Pediatrics

NIDDK NATIONAL INSTITUTE OF

DIABETES AND

DIGESTIVE

AND KIDNEY DISEASES

NATIONAL INSTITUTE

OF HEALTH

Eunice Kennedy Shriver

NICH

D

HP Live - Webinar May 17, 2013 – 11:00 am CDT

Professor of Pediatrics (Behavioral Nutrition & PA)

USDA/ARS Children’s Nutrition Research Center

Baylor College of Medicine

Houston, Texas, 77030, USA

www.bcm.edu/cnrc/faculty/?PMID=9519

Games for Health

with

Tom Baranowski, PhD

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Chronic Illnesses/Obesity Treatment • Regimen Adherence has been low

– often 50% or less

Chronic Illnesses/Obesity Prevention

• Behavior Change has been small

– if at all

Need alternatives to usual approaches?

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Videogames (Serious VG/VG for Health)

• Have story and interactivity to

engage/immerse/transport players

• Can incorporate behavior change or health

change procedures

• Can incorporate feedback and rewards to

motivate change

• Has “fun” to maintain game play

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

“Playing for Real” (Baranowski et al AJPM 2008)

• All 28 games reviewed showed evidence of

change in the desired direction

• We have developed and evaluated several

games for health

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Diab Trailer

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Preliminary Process Model of

Behavior Change from Games

Demographics

Pregame Characteristics

Motivation to Play Video Game

Psy

ch

oso

cia

l V

ari

ab

les:

Motivation to Continue Playing Game

Exposure to Video Game

Immersion

Succ

ess

?

Fun

? Practical Knowledge of Behavior for Change

Behavior Change Skill Development

Behavioral Self Control Skill Development - Include Asking

Motivation to Change Behavior

Physical Resources

Barriers to Change

Behavior Change Attempts

Continued Behavior Change Attempts

Habit Success

Fun

?

Challenging Success

…Time…

Home Accessibility/Availability

Attention to Video Game Activities

Central Processing

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Model Incorporates Elements of:

• Self Determination Theory

• Elaboration Likelihood Model

• Social Cognitive Theory

• Transportation Theory (Immersion)

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Process Model of Possible Mechanisms for Children’s Dietary and Physical Activity Change in Video Games

Demographics

Pregame Characteristics

Motivation to Play Video Game

Psy

ch

oso

cial V

ari

ab

les:

Game Activities:

Motivation to Continue Playing Game

Exposure to Video Game

Immersion

Attention to Video Game Activities

Succ

ess

?

Fun

?

Practical Knowledge of Behavior for Change

Story -Modeling Behavior -Modeling Overcoming Barriers - Moral of Story

Behavior Change Skill Development

Behavioral Self Control Skill Development - Include Asking

Simulation with Feedback

Motivation to Change Behavior

Self Control Activities -Goal Setting • action • coping -Problem Solving -Automation

Physical Resources

Barriers to Change

Behavioral Innoculation Procedures

Behavior Change Attempts

Tailored Motivational Messages -Outcome Expectancy -Values/Reasons

Continued Behavior Change Attempts

Habit Success

Knowledge Games

Fun

? Challenging

Success

Central Processing

…Time…

Home Accessibility/Availability

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Squire’s Quest!

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Squire’s Quest! Evaluation Design

• 1600 4th grade students in 26 schools

• Cluster randomized trial

• Pre & post assessment

• Multiple 24hour recalls – FIRSSt

• Treatment: SQ!; no intervention control

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Squire’s Quest! Outcomes

• Increased FV intake by 0.9 servings

• Changes occurred at snacks (fruit), lunch (vegetable)

– Need more work on breakfast, dinner

• Attain recipe prep goals → more FV consumption

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

GEMS – Fun Food & Fitness

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Boy Scout 5-A-Day & FFL Badges

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Fit For Life Boy Scout Badge Program (R Jago et al Prev Med 2006)

• Meeting + internet based

– Skill building

– Comic character modeling + goal setting

• Spring intervention

– + 12 minutes LPA

– - 12 minutes SB

• Not fall intervention (?)

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Escape from Diab

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Nanoswarm: Invasion from Inner Space

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Diab/Nanoswarm Outcomes

• + 1.0/+0.67 FV serving at 2 months post

(p<0.000)

• + 7/0 min MVPA at immediate post (p=0.107)

• No differences in BMI or mediators

• No moderators

• 80-90% enjoyed playing Diab/Nano

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Active Video games – Wii Study

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Active Video Games – Wii Study Design

l Stratified by mother reported neighborhood safety (not working)

l 7 days accelerometer readings at 5 times

l Children keep Wii console if provide complete data

l No differences across groups or time

l 700+ media releases around the world

AV1 AV2

Mid Baseline (wk 1)

Wk 6 Wk 6

Post

R

E

C

R

U

I

T

M

E

N

T

Wk 1 Wk 1

Wk 1 Wk 1 Wk 6 Wk 6 IV1 IV2

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Parenting Game

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Innovative: V Parenting Game

• “Train” Parents → Effective V Parenting Practices

• Simulation with feed back → learn to fly planes

• Simulate interaction with child with feedback

– Child resistant to V intake

– Parent offered parenting practice options at interaction points

• 2 effective; 2 ineffective

• Keep selecting until select effective

• See child response

– Algorithm governs interaction

– Tailor child responses to child temperament

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Future Research Needs

• Just learning how to capitalize on VG

• Vary VG intervention procedures

• Vary story components to assess how story

influences immersion and attention to game

components

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Future Research Needs

• Fun = IM?

– Active involvement (interactivity)?

– Overcoming challenges

– Making choices

– Observing consequences without real threat

– Increasing difficulty

– Personally relevant story & characters in meaningful situations

• How can we maximize “fun” to maximize health behavior change?

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Games for Health Journal Research, Development and Clinical Applications

• Only journal devoted to Games for Health

• Editorial Board

– international

– health industry

– academic

– game industry

– Government

• June 2013: Volume 2, Issue 3 (6 issues/year)

– Special issue devoted to Games and Childhood Obesity

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

Recent Topics

• Reviews of the effectiveness of games for health

• Innovative game components, e.g. computational intelligence

• Business models for G4H

• Exergame effectiveness among seniors, physically challenged

• Games to enhance mental health

• Game design issues to enhance health behavior change

• Health professional training games

Games for Health

HP Live – Webinar

May 17, 2013 – 11:00am CDT

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