Nutrition, Healthy
Conditions
Brief summary
The goal of this clinical trial was to test the preliminary efficacy of a digital dietary self-monitoring (dDSM) log that uses positive reinforcement strategies (caregiver praise and gamification) to improve child engagement in DSM. The main aims were to: * Conduct a proof-of-concept trial that examines the effects of positive reinforcement on child DSM behaviors. * Explore differences in children's intrinsic motivation. Participating children will be instructed to self-monitor their daily intake of targeted food groups (fruits, vegetables, sweet and salty snack foods, and sugar-sweetened beverages) for 4 weeks using a personal web-based DSM log. Each child-caregiver dyad will be randomly assigned to 1 of 4 conditions: BASIC, PRAISE, GAME, or PRAISE+GAME. For PRAISE and PRAISE+GAME conditions, caregivers will be instructed to provide daily process praise to their child related to DSM behaviors. For GAME and PRAISE+GAME conditions, logs will integrate three game mechanics: points, levels, and a virtual pet. Points will be accumulated for engaging in DSM behaviors, and accrual of points will evolve a virtual pet over time.
Detailed description
The objective of the proposed study was to test the usability, acceptability, and preliminary efficacy of a digital dietary self-monitoring (dDSM) log that used positive reinforcement strategies (caregiver praise and gamification) to improve child engagement in DSM. For this proof of concept trial, a mobile-optimized, web-based dDSM log was developed to test the two positive reinforcement strategies: caregiver praise and gamification. The dDSM log was developed as a mobile-optimized website, rather than an app, so that phone operating systems were not a limitation of use. Families were therefore able to access the dDSM log from a computer, smartphone, or other internet-enabled device. All dDSM logs included three basic features: 1) the ability to log targeted food groups with amounts and servings consumed, 2) the ability to indicate logging was complete for the day, and 3) access to a help feature that provided guidance on tracking and serving sizes. Children were instructed to self-monitor their daily intake of the following food groups: fruits, vegetables, sweet and salty snack foods, and sugar-sweetened beverages (SSBs). DSM focused on these four food groups because they had an established influence on health. Fruit and vegetable consumption was associated with a decreased risk of chronic disease, and reduced consumption of energy-dense foods like sweet and salty snacks and SSBs was recommended for weight loss in children. Additionally, these food groups were frequently targeted in childhood obesity treatment and were easily understood by young children. Using a 2x2 factorial design, each child-caregiver dyad was randomly assigned to 1 of 4 conditions: BASIC, PRAISE, GAME, or PRAISE+GAME. Each child was provided a unique URL to access a personal dDSM log with the appropriate, randomly assigned features (praise and/or gamification). For PRAISE and PRAISE+GAME conditions, caregivers were instructed to provide daily process praise to their child related to DSM behaviors. While DSM was frequently implemented within treatment, children in the proposed study engaged in DSM without a concurrent intervention to tightly control the influence of the independent variables on DSM behaviors only (as compared to having all adult caregivers learn how to praise or having caregivers focus their praise on achieving dietary goals, which were both standard components of family-based childhood obesity interventions). Thus, only caregivers randomized to PRAISE or PRAISE+GAME were instructed on praise and, in the absence of dietary goals for intervention, caregivers had only one behavior (DSM) to praise. For GAME and PRAISE+GAME conditions, logs integrated three game mechanics: points, levels, and a virtual pet. Points were accumulated for engaging in DSM behaviors, and the accrual of points evolved a virtual pet over time, acting as a digital token economy. The number of points to level up increased with each level, so that each consecutive level was harder to attain than the previous one. At the end of the 4-week DSM period, families who completed follow-up assessments received two $25 gift cards (one for the caregiver, one for the child) and were provided access to a short online behavioral nutrition education program. The primary DSM outcomes were frequency (i.e., the number of days any food/beverage item was tracked or logging was marked complete) and timing (i.e., how many sessions of recording were completed each day and whether foods/beverages were logged on the day of intake). On days in which no targeted food group was consumed, children had the ability to mark logging as complete for the day (Figure 1a). Indicating logging was complete in the absence of any tracked foods was considered a tracked day. Pre-post changes in intrinsic motivation were also examined.
