Games for Health: A feasibility study assessing the recruitment method for a randomised controlled trial investigating the use of interactive video games for improving health and diabetes-specific knowledge in children (9-16 years) 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. 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. Baseline Session: During one 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, and a questionnaire about their attitudes and preferences for the video games will be assessed. Follow up Session: Participants will be assessed for knowledge of healthy lifestyles via a survey emailed to them/their parents 4 weeks after the clinic type setting. Apart from these two time points, there is no other contact or intervention for the participants. The primary endpoint will be feasibility of the recruitment method, defined as recruitment and randomisation of 40 participants within a 1-month period. Participants will also be assessed for a change in knowledge of healthy lifestyles 15 min +/- 5 min after being given the game to play and at 4 weeks, as well as their attitudes and preferences regarding video game 15 min +/- 5 min after being given the game to play. Adherence to the intervention will be monitored by android game data from the device at baseline, time stamps on the surveys, and participant feedback on the games.