JMIR Publications

ABSTRACT

Background:

Exergames are novel promising interventions for physical activity (PA) promotion in children due to the attractiveness of the gaming component. Nevertheless, only a few studies have assessed the long term effects of exergames to promote PA. The school-based exergame BOOSTH combines an activity tracker, an online game and a battle which enables competition between groups. As a reward for the performed PA, children can unlock levels in the game. In a previous study on the effectiveness, no positive intervention effects on PA levels and motivation towards PA were detected. In the current study, the implementation of the school-based BOOSTH exergame was evaluated.

Objective:

The aim of the current study was to conduct a mixed method process evaluation of the school-based exergame BOOSTH.

Methods:

Both quantitative and qualitative data were collected from children (n=355), parents (n=122) and teachers (n=28) three- and six months after the start. Data were derived by means of self-administered questionnaires and focus groups (n=7). The following components were evaluated: recruitment, fidelity (quality), dose delivered (completeness), dose received (exposure and satisfaction), reach (participant rate) and context.

Results:

A top-down approach was used for the recruitment of the schools. After the implementation, 85% of the children reported that they logged into the game. After three months 48% of the children still logged into the BOOSTH app which decreased to 29% at six months. Although BOOSTH is an exergame, the activity tracker was mentioned by children as their favorite part of the intervention. Children did not experience group pressure to join friends in playing the game or joining the battle. The majority of children reported that the exergame was easy to use. Lack of instructions, time to support the use of BOOSTH, and technological issues were most frequently mentioned barriers by teachers.

Conclusions:

The school-based exergame BOOSTH is an innovative intervention, however, the implementation was not successful since the majority of the children did not use the game longer than a few weeks. Only delivery of an exergame intervention in a school setting is not sufficient for long-term use. Lessons learned from this study underscore the importance of a flawless technical application, tailored gaming experiences including variations in the game, the value of combining school-based interventions with clear teacher instructions and parental support, and additional activities to foster long-term behavioral change. Clinical Trial: ClinicalTrials.gov, NCT03440580, https://clinicaltrials.gov/ct2/show/NCT03440580.