challenges Challenges 2015: Half a century of ICT in Education Meio século de TIC na Educação,

Transcription

1 challenges maio may, 2015 Universidade do Minho Braga Portugal ATAS DA IX CONFERÊNCIA INTERNACIONAL DE TIC NA EDUCAÇÃO PROCEEDINGS OF THE IX INTERNATIONAL CONFERENCE ON ICT IN EDUCATION Challenges 2015: Meio século de TIC na Educação, Half a century of ICT in Education (Organizadores) Maria João Gomes António José Osório Luís Valente ISBN: UNIVERSIDADE DO MINHO CENTRO DE COMPETÊNCIA EM TIC NA EDUCAÇÃO BRAGA, PORTUGAL

2 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 42 NUTRIBUDDY AN INTERACTIVE DIGITAL GAME FOR OBESITY PREVENTION IN YOUNGSTERS Paula Boaventura Paulo Fontes Cláudia Azevedo Jaime Fins Guilherme Gomes Rui Leitão Sara Bastos Pedro Graça Luís Cirnes Paula Soares José Azevedo University of Porto, Portugal Abstract: The development of new applications for mobile devices expands the accessibility of health information promoting literacy, especially among young people. Obesity is a major epidemic problem, mostly preventable with adequate food choices and physical activity. Considering that youngsters have a great enthusiasm for new technologies and for recreational activities we are developing an interactive game designed to mobile platforms to improve nutrition literacy. The game prototype has been tested and its design is being improved. To evaluate the game efficacy students will be divided in three groups: one using the game, other attending nutritional activities, and the third without any intervention. Nutritional literacy enhancement and possible nutritional behavior changes will be addressed using a questionnaire filled before and after the interventions. We expect that this strategy may contribute to the youngsters nutritional improvement and thus to obesity prevention. Keywords: mobile apps; obesity; health literacy; digital game; nutrition Resumo: A criação de aplicações para dispositivos móveis aumenta o acesso à informação, promovendo a literacia em saúde, nomeadamente entre os jovens. A obesidade é atualmente um grave problema epidémico, que pode ser prevenido através de alimentação adequada e da prática de exercício físico. Dado que os jovens têm uma grande apetência pelas TIC e por actividades lúdicas desenvolvemos um jogo interativo para plataformas móveis para incrementar a literacia em nutrição. O protótipo já foi testado e o seu desenho está a ser melhorado. Para avaliarmos a sua eficácia os estudantes serão divididos em três grupos: um usará o jogo, outro fará actividades nutricionais, e o terceiro sem qualquer intervenção. Com o uso de um questionário, aplicado antes e após as intervenções, avaliaremos as alterações da literacia e dos comportamentos alimentares. Esperamos com esta abordagem apelativa contribuir para o aumento da literacia em nutrição dos jovens e, consequentemente, para a prevenção da obesidade. Palavras-chave: mobile apps; obesidade; literacia da saúde; jogos digitais; nutrição

3 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 43 Introduction The exponential use of mobile technology in Portugal is similar to what has been occurring in richer countries (APDSI, 2013) making the development of new applications for these devices an excellent opportunity to promote health literacy (Martin-Moreno et al., 2011), especially among children and young people, who adhere much more easily to new technologies (Xu, 2005). Mobile devices are widely used across age groups and populations, providing a cost-effective platform for health program implementation (Tate el al., 2013). The flexible nature of these media facilitates message targeting according to users cultural and personal backgrounds (Mackert et al., 2009), allowing the development of personalized technological based program, which increases its effectiveness (Tate et al., 2013). Mobile phones, in particular, are an intuitively appealing intervention platform given that they are ubiquitous, engaging and portable (Klasnja & Pratt, 2012). The use of interactive games, that play such an important role in the lives of many teenagers (Sturn et al., 2011), represents a strategy that is achieving increasing recognition, although its effectiveness as a learning tool is still poorly studied (Silk et al., 2008). Moreover, the interaction between game usage and social change is even less studied. Portugal is the second European country with highest prevalence of overweight and obesity in children (Padez et al., 2004).The obesity epidemic appears associated with several diseases such as cancer, diabetes and cardiovascular disease (Halfon et al., 2012; Nadeau, et al., 2011). Although genetic factors contribute to its development (WHO, 2011), there are other important etiological factors, such as the decrease in physical activity and the increase in food quantity and calorie ingestion (Diamond, 2007; White et al., 2013) that may be altered. Reducing obesity comprises behavioural changes that are not possible without increasing health literacy. Efforts to improve diet and increase physical activity depend largely on public knowledge of issues related to energy balance (Nelson et al., 2009), placing nutrition literacy as a key element for personal and societal wellbeing. Adolescence, apart from being a period of life with a height and weight spurts, is also a period of greater autonomy in eating habits and physical activity, so it has been recognized as an important stage for obesity prevention (Nelson et al., 2009),