Interventions
BEHAVIORALCaregiver Praise
Caregivers will provide praise for child's engagement in dietary self-monitoring behaviors as a form of positive reinforcement
BEHAVIORALGamification
DSM logs will include gamification (points, levels, virtual pets) as positive reinforcement for child's engagement in dietary self-monitoring behaviors
Sponsors
The University of Tennessee, Knoxville
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
OTHER
Masking
NONE
Intervention model description
2 x 2 factorial design
Eligibility
Sex/Gender
ALL
Age
8 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* Families with children ages 8-12 years with body mass index (BMI)-for-age ≥ 5th percentile who report eating foods/beverages (any serving size) from ≥2 targeted food groups (fruits, vegetables, sweet and salty snack foods, and SSBs) on ≥3 days/week each and who have an adult caregiver ≥18 years of age willing to participate * Family has reliable access to the internet via phone, computer, or another device that the child is able and permitted to operate
Exclusion criteria
* Child has major psychiatric diseases or organic brain syndromes * Family does not live in the greater Knoxville area * Family does not speak English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dietary Self-monitoring Frequency, Overall | 4 weeks | I.e., number of days with any logging. DSM frequency has been shown to predict success in family-based based childhood overweight and obesity programs. A day will be counted as tracked if any food or beverage is logged on that day or, if no food or beverage is logged, the Logging Complete button is clicked. |
| Dietary Self-monitoring Frequency, Weekly | 4 weeks | I.e., number of days with any logging per week |
| Proportion of Items Tracked on Day of Intake, Overall | 4 weeks | Proportion of food/beverage items that were tracked on the day of intake across the 4-week DSM period |
| Proportion of Items Tracked on Day of Intake, Weekly | 4 weeks | Proportion of food/beverage items that were tracked on the day of intake by week |
| Number of Logging Sessions, Overall | 4 weeks | The average number of logging sessions per day. Sessions were considered distinct tracking events if they occurred \>15 minutes apart. |
| Number of Logging Sessions, Weekly | 4 weeks | The average number of logging sessions per day. Sessions were considered distinct tracking events if they occurred \>15 minutes apart. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Child Intrinsic Motivation | 4 weeks | Gamification and caregiver praise may differentially affect child motivation to engage in DSM. The Task Evaluation Questionnaire of the Intrinsic Motivation Inventory (IMI) was used to determine whether there were differences in pre-post changes in child intrinsic motivation. This questionnaire consists of 22 items and utilizes a 5-point Likert scale (not at all true to very true) to assess interest/enjoyment, perceived choice, perceived competence, and pressure/tension. At baseline, the measure was administered after the child has practiced using the log with the research assistant so that he or she had some familiarity with the behavior before completing the measure. Scales range from 1 to 7, with a higher score indicating a greater degree of the respective motivation subdomain. |
| Child Dietary Intake, Sugar-sweetened Beverages | 4 weeks | The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete. |
| Child Motivation to Change Eating Behaviors | 4 weeks | Child's motivation to change eating habits will be measured, as this may influence engagement in DSM. Children will be asked to complete the 8-item diet subscale of the Motivation to Exercise and Diet Questionnaire-Adapted for Children (MED-C), which is based on self-determination theory. The MED-C diet subscale utilizes a 5-point Likert scale (never to always) and includes 5 items related to motivation and 3 items related to self-determination theory needs (autonomy, competence, relatedness). This validity of the questionnaire has been tested in children aged 7 to 11 years. Scale ranges from 0 to 32, with a higher score indicating greater motivation to change eating habits. |
| Child Dietary Intake, Fruit | 4 weeks | The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete. |
| Child Dietary Intake, Vegetables Excluding Potatoes | 4 weeks | The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete. |
| Child Dietary Intake, Potatoes | 4 weeks | The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete. |
| Child Dietary Intake, Sweet & Salty Snack Foods | 4 weeks | The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete. |
Countries
United States
Participant flow
Pre-assignment details
Numbers for Protocol Enrollment, Number Started, and Number Completed reflect dyads
Participants by arm
| Arm | Count |
|---|---|
| BASIC Children will be asked to track their intake of fruits, vegetables, sweet and salty snack foods, and sugary drinks in the web-based dietary self-monitoring (DSM) log for 4 weeks. Each child will be provided with a personal URL to access their log, which can be accessed from any internet-capable device (computer, phone, etc.). Caregivers will be asked to review their child's log each day and complete a caregiver check-in in the DSM log. | 10 |
| PRAISE In addition to conditions of the BASIC group, caregivers will also be asked to provide praise to their child for engaging in DSM over the 4 weeks. Additionally, when the caregiver completes caregiver check-ins in the DSM log, they will receive a prompt to also complete a praise check-in.
