Type 2 diabetes has increased in prevalence among youth, paralleling the increase in pediatric obesity. Helping youth achieve energy balance by changing diet and physical activity behaviors should decrease the risk for type 2 diabetes and obesity. Goal setting and goal review are critical components of behavior change. Theory-informed video games that emphasize development and refinement of goal setting and goal review skills provide a method for achieving energy balance in an informative, entertaining format. This article reports alpha-testing results of early versions of theory-informed goal setting and reviews components of two diabetes and obesity prevention video games for preadolescents.
Method:
Two episodes each of two video games were alpha tested with 9- to 11-year-old youth from multiple ethnic groups. Alpha testing included observed game play followed by a scripted interview. The staff was trained in observation and interview techniques prior to data collection.
Results:
Although some difficulties were encountered, alpha testers generally understood goal setting and review components and comprehended they were setting personal goals. Although goal setting and review involved multiple steps, youth were generally able to complete them quickly, with minimal difficulty. Few technical issues arose; however, several usability and comprehension problems were identified.
Conclusion:
Theory-informed video games may be an effective medium for promoting youth diabetes and obesity prevention. Alpha testing helps identify problems likely to have a negative effect on functionality, usability, and comprehension during development, thereby providing an opportunity to correct these issues prior to final production.
Fagot-CampagnaAPettittDJEngelgauMMBurrowsNRGeissLSValdezRBecklesGLSaaddineJGreggEWWilliamsonDFNarayanKM.Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. 2000;136 (5): 664–72.
2.
OgdenCLCarrollMDCurtinLRMcDowellMATabakCJFlegalKM.Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295 (13): 1549–55.
3.
HussainAClaussenBRamachandranAWilliamsR.Prevention of type 2 diabetes: a review. Diabetes Res Clin Pract. 2007;76 (3): 317–26.
4.
GoranMITreuthMS.Energy expenditure, physical activity, and obesity in children. Pediatr Clin North Am. 2001 Aug; 48 (4): 931–53.
5.
RollsBDrewnowskiALedikweJ.Changing the energy density of the diet as a strategy for weight management. J Am Diet Assoc. 2005;105: S98–S103.
6.
DomelSBBaranowskiTDavisHThompsonWOLeonardSBRileyPBaranowskiJDudovitzBSmythM.Development and evaluation of a school intervention to increase fruit and vegetable consumption among 4th and 5th grade students. J Nutr Educ. 1993;25: 345–9.
7.
BaranowskiTSmithMHearnMDLinLSBaranowskiJDoyleCResnicowKWangDT.Patterns in children's fruit and vegetable consumption by meal and day of the week. J Am Coll Nutr. 1997;16: 216–23.
8.
FrenchSALinBHGuthrieJF.National trends in soft drink consumption among children and adolescents age 6 to 17 years: prevalence, amounts, and sources, 1977/1978 to 1994/1998. J Am Diet Assoc. 2003;103 (10): 1326–31.
9.
MalikVSSchulzeMBHuFB.Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84 (2): 274–88.
10.
PateRRLongBJHeathG.Descriptive epidemiology of physical activity in adolescents. Pediatr Exerc Sci. 1994;6: 434–47.
11.
JagoRBaranowskiTBaranowskiJCThompsonDGreavesKA.BMI from 3–6 y of age is predicted by TV viewing and physical activity, not diet. Int J Obes (Lond). 2005;29 (6): 557–64.
12.
SallisJFProchaskaJJTaylorWC.A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc. 2000;32 (5): 963–75.
13.
De BourdeaudhuijITeVeldeSBrugJDuePWindMSandvikCMaesLWolfARodrigoCPYngveAThorsdottirIRasmussenMElmadfaIFranchiniBKleppKI.Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries. Eur J Clin Nutr. 2007 May 16 doi:10.1038/sj.ejcn.1602794.
14.
BaumanAESallisJFDzewaltowskiDAOwenN.Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med. 2002;23 (2S): 5–14.
15.
HochbaumGMSorensonJRLorigK.Theory in health education practice. Health Educ Q. 1992;19 (3): 295–313.
16.
BaranowskiTLinLSWetterDWResnicowKHearnMD.Theory as mediating variables: why aren't community interventions working as desired?Ann Epidemiol. 1997;S7: S89–S95.
17.
BanduraA.Social foundations of thought and action: a social cognitive theory. Englewood Cliffs (NJ): Prentice Hall; 1986.
18.
RyanRDeciE.Self determination theory and the facilitation of intrinsic motivation, social development, and well being. Am Psychol. 2000;55: 68–78.
19.
PettyRCacioppoJ.Communication and persuasion: central and peripheral routes to attitude change. New York: Springer-Verlag; 1986.
20.
McGuireW.Resistance to persuasion conferred by active and passive prior refutation of the same and alternative counterarguments. J Abnorm Soc Psychol. 1961;63: 326–32.
