Using a gamified monitoring app to change adolescents' snack intake: the development of the REWARD app and evaluation design

W Van Lippevelde, J Vangeel, N De Cock, C Lachat, L Goossens, K Beullens, L Vervoort, C Braet, L Maes, S Eggermont, B Deforche, J Van Camp, W Van Lippevelde, J Vangeel, N De Cock, C Lachat, L Goossens, K Beullens, L Vervoort, C Braet, L Maes, S Eggermont, B Deforche, J Van Camp

Abstract

Background: As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds.

Methods: The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents.

Discussion: When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs).

Trial registration: NCT02622165 registrated November 15, 2015 on clinicaltrials.gov.

Keywords: Adolescents; App; Conditioning; Diet; Dual-system model; Intervention; Learning theories; Nutrition; Obesity; Overweight; Snacks; mHealth.

Figures

Fig. 1
Fig. 1
An overview of the theoretical framework of the intervention including the determinants, theoretical methods/behavioral change strategies, and practical applications

References

    1. Diethelm K, Janckovic N, Moreno LA, Huybrechts I, De Henauw S, De Vriendt T, Gonzales-Gross M, Leclercq C, Gotrand F, Gilbert CC, the HELENA group Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2012;15:386–98. doi: 10.1017/S1368980011001935.
    1. Duffey KJ, Huybrechts I, Mouratidou T, Libuda L, Kersting M, De Vriendt T, Gottrand F, Widhalm K, Dallongeville J, Hallstrom L, the HELENA group Beverage consumption among European adolescents in the HELENA study. Eur J Clin Nutr. 2012;66:244–52. doi: 10.1038/ejcn.2011.166.
    1. Vereecken CA, De Henauw S, Maes L. Adolescents’ food habits: results of the health behavior in school-aged children survey. Br J Nutr. 2005;94(3):423–31. doi: 10.1079/BJN20051513.
    1. Matthys C, De Henauw S, Devos C, De Backer G. Estimated energy intake, macronutrient intake and meal pattern of Flemish adolescents. Eur J Clin Nutr. 2003;57:366–75. doi: 10.1038/sj.ejcn.1601533.
    1. De Cock N, Van Lippevelde W, Vervoort L, Vangeel J, Maes L, Eggermont S, Braet C, Lachat C, Huybregts L, Goossens L, Beullens K, Kolsteren P, Van Camp J. Sensitivity to reward is associated with snack and sugar-sweetened beverage consumption in adolescents. Eur J Nutr. 2015.
    1. Nicklaus S, Remy E. Early origins of overeating: tracking between early food habits and later eating patterns. Curr Obes Rep. 2013;2:179–84. doi: 10.1007/s13679-013-0055-x.
    1. World Health Organization. Report of the World Health Organization Study Group. Diet, Nutrition and the prevention of chronic diseases; 2008. Accessed May 12, 2014. Available from: . Accessed 2 Aug 2016.
    1. Gopinath B, Louie JCY, Flood VM, Burlutsky G, Hardy LL, Baur LA, Mitchell P. Influence of obesogenic behaviors on health-related quality of life in adolescents. Asia Pac J Clin Nutr. 2014;23:121–7.
    1. Kolbe L, Story M. Preventing childhood obesity. Washington, DC: National Academies Press; 2005.
    1. Crosby RA, Kegler MC, DiClemente RJ. Understanding and applying theory in health promotion practice and research. In: DiClemente RJ, Crosby RA, Kegler MC, editors. Emerging theories in health promotion practice and research: strategies for improving the public health. San Francisco: Josey-Bass; 2002.
    1. Kremers SPJ, de Bruyn G-J, Visscher TLS, van Mechelen W, de Vries NK, Brug J. Environmental influences on energy balance-related behaviors: a dual-process view. Int J Behav Nutr Phys Act. 2006;3:9. doi: 10.1186/1479-5868-3-9.
    1. De Bourdeaudhuij I, Van Cauwenberghe E, Spittaels H, Oppert J-M, Rostami C, Brug J, Van Lenthe F, Lobstein T, Maes L. School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obes Rev. 2010;12:205–16. doi: 10.1111/j.1467-789X.2009.00711.x.
    1. Van Cauwenberghe E, Maes L, Spittaels H, van Lenthe FJ, Brug J, Oppert JM, De Bourdeaudhuij I. Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and ‘grey’ literature. Br J Nutr. 2010;103(6):781–97. doi: 10.1017/S0007114509993370.
    1. Stice E, Shaw H, Marti CN. A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work. Psychol Bull. 2006;132(5):667–91. doi: 10.1037/0033-2909.132.5.667.