Caregiver Praise: Caregivers will provide praise for child's engagement in dietary self-monitoring behaviors as a form of positive reinforcement | 10 |
| GAME In addition to the conditions of the BASIC group, the child's log will also include a virtual pet that evolves over time as he/she uses the log. As the child earns points, the pet will level up and grow over time.
Gamification: DSM logs will include gamification (points, levels, virtual pets) as positive reinforcement for child's engagement in dietary self-monitoring behaviors | 10 |
| PRAISE+GAME In addition to conditions of the BASIC group, caregivers will also be asked to provide praise to their child for engaging in DSM over the 4 weeks. Additionally, when the caregiver completes caregiver check-ins in the DSM log, they will receive a prompt to also complete a praise check-in. The child's log will also include a virtual pet that evolves over time as he/she uses the log. As the child earns points, the pet will level up and grow over time.
Caregiver Praise: Caregivers will provide praise for child's engagement in dietary self-monitoring behaviors as a form of positive reinforcement
Gamification: DSM logs will include gamification (points, levels, virtual pets) as positive reinforcement for child's engagement in dietary self-monitoring behaviors | 8 |
| Total | 38 |
Baseline characteristics
| Characteristic | BASIC | PRAISE | GAME | PRAISE+GAME | Total |
|---|---|---|---|---|---|
| Age, Continuous | 43.0 years STANDARD_DEVIATION 2.6 | 43.0 years STANDARD_DEVIATION 7.1 | 44.0 years STANDARD_DEVIATION 3.6 | 41.0 years STANDARD_DEVIATION 6.7 | 42.8 years STANDARD_DEVIATION 4.9 |
| Caregiver education level College 1 year to 3 years (some college or technical school) | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Caregiver education level College 4 years or more (college graduate) | 5 Participants | 4 Participants | 4 Participants | 4 Participants | 17 Participants |
| Caregiver education level Grade 12 or GED (high school graduate) | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Caregiver marital status Married | 5 Participants | 5 Participants | 4 Participants | 3 Participants | 17 Participants |
| Caregiver marital status Never married | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Caregiver marital status Refused to answer | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Caregiver Parenting Styles & Dimensions Questionnaire (PSDQ) score Authoritarian domain | 1.5 units on a scale STANDARD_DEVIATION 0.2 | 1.5 units on a scale STANDARD_DEVIATION 0.3 | 1.8 units on a scale STANDARD_DEVIATION 0.3 | 1.7 units on a scale STANDARD_DEVIATION 0.5 | 1.6 units on a scale STANDARD_DEVIATION 0.3 |
| Caregiver Parenting Styles & Dimensions Questionnaire (PSDQ) score Authoritative domain | 4.1 units on a scale STANDARD_DEVIATION 0.1 | 4.2 units on a scale STANDARD_DEVIATION 0.5 | 4.1 units on a scale STANDARD_DEVIATION 0.2 | 4.2 units on a scale STANDARD_DEVIATION 0.3 | 4.1 units on a scale STANDARD_DEVIATION 0.3 |
| Caregiver Parenting Styles & Dimensions Questionnaire (PSDQ) score Permissive domain | 2.0 units on a scale STANDARD_DEVIATION 0.6 | 2.1 units on a scale STANDARD_DEVIATION 0.7 | 2.6 units on a scale STANDARD_DEVIATION 0.7 | 2.0 units on a scale STANDARD_DEVIATION 0.3 | 2.2 units on a scale STANDARD_DEVIATION 0.6 |
| Child BMI Percentile | 37.0 percentile STANDARD_DEVIATION 17.8 | 76.8 percentile STANDARD_DEVIATION 30.9 | 68.6 percentile STANDARD_DEVIATION 33.7 | 60.0 percentile STANDARD_DEVIATION 31.8 | 60.6 percentile STANDARD_DEVIATION 30.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 4 Participants | 5 Participants | 5 Participants | 4 Participants | 18 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Household income $100,000 to $149,999 | 0 Participants | 1 Participants | 1 Participants | 2 Participants | 4 Participants |
| Household income $10,000 to $19,999 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Household income $150,000 or more | 5 Participants | 3 Participants | 3 Participants | 1 Participants | 12 Participants |