21.
BaranowskiTBaranowskiJCullenKWMarshTIslamNZakeriIHoness-MorrealeLdeMoorC.“Squire's Quest!” Dietary outcome evaluation of a multimedia game. Am J Prev Med. 2003;24: 52–61.
22.
ThompsonDBaranowskiJCullenKBaranowskiT.Development of a theory-based Internet program promoting maintenance of diet and physical activity change to 8 year old African American girls. Comput Educ. 2007;48 (3): 446–59.
23.
BaranowskiTDavisMResnicowKBaranowskiJDoyleCLinLSSmithMWangDT.Gimme 5 fruit and vegetables for fun and health: outcome evaluation. Health Educ Behav. 2000;27 (1): 96–111.
24.
BaranowskiTBaranowskiJCullenKWdeMoorCRittenberryLHebertDJonesL.5 a day Achievement Badge for African-American Boy Scouts: pilot outcome results. Preventive Medicine, 2002;34: 353–363.
25.
JagoRBaranowskiTBaranowskiJCThompsonDCullenKWWatsonKLiuY.Fit For Life Boy Scout badge: outcome evaluation of a troop and internet intervention. Prev Med. 2006;42: 181–7.
26.
ElderJPLytleLSallisJFYoungDRStecklerASimons-MortonDStoneEJobeJBStevensJLohmanTWebberLPateRSaksvigBIRibislK.A description of the social-ecological framework used in the trial of activity for adolescent girls (TAAG). Health Educ Res. 2007;22 (2): 155–65.
27.
ZimmermanBJ.Self-efficacy: an essential motive to learn. Contemp Educ Psychol. 2000;25: 82–91.
GollwitzerPSheeranP.Implementation intentions and goal achievement: a meta-analysis of effects and processes. Adv Exp Soc Psychol. 2006;38: 69–119.
33.
JanzNKBeckerMH.The health belief model: a decade later. Health Educ Q. 1984;11 (1): 1–47.
34.
LytleLAVarnellSMurrayDMStoryMPerryCBirnbaumASKubikMY.Predicting adolescents' intake of fruit and vegetables. J Nutr Educ Behav. 2003;35: 170–8.
35.
TappeMKDudaJLEhrnwaldPM.Perceived barriers to exercise among adolescents. J Sch Health. 1989;59 (4): 153–5.
36.
AllisonKRDwyerJJMakinS.Perceived barriers to physical activity among high school students. Prev Med. 1999;28: 608–15.
37.
FrauenknechtMBlackD.The social problem solving inventory for adolescents (SPSI-A): a manual for application, interpretation, and psychometric evaluation. Morgantown (WV): PNG Publications; 2003.
38.
RobinsonT.Behavioural treatment of childhood and adolescent obesity. Int J Obes Relat Metab Disord. 1999;23Suppl 2: S52–7.
39.
KroezeWWerkmanABrugJ.A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med. 2006;31: 205–23.
40.
PfauMRoskos-EwoldsenDWoodMYinSChoJLuKHShenL.Attitude accessibility as an alternative explanation for how inoculation confers resistance. Commun Monographs. 2003;70 (1): 39–51.
41.
GillisL.Use of an interactive game to increase food acceptance—a pilot study. Child Care Health Dev. 2003;29 (5): 373–5.
42.
SouthardDRSouthardBH.Promoting physical activity in children with MetaKenkoh. Clin Invest Med. 2006;29 (5): 293–7.
43.
BrownSJLiebermanDAGermenyBAFanYCWilsonDMPastaDJ.Educational video game for juvenile diabetes: results of a controlled trial. Med Inform (Lond). 1997;22 (1): 77–89.
44.
AokiNOhtaSOkadaTOishiMFukuiT.INSULOT: a cellular phone-based edutainment learning tool for children with type 1 diabetes. Diabetes Care. 2005;28 (3): 760.
45.
AokiNOhtaSMasudaHNaitoTSawaiTNishidaKOkadaTOishiMIwasawaYToyomasuKHiraKFukuiT.Edutainment tools for initial education of type-1 diabetes mellitus: initial diabetes education with fun. Medinfo. 2004;11 (Pt 2): 855–9.
MuinMFonteloPLiuFAckermanM.SLIM: an alternative Web interface for MEDLINE/PubMed searches-a preliminary study. BMC Med Inform Decis Mak. 2005;5: 37.
48.
SerranoEAndersonJ.The evaluation of Food Pyramid Games, a bilingual computer nutrition education program for Latino youth. J Fam Consum Sci Educ. 2004;22: 1–16.
49.
Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington: Institute of Medicine of the National Academies; 2005 [cited 2007 Sep 14]. Available from: www.nap.edu/catalog/10490.html.
50.
RothmanA, Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000;19 (1 Suppl): 64–9.