    1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701. doi: 10.1037/a0016136.
    1. Carver CS, Scheier MF. Control theory: a useful conceptual framework for personality -social, clinical, and health psychology. Psychol Bull. 1982;92:111–35. doi: 10.1037/0033-2909.92.1.111.
    1. Michie S, Hardeman W, Fanshawe T, Prevost T, Taylor L, Kinmonth AL. Investigating theoretical explanations for behavior change: the case study of ProActive. Psychol Health. 2008;23(1):25–39. doi: 10.1080/08870440701670588.
    1. Berridge KC. Food reward: brain substrates of wanting and liking. Neurosci Biobehav Rev. 1996;20:1–25. doi: 10.1016/0149-7634(95)00033-B.
    1. Sclafani A. Oral and postoral determinants of food reward. Physiol Behav. 2004;81(5):773–9. doi: 10.1016/j.physbeh.2004.04.031.
    1. Davis C, Strachan S, Berkson M. Sensitivity to reward: implications for overeating and overweight. Appetite. 2004;42:131–8. doi: 10.1016/j.appet.2003.07.004.
    1. Verbeken S, Braet C, Lammertyn J, Goossens L, Moens E. How is reward sensitivity related to bodyweight in children? Appetite. 2012;58:478–83. doi: 10.1016/j.appet.2011.11.018.
    1. De Decker A, Sioen I, Verbeken S, Braet C, Michels N, De Henauw S. Associations of reward sensitivity with food consumption, activity pattern, and BMI in children. Appetite. 2016;100:189–96. doi: 10.1016/j.appet.2016.02.028.
    1. Hardin M, Ernst M. Functional brain imaging of development‐related risk and vulnerability for substance use in adolescents. J Addict Med. 2009;3:47–54. doi: 10.1097/ADM.0b013e31819ca788.
    1. Deutsch R, Strack F. Duality in models in social psychology: from dual processes to interacting systems. Psychol Inq. 2006;17:166–72. doi: 10.1207/s15327965pli1703_2.
    1. Moskowitz GB, Skurnik I, Galinski AD. Dual process theories in social psychology. New York: Guilford Press; 1999. The history of dual-process notions, and the future of preconscious control; pp. 12–36.
    1. Bargh JA, Chartrand TL. The unbearable automaticity of being. Am Psychol. 1999;54:462–79. doi: 10.1037/0003-066X.54.7.462.
    1. Haddon L, Livingstone S. EU Kids Online: National perspectives. Online report accessed on June 2016 at .
    1. DiFilippo KN, Huang WH, Andrade JE, Chapman-Novakofski KM. The use of mobile apps to improve nutrition outcomes: a systematic literature review. J Telemed Telecare. 2015;21(5):243–53. doi: 10.1177/1357633X15572203.
    1. Hieftje K, Edelman EJ, Camenga DR, Fiellin LE. Electronic media-based health interventions promoting behavior change in youth: a systematic review. JAMA Pediatr. 2013;167(6):574–80. doi: 10.1001/jamapediatrics.2013.1095.
    1. Lewis ZH, Lyons EJ, Jarvis JM, Baillargeon J. Using an electronic activity monitor system as an intervention modality: a systematic review. BMC Public Health. 2015;15:585. doi: 10.1186/s12889-015-1947-3.
    1. Tate EB, Spruijt-Metz D, O’Reilly G, Jordan-Marsh M, Gotsis M, Pentz MA, Dunton GF. mHealth approaches to child obesity prevention: successes, unique challenges, and next directions. Transl Behav Med. 2013;3(4):406–15. doi: 10.1007/s13142-013-0222-3.
    1. Konstantopoulos S. The power of the test for treatment effects in three-level cluster randomized designs. J Res Educ Eff. 2008;1:66–88.
    1. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning health promotion programs: an Intervention Mapping Approach. San Francisco: Jossey-Bass; 2006. pp. 8–14.
    1. McClain AD, Chappuis C, Nguyen-Rodriguez ST, Yaroch AL, Spruijt-Metz D. Psychosocial correlates of eating behavior in children and adolescents: a review. Int J Behav Nutr Phys Act. 2009;6(54). doi:10.1186/1479-5868-6-54.
    1. Martens MK, Van Assema P, Brug J. Why do adolescents eat what they eat? Personal and social environmental predictors of fruit, snack and breakfast consumption among 12–14-year-old Dutch students. Public Health Nutr. 2005;8(8):1258–65. doi: 10.1079/PHN2005828.
    1. Pearson N, Ball K, Crawford D. Predictors of changes in adolescents’ consumption of fruits, vegetables and energy-dense snacks. Br J Nutr. 2011;105:795–803. doi: 10.1017/S0007114510004290.
