Caregiver Praise + Gamification for Healthy Nutrition

Overseen By Hollie Raynor, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: The University of Tennessee, Knoxville

Disqualifiers: Major psychiatric diseases, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 4 weeks

80 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Enhancing Child Dietary Self-monitoring?

Research shows that using gamification (adding game-like elements) can help children eat more fruits and vegetables and improve their knowledge about healthy eating. Studies found that children who participated in game-based interventions increased their fruit and vegetable intake and were more willing to try new foods. ^{1 2 3 4 5}

Is the Caregiver Praise + Gamification for Healthy Nutrition treatment safe for humans?

The research articles do not provide specific safety data for the Caregiver Praise + Gamification for Healthy Nutrition treatment, but similar gamification approaches in schools have been well-received by teachers and students, suggesting they are generally safe and enjoyable. ^{5 6 7 8 9}

How does the treatment 'Enhancing Child Dietary Self-monitoring' differ from other treatments for improving child nutrition?

This treatment is unique because it combines caregiver praise with gamification, using a phone app to encourage children to monitor their own eating habits. Unlike traditional methods, it leverages technology and positive reinforcement to make healthy eating more engaging and self-directed for children. ^{1 7 10 11 12}

What is the purpose of this trial?

The goal of this clinical trial is to test the usability, acceptability, and preliminary efficacy of a digital dietary self-monitoring (dDSM) log that uses positive reinforcement strategies (caregiver praise and gamification) to improve child engagement in DSM. The main aims are to: * Examine the usability of a dDSM log that uses positive reinforcement (praise and gamification) among children 8-12 years and their adult caregivers. * Examine the acceptability of a dDSM log that uses positive reinforcement (praise and gamification) among children 8-12 years and their adult caregivers * Conduct a proof-of-concept trial that examines the effects of positive reinforcement on child DSM behaviors. * Explore differences in children's intrinsic motivation. Participating children will be instructed to self-monitor their daily intake of targeted food groups (fruits, vegetables, sweet and salty snack foods, and sugar-sweetened beverages) for 4 weeks using a personal web-based DSM log. Each child-caregiver dyad will be randomly assigned to 1 of 4 conditions: BASIC, PRAISE, GAME, or PRAISE+GAME. For PRAISE and PRAISE+GAME conditions, caregivers will be instructed to provide daily process praise to their child related to DSM behaviors. For GAME and PRAISE+GAME conditions, logs will integrate three game mechanics: points, levels, and a virtual pet. Points will be accumulated for engaging in DSM behaviors, and accrual of points will evolve a virtual pet over time.

Eligibility Criteria

This trial is for families with children aged 8-12 who are overweight or obese and regularly consume foods from at least two of the following groups: fruits, vegetables, sweet/salty snacks, and sugary drinks. They must have reliable internet access and an adult caregiver willing to participate.

Inclusion Criteria

Your family can easily use the internet on a phone, computer, or other device that your child is allowed to use.

My child is 8-12 years old, overweight, and we eat certain unhealthy foods regularly.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (virtual)

Orientation and Baseline Assessment

Families attend an orientation session, complete consent/assent, and baseline assessment measures

1 week

1 visit (in-person)

Treatment

Children self-monitor their dietary intake using a digital log with positive reinforcement strategies for 4 weeks

4 weeks

Daily self-monitoring

Follow-up

Participants complete follow-up assessments and receive feedback on dietary intake

1 week

1 visit (virtual)

Treatment Details

Interventions

• Enhancing Child Dietary Self-monitoring

Trial Overview The study tests a digital dietary self-monitoring log that encourages kids to track their food intake using praise from caregivers and game-like features. Children will be randomly placed in one of four groups to see which method boosts engagement in healthy eating habits.

Participant Groups

Group I: PRAISE+GAME Experimental Treatment 2 Interventions

In addition to conditions of the BASIC group, caregivers will also be asked to provide praise to their child for engaging in DSM over the 4 weeks. Additionally, when the caregiver completes caregiver check-ins in the DSM log, they will receive a prompt to also complete a praise check-in. The child's log will also include a virtual pet that evolves over time as he/she uses the log. As the child earns points, the pet will level up and grow over time.

Group II: PRAISE Experimental Treatment 1 Intervention

In addition to conditions of the BASIC group, caregivers will also be asked to provide praise to their child for engaging in DSM over the 4 weeks. Additionally, when the caregiver completes caregiver check-ins in the DSM log, they will receive a prompt to also complete a praise check-in.

Group III: GAME Experimental Treatment 1 Intervention

In addition to the conditions of the BASIC group, the child's log will also include a virtual pet that evolves over time as he/she uses the log. As the child earns points, the pet will level up and grow over time.

Group IV: BASIC Active Control 1 Intervention

Children will be asked to track their intake of fruits, vegetables, sweet and salty snack foods, and sugary drinks in the web-based dietary self-monitoring (DSM) log for 4 weeks. Each child will be provided with a personal URL to access their log, which can be accessed from any internet-capable device (computer, phone, etc.). Caregivers will be asked to review their child's log each day and complete a caregiver check-in in the DSM log.

Who Is Running the Clinical Trial?

The University of Tennessee, Knoxville

Lead Sponsor

Trials

93

Recruited

19,500+

Findings from Research

The pilot study involving 45 children aged 5 to 6 years showed that the digital game 'Veggies4myHeart' effectively increased children's willingness to taste red cabbage and improved overall vegetable preference scores after repeated tasting and education sessions.

Teachers found the game to be an acceptable tool for promoting vegetable consumption in schools, indicating potential for broader implementation, although further research is needed to confirm its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study. Bucher Della Torre, S., Lages, M., Dias, SS., et al.[2023]

Computer- and web-based interventions can effectively improve eating behaviors and diet-related physical outcomes in children and adolescents, as shown in a systematic review of 15 studies.

To enhance the success of these interventions, strategies such as conducting them in schools and providing individually tailored feedback are beneficial, although long-term maintenance of changes remains a challenge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. Hamel, LM., Robbins, LB.[2018]

Fourth grade students who participated in the Squire's Quest! intervention increased their fruit, juice, and vegetable consumption by an average of 1.0 serving per day compared to those in the control group.

The intervention specifically led to significant increases in fruit and 100% fruit juice consumption during snacks and regular vegetable intake at lunch, indicating that targeted meal times can effectively promote healthier eating habits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Squire's Quest: intervention changes occurred at lunch and snack meals. Cullen, KW., Watson, K., Baranowski, T., et al.[2015]

Gamification interventions significantly improved children's nutritional knowledge and increased their consumption of fruits and vegetables, as shown in a systematic review of 23 randomized controlled trials.

However, these interventions did not lead to significant changes in body mass index z-scores, indicating that while gamification can enhance knowledge and habits, it may not directly impact weight outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis. Suleiman-Martos, N., García-Lara, RA., Martos-Cabrera, MB., et al.[2021]

A gamification approach in a school-based intervention involving 180 students led to a significant increase in fruit consumption by 66% and vegetable consumption by 44% over 13 school days, demonstrating its effectiveness in promoting healthier eating habits.

Teachers found the intervention practical and enjoyable for students, and parents reported that their children were more willing to try new fruits and vegetables at home, indicating a positive impact beyond the school environment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gamification of dietary decision-making in an elementary-school cafeteria. Jones, BA., Madden, GJ., Wengreen, HJ., et al.[2022]

The study involved 120 children aged 8-13 years who used both the ASA24 and an interviewer-administered recall to assess nutrient intake, showing that child-friendly adaptations to the ASA24 did not significantly alter mean nutrient estimates.

However, the self-administered methods (ASA24 and its child-friendly version) reported significantly higher daily totals for total sugar and vitamin C compared to the interviewer-administered method, suggesting a need to review how dietary information is collected for these nutrients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Simulated adaptations to an adult dietary self-report tool to accommodate children: impact on nutrient estimates. Douglass, D., Islam, N., Baranowski, J., et al.[2021]

Untrained individuals can accurately rate the diet quality of food photos using the Traffic Light Diet (TLD) approach, achieving over 75% accuracy in categorizing foods as red, yellow, or green.

