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Title: Creating action plans in a serious video game increases and maintains child fruit-vegetable intake: A randomized controlled trial

Author
item Thompson, Deborah - Debbe
item BHATT, RIDDHI - Baylor College Of Medicine
item VAZQUEZ, ISABEL - Children'S Nutrition Research Center (CNRC)
item CULLEN, KAREN - Children'S Nutrition Research Center (CNRC)
item BARANOWSKI, JANICE - Children'S Nutrition Research Center (CNRC)
item BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC)
item LIU, YAN - Children'S Nutrition Research Center (CNRC)

Submitted to: International Journal of Behavioral Nutrition and Physical Activity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/6/2015
Publication Date: 3/18/2015
Citation: Thompson, D.J., Bhatt, R., Vazquez, I., Cullen, K.W., Baranowski, J., Baranowski, T., Liu, Y. 2015. Creating action plans in a serious video game increases and maintains child fruit-vegetable intake: A randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 12:39.

Interpretive Summary: Child fruit and vegetable intake is below recommended levels, which increases their risk of developing chronic disease. Interventions to increase their intake have had mixed effects. Therefore, different approaches are needed. Videogames are emerging as an effective way to change behavior. Effectiveness may be enhanced by helping children create plans as part of goal setting. A 10-episode, online videogame to increase fruit and vegetable intake in 4th and 5th graders was developed and tested.Children who participated in the group that created action plans increased and maintained fruit and vegetable intake. Videogames that include action plans as part of goal setting may be an effective way to help children increase their fruit and vegetable intake.

Technical Abstract: Child fruit and vegetable intake is below recommended levels, increasing risk for chronic disease. Interventions to influence fruit and vegetable intake among youth have had mixed effects. Innovative, theory-driven interventions are needed. Goal setting, enhanced by implementation intentions (i.e., plans tightly connected to a behavioral goal), may offer a solution. Action plans state "how" a goal will be achieved, while coping plans identify a potential barrier and corresponding solution. The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode, theoretically-grounded serious videogame promoting fruit and vegetables. This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children. A four-group randomized design with three data collection periods (baseline, immediate post-intervention, 3 months post-intervention) was employed. Groups varied on whether children created an implementation intention (none, action, coping, both) as part of goal setting. Participants were 4th and 5th grade children (approximately 9-11 years old) and one parent. An a priori power analysis indicated this would provide >80% power to detect a small effect (Cohen's d = 0.17). Children played a 10-episode online videogame; parents received 10 electronic newsletters and access to a parent-only website. The primary outcome was child fruit and vegetable intake, assessed via three, dietitian-assisted telephone recalls at each data collection period. The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure. Secondary analyses examined intervention effects on fruit and vegetables separately. Four hundred parent/child dyads were recruited. A significant group-by-time interaction for fruit and vegetable intake (p < 0.001) was found in only the Action group, which had significant increases in fruit and vegetable intake at post 1 (p < 0.0001) and post 2 (p < 0.0001). No other significant interactions were observed; however, there were significant time effects for fruit (p < 0.0001). Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children. Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children.