    1. Story M, Neumark- Sztainer D, French S. Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc. 2002;102(3):40–51. doi: 10.1016/S0002-8223(02)90421-9.
    1. Kadzin AE. Acceptability of aversive procedures and medication as treatment alternatives for deviant child behavior. J Abnorm Child Psychol. 1984;12(2):289–301. doi: 10.1007/BF00910669.
    1. NUBEL. The Belgian Food composition table. 5th ed. 2009.
    1. Lobstein T, Davies S. Defining and labelling ‘healthy’ and ‘unhealthy’ food. Public Health Nutr. 2009;12(3):331–40.
    1. Flemish Institute for Health Promotion and Disease prevention. Nutrition guidelines for adolescents. Accessed on 1 June 2016 at .
    1. Petty RE, Cacioppo JT. The elaboration likelihood model of persuasion. In: Berkowits L, editor. Advances in experimental social psychology. New York: Academic Press; 1986. pp. 123–205.
    1. Zajonc RB. Mere exposure: a getaway to subliminal. Curr Dir Psychol Sci. 2001;10:224–8. doi: 10.1111/1467-8721.00154.
    1. Fazio RH. On the automatic activation of associated evaluations: an overview. Cognit Emot. 2001;15:115–41. doi: 10.1080/02699930125908.
    1. Latham GP, Locke EA. New developments in and directions for goal-setting research. Eur Psychol. 2007;12:290–300. doi: 10.1027/1016-9040.12.4.290.
    1. Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: video games and stories for health-related behavior change. Am J Prev Med. 2008;34(1):74–82. doi: 10.1016/j.amepre.2007.09.027.
    1. Dickey M. Engaging by design: how engagement strategies in popular computer and video games can inform instructional design. Educ Technol Res Dev. 2005;53(2):67–83. doi: 10.1007/BF02504866.
    1. Annetta LA. The “I’s” have it: a framework for serious educational game design. Rev Gen Psychol. 2010;14(2):105–12. doi: 10.1037/a0018985.
    1. Baranowski T, Baranowski J, Thompson D, Buday R. Behavioral science in video games for children’s diet and physical activity change: key research needs. J Diabet Sci Technol. 2011;5(2):229–33. doi: 10.1177/193229681100500204.
    1. Peng W, Lin JH, Pfeiffer KA, Winn B. Need satisfaction supportive game features as motivational determinants: an experimental study of a self-determination theory guided exergame. Media Psychol. 2012;15(2):175–96. doi: 10.1080/15213269.2012.673850.
    1. Huybrechts I, Vereecken C, De Bacquer D, Vandevijvere S, Van Oyen H, Maes L, Vanhauwaert E, Temme L, De Backer G, De Henauw S. Reproducibility and validity of a diet quality index for children assessed using a FFQ. Brit J Nutr. 2010;104:135–44. doi: 10.1017/S0007114510000231.
    1. Rodriguez G, Moreno LA. Is dietary intake able to explain differences in body fatness in children and adolescents? Nutr Metab Cardiovasc. 2006;16(4):294–301. doi: 10.1016/j.numecd.2005.08.005.
    1. HELENA study, 2006–2007 accessed at . August 2nd 2016.
    1. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice‐Hall; 1986.
    1. Vereecken C, De Henauw S, Maes L, Moreno L, Manios Y, Phillipp K, Grp HS. Reliability and validity of a healthy diet determinants questionnaire for adolescents. Public Health Nutr. 2009;12(10):1830–8. doi: 10.1017/S1368980008004655.
    1. Gardner B. Habit as automaticity, not frequency. Euro Health Psychologist. 2012;14:32–6.
    1. Verplanken B, Orbell S. Reflections on past behavior: a self-report index of habit strength. J Appl Soc Psychol. 2003;33:1313–30. doi: 10.1111/j.1559-1816.2003.tb01951.x.
    1. Singh AS, Vik FN, Chinapaw MJM, Uijtdewilligen L, Verloigne M, Fernandez-Alvira JM, et al. Test-retest reliability and validity of the ENERGY child questionnaire on energy balance-related behaviors and their potential behavioral determinants: the ENERGY project. Int J Behav Nutr Phys Act. 2011;8:136. doi: 10.1186/1479-5868-8-136.
    1. Hartley JEK, Torsheim R, Currie C, et al. FASIII Development Study Report 2013.
    1. Van Stralen MM, Te Velde SJ, Singh AS, De Bourdeaudhuij I, Martens MM, Van der Sluis M, et al. EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) project: design and methodology of the ENERGY cross-sectional survey. BMC Public Health. 2011;11:65. doi: 10.1186/1471-2458-11-65.