4 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 44 considering that the diet and eating behaviours acquired at this time tend to persist throughout life (Wahl, 1999). Additionally, young people are more prone to social influence processes that allow healthy or unhealthy behaviours to spread contagiously (Martin-Moreno et al., 2011), making relevant the empowerment of youth with rigorous nutrition information. The aim of this ongoing project is to improve nutrition literacy in youngsters by engaging them in an attractive interactive educational game designed to mobile platforms. t is also a key element of the project to evaluate the youngster s interaction with the game and its potential to dietary change contributing to obesity prevention. The underlying assumption is that this kind of applications can be used to persuade people to change certain behaviours by appealing to intrinsically motivating strategies (Sturn et al., 2011). Objectives This project has two main objectives: 1) To engage adolescents in an educational game targeted to increase nutritional literacy and to improve more adequate nutritional habits; 2) To promote the usage of the game as a learning tool after testing and improving our first prototype. Methodology Based on the aforementioned premises, we are designing an interactive game to mobile platforms (Android and ios based smart phones and tablets) to improve nutrition literacy in the teenagers Nutribuddy. In the game, players will be able to choose a male or female character (Fig.1A), and are challenged to make correct decisions about food and leisure activities. The character has an objective to accomplish (ex: a sports competition) and should be able to achieve the most adequate weight and healthy status to undertake that objective. The game has four levels with increased complexity. In all the levels there will be a running game, a memory game, and a quiz. The fourth level is the restaurant, and the challenge is to keep the character healthy by feeding him outside the home context, with several healthy and

5 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 45 unhealthy items, with adequate or oversized portions simulating what frequently happens when the teenagers have to eat out of home (Fig. 1B). Fig. 1 Screenshots from NutriBuddy prototype A characters in a running game, B the restaurant level In line with other authors experience (Khaled et al., 2007; Silk et al., 2008), relevant information is presented in a manner that does not cause cognitive overload, and that players feel compelled to pay attention. This is especially important considering the target audience, as adolescence is a period of fast growing and independence that can difficult attention and motivation for learning (US Department of Education, 2005). As design aspects are of key importance to create successful games, we designed several characters that were proposed to a group of students, who were consulted for opinion and inputs. This provided users participation, in an iterative process of User- Centered Design that integrates input from users, and has been recommended to maximize user motivation and engagement (Mulvaney & Bosslet, 2011). Relying on the students opinions, the character for the game was chosen and its animation was developed to build a prototype that was tested with a group of 10 students for usability evaluation. The game design was modified and improved according to the results of these usability tests. As adolescents are concerned about their looking, the character will show some modifications in unhealthier states, accordingly to food choices (e.g. bad teeth, bad color, etc.), as well as weight gain and loss (Fig. 2). To give the notion that an adequate weight does not necessarily indicate a healthy status or wellbeing, the game

6 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 46 will show three bars energy, health and wellbeing that change according to player choices. This is particularly important as often youngsters assume unhealthy habits in order to control their body mass (Mikolajczak et al., 2012). Moreover, the game will have scores and alerts to reward and reinforce target behaviors or to warn about unhealthy choices. Fig.2 Screenshots from NutriBuddy prototype A Character with missing tooth, B character with unhealthy aspect, C character in a fat status We are also developing a handbook for teachers with detailed information on the game. With this strategy we aim at involving teachers, as we believe that NutriBuddy may be a useful tool in the classroom learning context. In order to evaluate the role of the game on improving nutrition knowledge and changing dietary habits we created a questionnaire adapted from Turconi et al. (2003), allowing data collection before and after the game usage. It is mainly focused on evaluating how the game interactions may have altered youngsters relations with nutrition. It will be applied to fourteen nine-grade classes divided in three groups: one using NutriBuddy, other attending nutritional activities [laboratory activities and a seminar on nutrition], and the third without any intervention. After a period of two months the questionnaires will be distributed again to the same students. With the two comparison groups we believe we will be able to validate NutriBuddy usage. Along with this evaluation, and in accordance with other authors (Sturn et al., 2011) we will store players interactions with the game, namely their activities and preferences. This will allow us to have better insights about the game usage and will support further development of the Nutribuddy prototype.

