Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Aug 1, 2019
Date Accepted: Oct 3, 2020
Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Results of a Randomized Controlled Trial
ABSTRACT
Background:
Video and mobile games have been shown to have a positive impact on behavior change in children. However, the mechanisms underlying game play behavior that impact outcomes of interest are yet to be understood.
Objective:
This study investigates the immediate impact of a pediatric virtual reality (VR)-based dietary mobile game on actual and hypothetical food choices, explores children’s heterogeneous game play patterns, and associates them with players’ food choices.
Methods:
We analyzed data from a randomized controlled trial (RCT) involving 104 children, 10-11 years of age, who were randomly assigned to the treatment group (played the mobile game) or the control group (played a board game). Telemetry data, survey data, and observational data were collected for analysis. We first compare actual and hypothetical food choices of treatment and control groups using Mann-Whitney statistical tests. We then model the process of game playing at any level across all students as a discrete, time- homogeneous, first-order Markov chain with multiple states, each representing a key action in the game, to identify distinct patterns in the game sequences. Finally, regression models are used to establish the relationship between game play patterns and behavioral outcomes with actual and hypothetical food choices at the end of the game.
Results:
The treatment group chose significantly more healthy foods, on average, than the control group (T: 2.48; C: 1.10; P<.001). When asked to make hypothetical food choices for drink, savory, and sweet snacks in surveys, students in the treatment group also made significantly better choices than the control group for all three food categories (P<.001, P=.02, P=.08, respectively). Despite high variability in game play patterns, better food choices were consistently associated with more incentive-reactive players who are highly engaged, and either very observant or very active during the game play. Food facts that are read during game play also impact children’s food choices.
Conclusions:
A mobile, VR-based game combining Artificial Intelligence and neuroscience shows a strong, positive impact on children’s food choices immediately following the game. Understanding the association between game play patterns and behavioral outcomes, and related significant factors, has the potential to improve the design and uptake of such novel digital interventions for addressing pediatric obesity challenges. Longitudinal RCTs are needed for generalizability. Clinical Trial: ClinicalTrials.gov NCT04082195
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