    1. Hamel LM, Robbins LB. Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. J Adv Nurs. 2013;69:16–30. doi: 10.1111/j.1365-2648.2012.06086.x.
    1. Franken IHA, Muris P, Rassin E. Psychometric properties of the Dutch BIS/BAS Scales. J Psychopathol Behav Assess. 2005;27:25–30. doi: 10.1007/s10862-005-3262-2.
    1. Cooper A, Gomez R, Aucote H. The Behavioral Inhibition System and Behavioral Approach System (BIS/BAS) Scales: Measurement and structural invariance across adults and adolescents. Personal Individ Differ. 2007;43:295–305. doi: 10.1016/j.paid.2006.11.023.
    1. Yu R, Branje SJT, Keijsers L, Meeus WHJ. Psychometric characteristics of Carver and White’s BIS/BAS scales in Dutch adolescents and their mothers. J Pers Assess. 2011;93:500–7. doi: 10.1080/00223891.2011.595745.
    1. Muris P, Meesters C, de Kanter E, Timmerman PE. Behavioral inhibition and behavioral activation system scales for children: relationships with Eysenck’s personality traits and psychopathological symptoms. Personal Individ Differ. 2005;38:831–41. doi: 10.1016/j.paid.2004.06.007.
    1. Decaluwé V. Child Eating Disorder Examination-Questionnaire. Dutch translation and adaptation of the Eating Disorder Examination-Questionnaire. In: Fairburn CG, Beglin SJ. 1999.
    1. Goossens L, Braet C. Screening for eating pathology in the pediatric field. Int J Pediatr Obes. 2010;5(6):483–90. doi: 10.3109/17477160903571995.
    1. Decaluwé V, Braet C. Prevalence of binge-eating disorder in obese children and adolescents seeking weight-loss treatment. Int J Obes. 2003;27(3):404–9. doi: 10.1038/sj.ijo.0802233.
    1. Petersen AC, Crockett LJ, Richards MH, Boxer AM. Measuring pubertal status: reliability and validity of a self-report measure. J Youth Adolesc. 1988;7:117–33. doi: 10.1007/BF01537962.
    1. Bolca S, Huybrechts I, Verschraegen M, De Henauw S, Van de Wiele T. Validity and reproducibility of a self-administered semi-quantitative food-frequency questionnaire for estimating usual daily fat, fibre, alcohol, caffeine and theobromine intakes among Belgian post-menopausal women. Int J Environ Res Public Health. 2009;6:121–50. doi: 10.3390/ijerph6010121.
    1. Huybrechts I, De Bacquer D, Matthys C, De Backer G, De Henauw S. Validity and reproducibility of a semi-quantitative food-frequency questionnaire for estimating calcium intake in Belgian preschool children. Br J Nutr. 2006;95:802–16. doi: 10.1079/BJN20051671.
    1. Moreno LA, Rodriguez G. Dietary risk factors for development of childhood obesity. Curr Opin Clin Nur Metab Care. 2007;10:336–41. doi: 10.1097/MCO.0b013e3280a94f59.
    1. Van den Bulck J, Beullens K. Television and music video exposure and adolescent alcohol use while going out. Alcohol Alcohol (Oxford, Oxfordshire) 2005;40(3):249–53. doi: 10.1093/alcalc/agh139.
    1. Tanis M, Jansz J. Annual conference of the ICA, Montreal, Canada. 2008. Gaming for different reasons: What motivates people to play a specific video game.
    1. Vorderer P, Bryant J (Eds). Playing video games: motives, responses, and consequences. New York: Routledge; 2006.
    1. Sherry JL, Lucas K, Greenberg BS, Lachlan K. Video game uses and gratifications as predictors of use and game preference. In: Vorderer P, Bryant J, editors. Playing video games motives responses and consequences. 2006. p. 213–24. Retrieved from . Accessed 2 Aug 2016.
    1. Brockmeyer JH, Fox CM, Curtiss KA, McBroom E, Burkhart KM, Pidruzny JN. The development of the game engagement questionnaire: a measure of engagement in video game-playing. J Exp Soc Psychol. 2009;45(4):624–34. doi: 10.1016/j.jesp.2009.02.016.
    1. Lemmens J, Valkenburg P, Peter J. Development and validation of a game addiction scale for adolescents. Media Psychol. 2009;12(1):77–95. doi: 10.1080/15213260802669458.
    1. King DL, Delfabbro PH, Griffiths MD. The role of structural characteristics in problematic video game play: an empirical study. Int J Ment Heal Addict. 2011;9(3):320–33. doi: 10.1007/s11469-010-9289-y.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever