Acceptability and Applicability of an American Health Videogame with Story for Childhood Obesity Prevention Among Hong Kong Chinese Children.

OBJECTIVE Positive changes in diet have been observed in research carried out in the United States from the use of "Escape from Diab" (Diab), a health videogame designed to lower the risk of obesity and type 2 diabetes. Whether the American story and characters in Diab might be perceived by Hong Kong Chinese children as interesting has not been explored. This study assessed the acceptability and applicability of Diab among Hong Kong Chinese children, whether the Diab story was understood by them, and whether it had potential to influence them both during the game and afterward. SUBJECTS AND METHODS Thirty-four students (21 males, 13 females) 9-12 years of age were included. Upon completion of all the Diab episodes, children completed an immersion scale with 18 items, as well as an individual interview with 10 open-ended questions. RESULTS Children achieved average immersion after playing Diab with the mean score at 39.1 (standard deviation = 9.0), higher than the median (36) of possible scores (range, 18-54). Four themes using framework analysis emerged from the interviews, including intuitive feelings about the interface, playing experience, perception of the effect of Diab on behavior change, and the applicability of Diab to Hong Kong children. The story and game developed for American children were found acceptable and applicable to Hong Kong Chinese children. CONCLUSIONS The combination of quantitative and qualitative methods confirmed the acceptability and applicability of Diab to Hong Kong Chinese children.

[1]  A. Bandura Social cognitive theory of self-regulation☆ , 1991 .

[2]  W. Maziak,et al.  Childhood obesity: are we missing the big picture? , 2007, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[3]  Katherine E. Buckley,et al.  Violent video game effects on children and adolescents. A review of the literature. , 2005, Minerva pediatrica.

[4]  K. Flegal,et al.  Prevalence of Childhood and Adult Obesity in the United States, 2011–2012 , 2014 .

[5]  Janice Baranowski,et al.  Squire's Quest! Dietary outcome evaluation of a multimedia game. , 2003, American journal of preventive medicine.

[6]  S. Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[7]  P. Gollwitzer Implementation intentions: Strong effects of simple plans. , 1999 .

[8]  K. Malterud Qualitative research: standards, challenges, and guidelines , 2001, The Lancet.

[9]  A. Prentice The emerging epidemic of obesity in developing countries. , 2006, International journal of epidemiology.

[10]  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 .

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

[12]  Julia A. Ello-Martin,et al.  What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management? , 2004, Nutrition reviews.

[13]  Janice Baranowski,et al.  Child Goal Setting of Dietary and Physical Activity in a Serious Videogame. , 2013, Games for health journal.

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

[15]  J. Skelton,et al.  Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. , 2014, JAMA pediatrics.

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

[17]  E. Biddiss,et al.  Active video games to promote physical activity in children and youth: a systematic review. , 2010, Archives of pediatrics & adolescent medicine.

[18]  C. Tsang,et al.  Youth risk behaviour in a Chinese population: a territory-wide youth risk behavioural surveillance in Hong Kong. , 2004, Public health.

[19]  T. Cole,et al.  Establishing a standard definition for child overweight and obesity worldwide: international survey , 2000, BMJ : British Medical Journal.

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

[21]  David S. Miall Experiencing narrative worlds: On the psychological activities of reading , 2000 .

[22]  D. Jolliffe,et al.  Extent of overweight among US children and adolescents from 1971 to 2000 , 2004, International Journal of Obesity.

[23]  Tian-jiao Chen,et al.  Empirical changes in the prevalence of overweight and obesity among Chinese students from 1985 to 2010 and corresponding preventive strategies. , 2013, Biomedical and environmental sciences : BES.

[24]  B. Popkin,et al.  Impact of water intake on energy intake and weight status: a systematic review. , 2010, Nutrition reviews.

[25]  Jim Bizzocchi Games and Narrative: An Analytical Framework , 2007 .

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

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

[28]  Femida Gwadry-Sridhar,et al.  Moving Beyond the Stigma: Systematic Review of Video Games and Their Potential to Combat Obesity , 2011, International journal of hypertension.

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

[30]  S. J. Fang,et al.  Final summary report , 1992 .

[31]  N. Bradburn,et al.  An Investigation of Interview Method, Threat and Response Distortion , 1976 .

[32]  A. McMahan Immersion, Engagement, and Presence: A Method for Analyzing 3-D Video Games , 2013 .

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

[34]  Deborah I Thompson,et al.  Playing for real: video games and stories for health-related behavior change. , 2008, American journal of preventive medicine.

[35]  D. Ziedonis,et al.  Addressing Tobacco Through Organizational Change in a Hospital-Based Mental Health Center in China: The Intervention and Lessons Learned in a Pilot Implementation Project , 2012 .

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

[37]  M. Ho,et al.  Maternal influences on fruit and vegetable consumption of schoolchildren: case study in Hong Kong. , 2009, Maternal & child nutrition.

[38]  C. Cheung,et al.  Reducing youth's drug abuse through training social workers for cognitive–behavioral integrated treatment , 2013 .