Story Immersion May Be Effective in Promoting Diet and Physical Activity in Chinese Children

Objective: To evaluate the effect of playing a health video game embedded with story immersion, Escape from Diab (Diab), on children's diet and physical activity (PA) and to explore whether children immersed in Diab had greater positive outcomes. Design: Two groups, nonrandomized; 3 outcome assessments: at baseline, immediately after the game (post 1), and 8–10 weeks after the game (post 2). Participants: A total of 179 Chinese children aged 8–12 years. Intervention: The treatment group played Diab; the control group received no intervention. Main Outcome Measures: Motivation; self‐efficacy; preference for fruit, vegetables, water, and PA; as well as PA behavior. Analysis: Adjusted changes to post 1 and post 2 by ANCOVA controlling for demographic and baseline variables. Results: Children who played Diab had increased intrinsic motivation for fruit and water, self‐efficacy for PA, and self‐reported PA scores at post 1 (all P < .05). Children with higher immersion scores (above the median) had increased intrinsic motivation for fruit and water, and autonomous and controlled motivation for PA at post 1 (all P < .05). However, these were not significant at post 2. Conclusions and Implications: Diab provides a promising innovative medium for promoting Chinese children's psychological correlates of diet and PA and PA behavior. However, its maintenance of effectiveness needs to be enhanced and mechanisms of change need to be investigated more thoroughly.

[1]  T. Baranowski,et al.  Development and evaluation of a school intervention to increase fruit and vegetable consumption among 4th and 5th grade students , 1993 .

[2]  Tom Baranowski,et al.  Acceptability and Applicability of an American Health Videogame with Story for Childhood Obesity Prevention Among Hong Kong Chinese Children. , 2015, Games for health journal.

[3]  G. Ayala,et al.  Theories and intervention approaches to health-behavior change in primary care. , 1999, American journal of preventive medicine.

[4]  Miguel de Aguilera,et al.  Video games and education: (Education in the Face of a “Parallel School”) , 2003, CIE.

[5]  S. Zyzanski,et al.  Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy. , 1991, Social science & medicine.

[6]  Dale H. Schunk,et al.  Vicarious Influences on Self-Efficacy for Cognitive Skill Learning , 1986 .

[7]  Joel Epstein,et al.  The Impact of a Science Education Game on Students’ Learning and Perception of Inhalants as Body Pollutants , 2011, Journal of science education and technology.

[8]  Chris Dede,et al.  The Evolution of Constructivist Learning Environments : Immersion in Distributed , Virtual Worlds , 1995 .

[9]  H A Feldman,et al.  Validation of interviewer- and self-administered physical activity checklists for fifth grade students. , 1996, Medicine and science in sports and exercise.

[10]  R. Mcmurray,et al.  Calibration of two objective measures of physical activity for children , 2008, Journal of sports sciences.

[11]  E. A. Locke.  Social Foundations of Thought and Action: A Social-Cognitive View , 1987 .

[12]  Tom Baranowski,et al.  Self efficacy for fruit, vegetable and water intakes: Expanded and abbreviated scales from item response modeling analyses , 2010, The international journal of behavioral nutrition and physical activity.

[13]  E. Burnstein,et al.  Similarity to a model and self-evaluation. , 1961, Journal of abnormal and social psychology.

[14]  John Wong,et al.  Meta-analysis: The Effect of Dietary Counseling for Weight Loss , 2007, Annals of Internal Medicine.

[15]  W. van Mechelen,et al.  Clinimetric review of motion sensors in children and adolescents. , 2006, Journal of clinical epidemiology.

[16]  Charles E Matthews,et al.  The effect of social desirability and social approval on self-reports of physical activity. , 2005, American journal of epidemiology.

[17]  Mark D. Griffiths,et al.  Game Transfer Phenomena in Video Game Playing: A Qualitative Interview Study , 2011, Int. J. Cyber Behav. Psychol. Learn..

[18]  Margaret E. Beier,et al.  Teaching the Biological Consequences of Alcohol Abuse through an Online Game: Impacts among Secondary Students , 2012, CBE life sciences education.

[19]  T. Baranowski,et al.  Video game play, child diet, and physical activity behavior change a randomized clinical trial. , 2011, American journal of preventive medicine.

[20]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychology Review.

[21]  T. Brock,et al.  Journal of Personality and Social Psychology the Role of Transportation in the Persuasiveness of Public Narratives Text Quality Individual Differences and Situational Influences Transportation Scale Items Gender Differences Discriminant Validation: Need for Cognition Effect of Text Manipulation Beli , 2022 .

[22]  Jim Bizzochi.  Games and Narrative: An Analytical Framework , 2007 .

[23]  Michael Zyda,et al.  From visual simulation to virtual reality to games , 2005, Computer.

[24]  Deborah I Thompson,et al.  Development of new physical activity and sedentary behavior change self-efficacy questionnaires using item response modeling , 2009, The international journal of behavioral nutrition and physical activity.

[25]  R. Ryan,et al.  Self-determination theory , 2015 .

[26]  Tom Baranowski,et al.  Are current health behavioral change models helpful in guiding prevention of weight gain efforts? , 2003, Obesity research.

[27]  Janice Baranowski,et al.  Story Immersion in a Health Videogame for Childhood Obesity Prevention. , 2012, Games for health journal.

[28]  Deborah I Thompson,et al.  Serious Video Games for Health: How Behavioral Science Guided the Development of a Serious Video Game , 2010, Simulation & gaming.

[29]  W. Fisher.  The Narrative Paradigm: in the Beginning , 1984 .

[30]  William R. Watson,et al.  A case study of the in-class use of a video game for teaching high school history , 2011, Comput. Educ..

[31]  W. Dietz,et al.  Relation of childhood height to obesity among adults: the Bogalusa Heart Study . , 2002, Pediatrics.

[32]  T. Baranowski,et al.  Validation of the Physical Activity Questionnaire for Older Children (PAQ-C) among Chinese Children. , 2016, Biomedical and environmental sciences : BES.

[33]  Deborah I Thompson,et al.  What Serious Video Games Can Offer Child Obesity Prevention , 2014, JMIR serious games.

[34]  Franziska Marquart,et al.  Communication and persuasion : central and peripheral routes to attitude change , 1988 .

[35]  Melanie C. Green,et al.  Transportation Into Narrative Worlds: The Role of Prior Knowledge and Perceived Realism , 2004 .

[36]  D. Mozaffarian,et al.  The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors , 2009, PLoS medicine.

[37]  E. Deci,et al.  Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. , 2000, The American psychologist.

[38]  R R Wing,et al.  Long-term maintenance of weight loss: current status. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[39]  Doug A. Bowman,et al.  Virtual Reality: How Much Immersion Is Enough? , 2007, Computer.

[40]  Ralf Schwarzer,et al.  Modelando el cambio en el comportamiento de salud: Cómo predecir y modificar la adopción y el mantenimiento de comportamientos de salud/Modeling Health Behavior Change: How to Predict and Modify the Adoption and Maintenance of Health Behaviors , 2009 .

[41]  Kevin Durkin,et al.  Videogames and Young People with Developmental Disorders , 2010 .

[42]  C. Reynolds,et al.  National normative and reliability data for the revised Children's Manifest Anxiety Scale. , 1983 .

[43]  J. Sallis,et al.  Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. , 2009, Nutrition reviews.

[44]  R. Schwarzer,et al.  Bridging the intention–behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise , 2005 .

[45]  Patty Kostkova,et al.  Computer games to teach hygiene: an evaluation of the e-Bug junior game. , 2011, The Journal of antimicrobial chemotherapy.