Games for Health: A trial to determine whether using interactive video games can improve healthy-lifestyle and diabetes specific knowledge in youth (9-16years) who are at risk for type 2 diabetes.

This three-arm, parallel, randomised controlled feasibility trial will compare the effect of two different interactive video games on children engagement with interactive serious games, their preferences and attitudes to serious games, and whether playing these games impact on knowledge of healthy lifestyle behaviours. In order to participate, children will need to be classified as being at-risk for type 2 diabetes. This means they must either have been told by their doctor that they are at-risk for type 2 diabetes, or they are overweight/obese, or they have a family history of type 2 diabetes. This classification of being ‘at-risk for type 2 diabetes’ was based on professional opinion and recommended guidelines. Participants will be randomised to receive one of two interactive serious video designed to improve health knowledge or a control game, which is a similar game without the health information. Preferences and attitudes to the games (active groups only), impact on healthy lifestyle behaviours and diabetic knowledge will be assessed. Participants will play the game for 15-min +/- 5 min during a 1-hour clinic session and will be invited to take the game home for 4 weeks. During a 15-min +/- 5 min clinic type setting with a research assistant, participants will complete a healthy lifestyle and diabetes knowledge questionnaire. Participant's height and weight will be measured and they will then be given the instructions for one of the two health games or the control game by the research assistant and be invited to play the game for 15-min +/- 5 min. After playing, the participants will repeat the healthy lifestyle and diabetes knowledge questionnaire. Participants in the active groups will then be invited to take the game home for 4 weeks to play or not play at their discretion to determine sustained use. Two games have been developed, which aim to educate children at risk of diabetes: Arm 1- Ari and Friends: The game can be played on an Android phone or tablet. The main character of the game, named Ari, has to watch what he eats, how much he exercises and the amount of sleeps he gets on his way to save the princess who is locked in a castle. Thus, the health challenges faced by Ari become the health challenges to be solved by the player. To achieve the goal and progress to next level, Ari needs to manage his energy levels (shown at the top of the game) while fighting against a variety of evil guards during multiple stages of the game. Ari's energy level changes depending on food choices the player makes. The player has to answer some multiple-choice health related questions as well throughout the game and immediate feedback on their answers will be provided. It is expected that, as children progress through stages of the game, they will gradually learn the skills to remain healthy by choosing appropriate food options, and being physically active. Arm 2 - Diabetic Jumper: The concepts we are trying to teach on healthy lifestyle are similar to Ari and Friends in this game, and it can be played on Android phones/tablets. Diabetic Jumper consists of two main screens, the menu screen and the play screen. The menu screen is the entry point for each participant where the setting of the game can be modified (theme, music on/off, gender of the character F/M/Neutral and colour of the background) a demo can be accessed for beginners. The goal of the game is to jump to the top of the level by steering the character/jumper from platform to platform, gradually gaining height and collecting coins and making food, sleep and exercise choices on the way up (the icons appear along the way). Similar to Ari and Friends, energy level of the jumper is displayed at the top and some multiple choice health related questions will be displayed from time to time (immediate feedback will be displayed to children). The jumping is done automatically and cannot be stopped by the participant, who can only give the jumper a direction to the left or right by tilting the tablet devices we use for the experiment. With an increasing height, the jumper will face flying enemies that move from side to side and that will end the game for children immediately, once it is touched by the jumper or if the jumper falls off a platform. A key feature of the games is that the software records when children play the game, the duration, and the game-playing activities (e.g. amount of character food consumption). Participants will be assessed for knowledge of healthy lifestyles, video game play (active groups only), as well as attitudes and preferences for the video games (active groups only) via a survey emailed to them/their parents 4 weeks after receiving the game to take home.