7 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 47 Results and discussion There are several examples of games that seek to improve health literacy and promote healthier behaviors (Khaled et al., 2007). Concerning children obesity prevention, a recent survey in the USA testing 57 apps has shown that most of them were void of expert-recommended strategies; the apps presented a huge lost opportunity for the provision of solid recommendations for health change (Schoffman et al., 2013). In Portugal, Nutri Ventures has been having a huge impact as seen by its visualizations and its presence in social network (Nutri Ventures, 2015), however this game is directed to 5-10 years old children. NutriBuddy s target audience is slightly older for the reasons mentioned before. To accomplish the challenge of developing an attractive and engaging game, and considering our target audience are adolescents, we have adopted strategies more related to the real world, such as the restaurant (4 th level). We have included short quizzes on information that is presented in the game. With this process the interactive learning will be more enjoyable and feel less forced. We propose an evaluation of the NutriBuddy impact on nutrition literacy improvement and, ultimately, on a healthier nutritional behavior. The evaluation of both aspects is crucial as popularizing nutrition knowledge is the basis for behavioral changes (Morgan et al., 2010; Vijayapushpam et al., 2010) but it does not always lead to the desired behavioral change (Wang et al., 2014). As this is an ongoing project, we do not have final results yet. As first step, we have tested our questionnaire, observing that 87% of the 9 th grade students (n=23) owns a smartphone, what is in accordance with the spread of new media technology, and validates the use of this platform Nutribuddy usage. The questionnaire also revealed that 26% of the students, mainly boys, were not interested on using a game with nutritional content (before knowing details of the game). This suggests that part of our target audience may be not prone to engage with the topic. As second step, we have delivered the questionnaires to all the students (n=240) in order to evaluate their nutritional knowledge and food habits at the beginning of the study. The information obtained in the questionnaires is now being registered using the PASW Statistics 22 program for further statistical analysis. As third step, for the group using Nutribuddy, we have displayed the game to the students and have installed it in their mobile phones. The students were very excited to play the game. In the group attending nutritional activities [laboratory activities and a

8 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 48 seminar on nutrition] the laboratory activities are ongoing and the seminar will take place immediately after their finalized. As fourth step, the same questionnaires will be delivered again to all the students to evaluate for eventual differences in the students nutritional knowledge and / or food habits. Moreover, in these second questionnaires, it will be included self-reported information on game usage / or nutritional activities attendance. This will allow us to have the student s perspective about the Nutribuddy prototype for its further improvement. At fifth step, with the evaluation of the game usage by the students, we will provide the game to the teachers, including a teacher s manual to promote its usage as a learning tool. One of the limitations of the present study is the short observational period. It is well known that behavioural changes are a difficult goal to achieve. In order to overcome this problem we intend to deliver the questionnaires again at the end of the year for comparison with the initial results. Conclusion We expect that the game will promote changes in attitudes and behaviors related to nutrition and healthy lifestyles, contributing to long term commitment with healthier dietary habits and obesity prevention. We also expect that the project may have indirect impact on other members of the youngsters community, namely their parents, who still are the major authority in the household eating decisions at home. We believe that this approach will have a positive impact in youngsters health literacy, through their engagement in an attractive, funny, educational game, contributing to obesity prevention, and leading to a future healthier life. References APDSI Observatório da Economia da Informação. (2013). Aspetos Económicos e Sociais da Internet Retrieved 12 September 2013, from 20E%20SOCIAIS%20DA%20INTERNET_Memorando%202_V5_2013.pdf

9 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 49 Diamond, J. J. (2007). Development of a reliable and construct valid measure of nutritional literacy in adults. Nutr J, 6, 5. doi: / Halfon, N., Verhoef, P. A., & Kuo, A. A. (2012). Childhood antecedents to adult cardiovascular disease. Pediatr Rev, 33(2), 51-60; quiz 61. doi: /pir APDSI Observatório da Economia da Informação. (2013). Aspetos Económicos e Sociais da Internet Retrieved 12 September 2013, from 20E%20SOCIAIS%20DA%20INTERNET_Memorando%202_V5_2013.pdf Khaled, R. B., P.; Noble, J.; Fischer, R.; Biddle, R. (2007). Fine Tuning the Persuasion in Persuasive Games. In Y. d. K. e. al. (Ed.), Persuasive Technology. Heidelberg: Springer-Verlag. Klasnja, P., & Pratt, W. (2012). Healthcare in the pocket: mapping the space of mobilephone health interventions. J Biomed Inform, 45(1), doi: /j.jbi Mackert, M., Kahlor, L., Tyler, D., & Gustafson, J. (2009). Designing e-health interventions for low-health-literate culturally diverse parents: addressing the obesity epidemic. Telemed J E Health, 15(7), doi: /tmj Martin-Moreno, J. M., Apfel, F., Sanchez, J. L., Galea, G., & Jakab, Z. (2011). The social nature of chronic noncommunicable diseases and how to tackle them through communication technology, training, and outreach. J Health Commun, 16 Suppl 2, doi: / Mikolajczak, J., Piotrowska, E., Biernat, J., Wyka, J., & Zechalko-Czajkowska, A. (2012). Self-perceived assessment of nutritional status as a determinant of health-promoting and anti-health-promoting behaviors of adolescent boys. Adv Clin Exp Med, 21(2), Morgan, P. J., Warren, J. M., Lubans, D. R., Saunders, K. L., Quick, G. I., & Collins, C. E. (2010). The impact of nutrition education with and without a school garden on knowledge, vegetable intake and preferences and quality of school life among primary-school students. Public Health Nutr, 13(11), doi: /S Mulvaney, S. R., L., Bosslet, L. (2011). Mobile Intervention Design in Diabetes: Review and Recommendations. Current Diabetics.

