Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial

Abstract

Background Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. Objective This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children’s heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players’ food choices. Methods We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. Results We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; P<.001; Cohen d=1.25) and identified (treatment 7.3, control 6.94; P=.048; Cohen d=.25). A large variation was observed in children’s game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall τ=–.32, P=.04), even after controlling for baseline food preference. Conclusions A mobile video game embedded with implicit learning components showed a strong positive impact on children’s food choices immediately following the game. Game telemetry captured children’s different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. Trial Registration ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively.

The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study

“…In particular, mHealth interventions have the potential to better engage youth about health-related topics, compared with traditional health interventions [17]. Among youth, mHealth apps have been found to increase fruit and vegetable intake [30][31][32][33], improve nutrition knowledge [32][33][34], promote food choice awareness and healthy eating behaviors [35,36], reduce sugar intake [37], and improve physical activity [38]. Furthermore, mHealth apps, as part of multicomponent interventions, can be effective tools to improve and support health-related behaviors [38].…”

Using Games to Promote Healthy Behavior in Children: A Narrative Review

“…The games used also vary, some use Foodbot Factory [10], Feed the alien [11], My Plate Picks [12], and Play and grow [13]. Research in the field of nutritional behavior also found that the characters used in the game affect the selection, snack consumption patterns [14], and healthy eating patterns [15]. In addition, games are also effectively used to promote healthy eating patterns in obese children [16], [17].…”

The Recent Advances of Mobile Healthcare in Cardiology Practice

“…It has been shown that health digital platforms can help to improve physical activity, healthy eating, and socialization ( 71 - 74 ). Moreover, mHealth applications demonstrated an effectiveness to treat various behavioral outcomes such as an adherence to the treatment ( 75 - 79 ).…”