage in more physical activity than those receiving an inactive video game, and whether the effect would be greater among children in unsafe neighborhoods, who might not be allowed to play outside. METHODS: Participants were children 9 to 12 years of age, with a BMI >50th percentile, but <99th percentile; none of these children a medical condition that would preclude physical activity or playing video games. A randomized clinical trial assigned children to receiving 2 active or 2 inactive video games, the peripherals necessary to run the games, and a Wii console. Physical activity was monitored by using accelerometers for 5 weeks over the course of a 13-week experiment. Neighborhood safety was assessed with a 12 item validated questionnaire. RESULTS: There was no evidence that children receiving the active video games were more active in general, or at anytime, than children receiving the inactive video games. The outcomes were not moderated by parent perceived neighborhood safety, child BMI z score, or other demographic characteristics. CONCLUSIONS: These results provide no reason to believe that simply acquiring an active video game under naturalistic circumstances provides a public health benefit to children.

Distance to food stores & adolescent male fruit and vegetable consumption: mediation effects

BackgroundThe physical environments in which adolescents reside and their access to food stores may influence their consumption of fruit and vegetables. This association could either be direct or mediated via psychosocial variables or home availability of fruit and vegetables. A greater understanding of these associations would aide the design of new interventions. The purpose of this study was to examine associations between distance to food stores and restaurants and fruit and vegetable consumption and the possible mediating role of psychosocial variables and home availability.MethodsFruit and vegetable consumption of 204 Boy Scouts was assessed by a food frequency questionnaire in 2003. Participant addresses were geo-coded and distance to different types of food stores and restaurants calculated. Fruit and vegetable preferences, home availability and self-efficacy were measured. Regression models were run with backward deletion of non-significant environmental and psychosocial variables. Mediation tests were performed.ResultsResiding further away from a small food store (SFS) (convenience store and drug store) was associated with increased fruit and juice and low fat vegetable consumption. Residing closer to a fast food restaurant was associated with increased high fat vegetable and fruit and juice consumption. Vegetable preferences partially mediated (26%) the relationship between low fat vegetable consumption and distance to the nearest SFS.ConclusionDistance to SFS and fast food restaurants were associated with fruit and vegetable consumption among male adolescents. Vegetable preferences partially mediated the distance to low fat vegetable relationship. More research is needed to elucidate how environmental variables impact childrens dietary intake.

A meta-analysis of serious digital games for healthy lifestyle promotion.

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed that serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further explorations of which game features create larger effects are needed.

Food, fun, and fitness internet program for girls: pilot evaluation of an e-Health youth obesity prevention program examining predictors of obesity.

OBJECTIVE This pilot study tested whether an Internet-based intervention could achieve change in fruit, juice, and vegetable consumption, physical activity, and self-efficacy in youth at-risk of obesity. METHOD Participants were 80 8-to-10-year-old African American girls at-risk of obesity, with a home computer, Internet access, and an e-mail address. A two-group design was followed. Groups differed only on incentive schedule (immediate, delayed). The 8-week home-based program, conducted entirely over the Internet, promoted fruit, juice, vegetables, and water intake and physical activity. Pre-post measures were collected through self-report via the program website. The study was conducted in the greater Houston, TX, area September through November, 2004. RESULTS Statistically significant pre-to-post differences were observed in fruit, juice, and vegetable consumption (p=.002), physical activity--yesterday (p<.001), physical activity--usually (p=.001), and fruit, juice, and vegetable self-efficacy (p=.003). CONCLUSION Internet-based obesity prevention programs may be an effective channel for promoting healthy diet and physical activity behaviors to youth at-risk of obesity. Additional research is needed to more fully examine their effectiveness at promoting and maintaining diet and physical activity change.

In pursuit of change: youth response to intensive goal setting embedded in a serious video game

Background: Type 2 diabetes has increased in prevalence among youth, paralleling the increase in pediatric obesity. Helping youth achieve energy balance by changing diet and physical activity behaviors should decrease the risk for type 2 diabetes and obesity. Goal setting and goal review are critical components of behavior change. Theory-informed video games that emphasize development and refinement of goal setting and goal review skills provide a method for achieving energy balance in an informative, entertaining format. This article reports alpha-testing results of early versions of theory-informed goal setting and reviews components of two diabetes and obesity prevention video games for preadolescents. Method: Two episodes each of two video games were alpha tested with 9- to 11-year-old youth from multiple ethnic groups. Alpha testing included observed game play followed by a scripted interview. The staff was trained in observation and interview techniques prior to data collection. Results: Although some difficulties were encountered, alpha testers generally understood goal setting and review components and comprehended they were setting personal goals. Although goal setting and review involved multiple steps, youth were generally able to complete them quickly, with minimal difficulty. Few technical issues arose; however, several usability and comprehension problems were identified. Conclusion: Theory-informed video games may be an effective medium for promoting youth diabetes and obesity prevention. Alpha testing helps identify problems likely to have a negative effect on functionality, usability, and comprehension during development, thereby providing an opportunity to correct these issues prior to final production.

Games for Health for Children - Current Status and Needed Research

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a populations diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.

Comparison of a Web-Based versus Traditional Diet Recall among Children

Self-administered instruments offer a low-cost diet assessment method for use in adult and pediatric populations. This study tested whether 8- to 13-year-old children could complete an early version of the Automated Self Administered 24-hour diet recall (ASA24) and how this compared to an interviewer-administered 24-hour diet recall. One-hundred twenty 8- to 13-year-old children were recruited in Houston from June through August 2009 and randomly assigned to complete either the ASA24 or an interviewer-administered 24-hour diet recall, followed by the other recall mode covering the same time interval. Multivariate analysis of variance, testing for differences by age, sex, and ethnic/racial group, were applied to percentages of food matches, intrusions, and omissions between reports on the ASA24 and the interviewer-administered 24-hour diet recall. For the ASA24, qualitative findings were reported regarding ease of use. Overall matches between interviewer-administered and ASA24 self-administered 24-hour diet recall was 47.8%. Matches were significantly lower among younger (8- to 9-year-old) compared with older (10- to 13-year-old) children. Omissions on ASA24 (18.9% overall) were most common among 8-year-olds and intermediate among 9-year-olds. Eight- and 9-year-olds had substantial difficulties and often required aid in completing ASA24. Findings from this study suggest that a simpler version of an Internet-based diet recall program would be easier for children to use.

Boy scout 5-a-day badge: outcome results of a troop and internet intervention.

OBJECTIVES The effects of a Boy Scout Five-A-Day Badge program on fruit juice (FJ) and low-fat vegetable (LV) consumption were evaluated using a two-condition (treatment, active-attention-placebo-control) group randomized trial, with three data collection periods (baseline, immediate post, 6-month post). METHODS Forty-two Boy Scout troops (n=473, 10- to 14-year-old Scouts) in Houston, TX, were randomly assigned to condition. The 9-week program included approximately 30 min of weekly troop time, plus approximately 25 min of weekly Internet programming. The intervention was delivered in two waves (Spring and Fall). Data were collected in 2003-2004, and analyses were completed in 2008. Main outcomes were FJ and LV consumption (validated food frequency questionnaire). FV self-efficacy, preferences, and home availability were also measured. RESULTS Significant increases in FJ consumption (p=.003), FJ home availability (p=.009), and LV self-efficacy (p=.004) were observed among the intervention group immediately following the intervention but were not maintained 6 months later. CONCLUSION A Boy Scout troop-plus-Internet intervention promoting FJ and LV consumption resulted in short-term changes in FJ consumption among U.S. Boy Scouts. Future research should investigate ways to extend these results to LV and maintain the increases over time.

Conceptual Model for the Design of a Serious Video Game Promoting Self-Management among Youth with Type 1 Diabetes

Video games are a popular form of entertainment. Serious video games for health attempt to use entertainment to promote health behavior change. When designed within a framework informed by behavioral science and supported by commercial game-design principles, serious video games for health have the potential to be an effective method for promoting self-management behaviors among youth with diabetes. This article presents a conceptual model of how this may be achieved. It concludes by identifying research needed to refine our knowledge regarding how to develop effective serious video games for health.