10 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 50 Nadeau, K. J., Maahs, D. M., Daniels, S. R., & Eckel, R. H. (2011). Childhood obesity and cardiovascular disease: links and prevention strategies. Nature reviews Cardiology, 8(9), doi: /nrcardio Nelson, M. C., Lytle, L. A., & Pasch, K. E. (2009). Improving literacy about energyrelated issues: the need for a better understanding of the concepts behind energy intake and expenditure among adolescents and their parents. J Am Diet Assoc, 109(2), doi: /j.jada Nutriventures. (2015). Padez, C., Fernandes, T., Mourao, I., Moreira, P., & Rosado, V. (2004). Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from Am J Hum Biol, 16(6), doi: /ajhb Schoffman, D., Turner-McGrievy, G., Jones, S., Wilcox, S. (2013). Mobile apps for pediatric obesity prevention and treatment, healthing eating, and physical activity promotion: just fun and games? Transl Behav Med, 3, doi: /s Silk, K. J., Sherry, J., Winn, B., Keesecker, N., Horodynski, M. A., & Sayir, A. (2008). Increasing nutrition literacy: testing the effectiveness of print, Web site, and game modalities. J Nutr Educ Behav, 40(1), doi: /j.jneb Sturn, J., Tieben, R; Deen, M; Bekker, T., Schouten, B. (2011). PlayFit: Designing playful activity interventions for teenagers. Paper presented at the Think Design Play. Tate, E., Spruijt-Metz, D., O Reilly, G., Jordan-Marsch, M., Gotsis, M., Pentz, M., & Dunton, G. (2013). mhealth approaches to child obesity prevention: successes, unique challenges, and next directions. Transl Behav Med, 3(4), doi: /s Turconi, G., Celsa, M., Rezzani, C., Biino, G., Sartirana, M. A., & Roggi, C. (2003). Reliability of a dietary questionnaire on food habits, eating behaviour and nutritional knowledge of adolescents. Eur J Clin Nutr, 57(6), U.S. Department of Education, Office of Communications and Outreach. (2005). Helping Your Child through Early Adolescence - for for parents of children from 10 through 14. ED Pubs Education Publications Center U.S. Department of Education Retrieved from

11 Challenges 2015: Meio Século de TIC na Educação, Half a Century of ICT in Education 51 Vijayapushpam, T., Antony, G. M., Rao, G. M., & Rao, D. R. (2010). Nutrition and health education intervention for student volunteers: topic-wise assessment of impact using a non-parametric test. Public Health Nutr, 13(1), doi: /S Wahl, R. (1999). Nutrition in the adolescent. Pediatr Ann, 28(2), Wang, D., Shi, Y., Chang, C., Stewart, D., Ji, Y., Wang, Y., & Harris, N. (2014). Knowledge, attitudes and behaviour regarding nutrition and dietary intake of seventh-grade students in rural areas of Mi Yun County, Beijing, China. Environ Health Prev Med, 19(3), doi: /s White, R. O., Thompson, J. R., Rothman, R. L., McDougald Scott, A. M., Heerman, W. J., Sommer, E. C., & Barkin, S. L. (2013). A health literate approach to the prevention of childhood overweight and obesity. Patient Educ Couns, 93(3), doi: /j.pec WHO Geneva, S. (2011). Global status report on alcohol and death. from uprofiles.pdf Xu, D. (2005). Tangible User Interface for Children - An Overview. UCLAN Department of Computing Science.