The Impact of a Health Video Game on User-Game Engagement and Dietary Choices
Condition: Dietary Habits; Nutrition Knowledge
Study type: Interventional

Summary: 
      Pediatric obesity is one of the most serious public health challenges of the 21st century. It
      is a serious problem that is expected to create lifelong health challenges and potentially
      overwhelm the ability of healthcare providers to manage the consequences. While many factors
      contribute to pediatric obesity, dietary choices are the leading cause. A key concern is how
      to inculcate healthy dietary habits early among young children. Over the past 20 years, there
      has been significant scientific interest in examining the potential learning consequences of
      playing video games given children's interests in such games. This study investigates the
      impact of a health video game on children's nutritional knowledge and dietary choices.
    

Detailed description: 
      Brief Overview of the Study Protocol

      Study Design, Participants and Recruitment

      A cluster randomized controlled trial with three data collection periods-baseline, post one,
      and post two- will be adopted for this study. We will collaborate with a primary school in
      the North-East District of Botswana. Recruitment will be done with the help of the school
      with which we are collaborating. The children will be sent home with consent forms to obtain
      parental consent. Before participation, eligible parents will provide informed consent and
      child assent. To ensure sufficient power of 0.8 with a medium effect size, 120 participants
      will be recruited to participate in the experiment.

      Procedures

      Following baseline assessment, the children will be randomly assigned to one of three groups:
      playfulness condition, non-playfulness condition, and control condition. The playfulness and
      non-playfulness conditions will vary in terms of the climate such that children in the
      playfulness condition will have a relaxed, play-oriented context while those in the
      non-playfulness condition will have a more formal work-oriented context. The children in the
      control condition will play a video game that is unrelated to diet and lifestyle choices.
      Randomization will be done at the class/cluster level to avoid contamination between the
      experimental conditions (Puffer et al. 2005). The baseline survey, including demographics and
      family environment, gaming experience/ frequency of gameplay, nutrition knowledge, social
      cognitive factors (i.e., attitude, intention, and health locus of control), will be
      administered after obtaining consent. Since the administration of a pre-test survey may
      change the way that participants interact with the game (during the experiment) and/or
      suggest to the participants that there is a socially desirable way to respond to outcome
      measures, the pre-test survey will be administered a week before the actual experiment. Post
      1 experiment data collection will occur immediately upon completion of the experiment. The
      study will be conducted from November 2019 to May 2020. Post 2 experiment data collection
      will occur three months after the experiments.

      Experimental Setup

      Taking into account the malleability of the engagement construct (Boekaerts 2016), we ensured
      that our setup does not use invasive equipment. The chosen setup thus results from a
      trade-off between sensitivity and practical requirements. We will use the Tobii pro nano eye
      tracker that captures gaze data at 60Hz. Skin conductance will be measured using the shimmer
      3 GSR kit. It was selected because of its small size and lightweight (28g).

      All the experiments will be conducted individually as follows. The participants will sit in a
      non-swiveling chair in front of an IPAD with an eye tracker. An eye tracker will be attached
      to the IPAD. The experimenter will begin the session by describing the procedure to the
      participant. The experimenter will then place physiological feedback sensors to measure skin
      conductance on the participants' non-dominant hand. The non-dominant hand will be chosen to
      allow participants free access to the video game touch screen with the dominant hand (Jensen
      et al. 2016). The participant will be given 6 minutes to feel comfortable, and, at that time,
      any necessary technical adjustments will be made. We will exclude children who report that
      they are not comfortable and/or depict symptoms of discomfort. After the participant is
      comfortable, a survey will be administered to capture their mood. Next, the experimenter will
      record baseline GSR and gaze data for 2 minutes. To initiate the calibration process for eye
      gaze data, participants will be required to trace an on-screen object with their eyes (Jensen
      et al. 2016). Participants will play eight levels of the mobile health game. Based on our
      pre-tests, the completion of eight levels should take about 20 minutes. This duration was
      chosen because to prevent myopia, children are advised not to play with handheld devices for
      more than 30 minutes at a stretch.

      After the game, a post-test questionnaire will be administered to capture 1) nutritional
      knowledge acquisition, 2) subjective emotional responses, 3) social cognitive factors, and 4)
      perceived game complexity. After completing the post hoc survey, participants will choose
      four actual food items under the pretext of a parting gift. The following instruction will be
      used: "thank you for your time. You may now pick what you like from these options. You can
      eat your choice now or later. It is entirely up to you." The choice will serve as an
      objective measure of on-site behavior. Following the experiments, we will conduct a follow-up
      data collection after three months.
    

Intervention name(s): fooya!™; WordSearch
Intervention type(s): Behavioral; Other
Intervention description(s): fooya!™ is a science/evidence-based AI-enabled neuromodulation and Cognitive Behavior Therapy (CBT) technology. fooya!™ has been shown to deliver statistically significant outcomes concerning food choices during randomized-controlled clinical trials conducted at the Baylor College of Medicine's Children's Nutrition Research in the United States of America as well as India. In the game, children make several decisions with split-second timing, such as food choices, destroying bad/unhealthy food robots using the bad foods that are thrown at the player, and saving themselves. If the children collect good/healthy foods, they are in fit-zone for a while, which shields them from bad food robots.; We will have an active control group that will play a WordSearch game. The intention is to have the children play a familiar video game through the same modality (IPAD) that is unrelated to diet or lifestyle choices.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention