Examining the Impact of a Mobile Nutrition Education App for Child Nutrition Education in Canada

Study Overview
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Brief Summary
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This trial will test the hypothesis that a digital curriculum-based nutrition education intervention using the Foodbot Factory serious game (i.e., a game designed for learning) leads to greater student engagement and learning about nutrition, compared to conventional nutrition education (e.g., worksheets), among students in Grades 4 and 5 in Ontario, Canada. This hypothesis is based on existing research suggesting that digital serious games, when well-integrated into the classroom setting, promote greater student engagement, learning and knowledge retention.

Detailed Description
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This two-arm parallel cluster randomized controlled efficacy trial will determine if a digital curriculum-based nutrition education intervention (intervention group) leads to greater increases in overall nutrition knowledge compared to conventional nutrition education (control group) in Grade 4 and 5 classrooms after 1 week, and that it facilitates greater retention at 4 weeks and 3 months following the intervention period. Secondary outcomes include sub-scores of nutrition knowledge (i.e., knowledge of specific food groupings), nutrition attitudes, general child nutrition behaviours and dietary intakes. Due to the enhanced engagement serious games can provide, it is hypothesized that participants in the intervention group will show greater changes in and retention of their nutrition knowledge and nutrition behaviours. Twenty-eight Grade 4, 4/5 and 5 classrooms in Ontario, Canada will be randomized to the intervention or control group. Participants in both groups will receive nutrition education lessons for 35-40 minutes a day for five consecutive days. Participants in the intervention group will use the Foodbot Factory serious game while participants in the control group will use conventional learning materials (e.g., worksheets, teacher-led instruction). Both interventions will have these learning materials integrated into standardized nutrition education lesson plans. Overall and sub-scores of nutrition knowledge, and nutrition attitudes will be assessed using the Nutrition Attitudes and Knowledge questionnaire. General child nutrition behaviours (e.g., frequency of eating meals outside the home) will be assessed using a modified version of the Family Nutrition and Physical Activity Screening Tool and dietary intake will be assessed using the Block Food Screener for Ages 2-17. At baseline, parents and classroom teachers will respectively complete demographic questionnaires to measure co-variates that may impact outcomes of interest (e.g., household food security, presence of school food programs).

Official Title
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Efficacy of a Digital School-Based Nutrition Education Intervention to Improve Children's Healthy Eating Knowledge, Attitudes and Behaviours

Conditions
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Nutrition, Healthy

Intervention / Treatment
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* Other: Serious game nutrition education intervention
* Other: Conventional nutrition education intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Grade 4, 4/5 or 5 classroom Classroom is located in a participating school board in Ontario Exclusion Criteria: Classroom has already covered the Healthy Eating component of the Ontario Physical Health Education curriculum
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental (Foodbot Factory) Group<br> | Other: Serious game nutrition education intervention<br>* Classrooms will receive nutrition education lessons for 35-40 minutes for 5 consecutive days. As part of each lesson, students will play the Foodbot Factory nutrition education serious game for 10-15 minutes. The Foodbot Factory serious game and lessons are based on Ontario curriculum requirements and aligned Canada's Food Guide.<br>|
| Active Comparator: Control Group<br> | Other: Conventional nutrition education intervention<br>* Classrooms will receive nutrition education lessons for 35-40 minutes for 5 consecutive days. As part of each lesson, students will use conventional learning activities, such as worksheets, sourced from an online teaching resource repository. The lessons are based on Ontario curriculum requirements and aligned Canada's Food Guide.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall nutrition knowledge | Change in knowledge of healthy food choices based on Canada's Food Guide from baseline to immediately post-intervention as assessed by the Nutrition Attitudes and Knowledge Questionnaire. The minimum score is 0 and the maximum score is 20 with higher scores indicating higher knowledge. | Measured at baseline and immediately post-intervention (Day 5). | 
| Overall nutrition knowledge | Change in knowledge of healthy food choices based on Canada's Food Guide from baseline to immediately post-intervention as assessed by the Nutrition Attitudes and Knowledge Questionnaire. The minimum score is 0 and the maximum score is 20 with higher scores indicating higher knowledge. | Measured at baseline and 4 weeks post-intervention. | 
| Overall nutrition knowledge | Change in knowledge of healthy food choices based on Canada's Food Guide from baseline to immediately post-intervention as assessed by the Nutrition Attitudes and Knowledge Questionnaire. The minimum score is 0 and the maximum score is 20 with higher scores indicating higher knowledge. | Measured at baseline and 3 months post-intervention. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Drinks knowledge | Change in knowledge of drink choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and immediately post-intervention (Day 5). | 
| Drinks knowledge | Change in knowledge of drink choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and 4 weeks post-intervention. | 
| Drinks knowledge | Change in knowledge of drink choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and 3 months post-intervention. | 
| Whole grain foods knowledge | Change in knowledge of whole grain food choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and immediately post-intervention (Day 5). | 
| Whole grain foods knowledge | Change in knowledge of whole grain food choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and 4 weeks post-intervention. | 
| Whole grain foods knowledge | Change in knowledge of whole grain food choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and 3 months post-intervention. | 
| Vegetables & fruit knowledge | Change in knowledge of vegetable & fruit choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and immediately post-intervention (Day 5). | 
| Vegetables & fruit knowledge | Change in knowledge of vegetable & fruit choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and 4 weeks post-intervention. | 
| Vegetables & fruit knowledge | Change in knowledge of vegetable & fruit choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The maximum score on the scale is 5 with higher scores indicating higher knowledge. | Measured at baseline and 3 months post-intervention. | 
| Protein foods knowledge | Change in knowledge of protein food choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and immediately post-intervention (Day 5). | 
| Protein foods knowledge | Change in knowledge of protein choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and 4 weeks post-intervention. | 
| Protein foods knowledge | Change in knowledge of protein food choices based on Canada's Food Guide and assessed by the Nutrition Knowledge and Attitudes Questionnaire. The minimum score is 0 and the maximum score is 5 with higher scores indicating higher knowledge. | Measured at baseline and 3 months post-intervention. | 
| Nutrition attitudes | Change in attitudes towards nutrition and healthy eating assessed by the Nutrition Attitudes and Knowledge Questionnaire. Minimum score is 4 and maximum score is 20 with higher scores indicating more positive attitudes towards nutrition and healthy eating. | Measured at baseline and immediately post-intervention (Day 5). | 
| Nutrition attitudes | Change in attitudes towards nutrition and healthy eating assessed by the Nutrition Attitudes and Knowledge Questionnaire. Minimum score is 4 and maximum score is 20 with higher scores indicating more positive attitudes towards nutrition and healthy eating. | Measured at baseline and 4 weeks post-intervention. | 
| Nutrition attitudes | Change in attitudes towards nutrition and healthy eating assessed by the Nutrition Attitudes and Knowledge Questionnaire. Minimum score is 4 and maximum score is 20 with higher scores indicating more positive attitudes towards nutrition and healthy eating. | Measured at baseline and 3 months post-intervention. | 
| Dietary intake | Change in usual intake of foods (e.g., fruit, vegetables, whole grains), reported as average number of daily servings, over the past week assessed by the Block Food Screener Kids. | Measured at baseline and immediately post-intervention (Day 5). | 
| Dietary intake | Change in usual intake of foods (e.g., fruit, vegetables, whole grains), reported as average number of daily servings, over the past week assessed by the Block Food Screener Kids. | Measured at baseline and 4 weeks post-intervention. | 
| Dietary intake | Change in usual intake of foods (e.g., fruit, vegetables, whole grains), reported as average number of daily servings, over the past week assessed by the Block Food Screener Kids. | Measured at baseline and 3 months post-intervention. | 
| General nutrition behaviours | Change in behaviours relevant to nutrition and eating (e.g., frequency of consuming breakfast and meals outside the home) assessed by a modified version of the Family Nutrition and Physical Activity Screening Tool. There are 10 questions evaluating how often the child engages in a nutrition behaviour, with responses ranging from Never/Almost Never (1) to Very Often/Always (4). Changes in each behaviour will be reported independently. | Measured at baseline and immediately post-intervention (Day 5). | 
| General nutrition behaviours | Change in behaviours relevant to nutrition and eating (e.g., frequency of consuming breakfast and meals outside the home) assessed by a modified version of the Family Nutrition and Physical Activity Screening Tool. There are 10 questions evaluating how often the child engages in a nutrition behaviour, with responses ranging from Never/Almost Never (1) to Very Often/Always (4). Changes in each behaviour will be reported independently. | Measured at baseline and 4 weeks post-intervention. | 
| General nutrition behaviours | Change in behaviours relevant to nutrition and eating (e.g., frequency of consuming breakfast and meals outside the home) assessed by a modified version of the Family Nutrition and Physical Activity Screening Tool. There are 10 questions evaluating how often the child engages in a nutrition behaviour, with responses ranging from Never/Almost Never (1) to Very Often/Always (4). Changes in each behaviour will be reported independently. | Measured at baseline and 3 months post-intervention. | 
| Intervention acceptability | Acceptability of the nutrition education interventions assessed by a questionnaire based on the Theoretical Framework of Acceptability. There are 11 questions evaluating different dimensions of intervention acceptability, with responses ranging from 1, indicating strong disagreement, to 5, indicating strong agreement (response options are specific to each question). Responses to each question will be reported independently. | Measured immediately post-intervention (Day 5). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diet, Healthy, Digital Technology, Gamification, Health Education, School Health Services, Food Literacy