Crowdsourcing feedback from a relatively small number of participants (as few as 15) can provide reliable diet quality ratings, suggesting that this method could effectively reduce the burden of dietary self-monitoring.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Crowdsourcing for self-monitoring: Using the Traffic Light Diet and crowdsourcing to provide dietary feedback. Turner-McGrievy, GM., Wilcox, S., Kaczynski, AT., et al.[2022]

INTAKE24 is an innovative online tool designed for dietary recall that significantly improved user experience and efficiency, reducing the time to complete a dietary recall by nearly half through iterative user feedback from 80 participants aged 11-24.

The tool's design enhancements, such as a simplified interface and improved search functionality, led to better agreement with traditional interviewer-led dietary recalls, indicating its potential effectiveness for large-scale dietary data collection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Iterative Development of an Online Dietary Recall Tool: INTAKE24. Simpson, E., Bradley, J., Poliakov, I., et al.[2022]

The FIT Game, a no-cost intervention implemented in four elementary schools, significantly increased children's consumption of fruits and vegetables (FV) during an 8-week period, with notable improvements in vegetable and fruit intake and skin carotenoid levels.

These increases in FV consumption were not only significant at the end of the intervention but were also maintained three months later, indicating lasting positive effects without harming children's intrinsic motivation to eat healthily.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial Evaluating the FIT Game's Efficacy in Increasing Fruit and Vegetable Consumption. Wengreen, HJ., Joyner, D., Kimball, SS., et al.[2021]

The Food Game intervention successfully engaged high school students in Northern Italy through gamification, promoting peer-led activities and competition, although it did not significantly change adherence to the Mediterranean diet.

While there was no notable improvement in dietary adherence, students showed increased pro-environmental behaviors and positive attitudes towards healthy eating, suggesting the program's potential as a motivational strategy for promoting healthier lifestyles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Process Evaluation of Food Game: A Gamified School-Based Intervention to Promote Healthier and More Sustainable Dietary Choices. Aresi, G., Giampaolo, M., Chiavegatti, B., et al.[2023]

The study introduces an AI-based app called FRANI, designed to improve dietary data collection and food choices among adolescents in Ghana and Vietnam, addressing the challenges of unhealthy diets in developing countries.

In a pilot study involving 72 adolescents (36 from each country), FRANI's feasibility, acceptability, and usability will be assessed over six weeks, with the potential to enhance nutrition quality and inform future larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring adherence, acceptability and likability of an artificial-intelligence-based, gamified phone application to improve the quality of dietary choices of adolescents in Ghana and Vietnam: Protocol of a randomized controlled pilot test. Braga, BC., Arrieta, A., Bannerman, B., et al.[2022]

A study involving 32 young adults revealed that a gamified smartphone app could effectively promote vegetable intake, with participants favoring features like visual guides for tracking vegetable quantities and a simple user interface.

Social media strategies that include appealing food pictures and relatable 'Gen Y' language were found to be the most motivating, suggesting that engaging and visually attractive content is key to encouraging healthier eating habits among young adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring young adult perspectives on the use of gamification and social media in a smartphone platform for improving vegetable intake. Nour, MM., Rouf, AS., Allman-Farinelli, M.[2018]

References

1. Canada pubmed.ncbi.nlm.nih.gov

Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. [2018]

3. England pubmed.ncbi.nlm.nih.gov

Squire's Quest: intervention changes occurred at lunch and snack meals. [2015]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Gamification of dietary decision-making in an elementary-school cafeteria. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Simulated adaptations to an adult dietary self-report tool to accommodate children: impact on nutrient estimates. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Crowdsourcing for self-monitoring: Using the Traffic Light Diet and crowdsourcing to provide dietary feedback. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Iterative Development of an Online Dietary Recall Tool: INTAKE24. [2022]

9. Switzerland pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial Evaluating the FIT Game's Efficacy in Increasing Fruit and Vegetable Consumption. [2021]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Process Evaluation of Food Game: A Gamified School-Based Intervention to Promote Healthier and More Sustainable Dietary Choices. [2023]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Measuring adherence, acceptability and likability of an artificial-intelligence-based, gamified phone application to improve the quality of dietary choices of adolescents in Ghana and Vietnam: Protocol of a randomized controlled pilot test. [2022]

12. England pubmed.ncbi.nlm.nih.gov

Exploring young adult perspectives on the use of gamification and social media in a smartphone platform for improving vegetable intake. [2018]