| Household income $20,000 to $29,999 | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Household income $30,000 to $39,999 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Household income $40,000 to $49,999 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Household income $50,000 to $59,999 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Household income $60,000 to $69,999 | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Household income $70,000 to $79,999 | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Household income $80,000 to $89,999 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Household income $90,000 to $99,999 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Household income Less than $10,000 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 1 Participants | 0 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 5 Participants | 3 Participants | 5 Participants | 2 Participants | 15 Participants |
| Sex: Female, Male Female | 4 Participants | 2 Participants | 3 Participants | 4 Participants | 11 Participants |
| Sex: Female, Male Male | 1 Participants | 3 Participants | 2 Participants | 2 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk |
|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 5 | 0 / 5 | 0 / 5 | 0 / 4 | 0 / 5 | 0 / 5 | 0 / 5 | 0 / 4 |
| other Total, other adverse events | 0 / 5 | 0 / 5 | 0 / 5 | 0 / 4 | 0 / 5 | 0 / 5 | 0 / 5 | 0 / 4 |
| serious Total, serious adverse events | 0 / 5 | 0 / 5 | 0 / 5 | 0 / 4 | 0 / 5 | 0 / 5 | 0 / 5 | 0 / 4 |
Outcome results
Primary
Dietary Self-monitoring Frequency, Overall
I.e., number of days with any logging. DSM frequency has been shown to predict success in family-based based childhood overweight and obesity programs. A day will be counted as tracked if any food or beverage is logged on that day or, if no food or beverage is logged, the Logging Complete button is clicked.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Dietary Self-monitoring Frequency, Overall | 23.0 days | Standard Error 1.4 |
| Caregiver Praise | Dietary Self-monitoring Frequency, Overall | 24.3 days | Standard Error 1.4 |
| No Gamification | Dietary Self-monitoring Frequency, Overall | 22.0 days | Standard Error 1.3 |
| Gamification | Dietary Self-monitoring Frequency, Overall | 25.3 days | Standard Error 1.4 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: >0.05ANOVA
p-value: >0.05ANOVA
Primary
Dietary Self-monitoring Frequency, Weekly
I.e., number of days with any logging per week
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| No Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 1 | 6.8 days | Standard Error 0.1 |
| No Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 2 | 6.0 days | Standard Error 0.4 |
| No Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 3 | 5.4 days | Standard Error 0.5 |
| No Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 4 | 4.8 days | Standard Error 0.7 |
| Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 2 | 6.5 days | Standard Error 0.4 |
| Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 3 | 6.5 days | Standard Error 0.5 |
| Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 4 | 4.6 days | Standard Error 0.8 |
| Caregiver Praise | Dietary Self-monitoring Frequency, Weekly | Week 1 | 6.8 days | Standard Error 0.1 |
| No Gamification | Dietary Self-monitoring Frequency, Weekly | Week 3 | 5.4 days | Standard Error 0.5 |
| No Gamification | Dietary Self-monitoring Frequency, Weekly | Week 2 | 5.9 days | Standard Error 0.4 |
| No Gamification | Dietary Self-monitoring Frequency, Weekly | Week 4 | 4.0 days | Standard Error 0.7 |
| No Gamification | Dietary Self-monitoring Frequency, Weekly | Week 1 | 6.7 days | Standard Error 0.1 |
| Gamification | Dietary Self-monitoring Frequency, Weekly | Week 4 | 5.4 days | Standard Error 0.8 |
| Gamification | Dietary Self-monitoring Frequency, Weekly | Week 2 | 6.6 days | Standard Error 0.4 |
| Gamification | Dietary Self-monitoring Frequency, Weekly | Week 1 | 6.9 days | Standard Error 0.1 |
| Gamification | Dietary Self-monitoring Frequency, Weekly | Week 3 | 6.5 days | Standard Error 0.5 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: <0.001ANOVA
Primary
Number of Logging Sessions, Overall
The average number of logging sessions per day. Sessions were considered distinct tracking events if they occurred \>15 minutes apart.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Number of Logging Sessions, Overall | 24.6 logging sessions/day | Standard Error 2.8 |
| Caregiver Praise | Number of Logging Sessions, Overall | 21.5 logging sessions/day | Standard Error 2.9 |
| No Gamification | Number of Logging Sessions, Overall | 22.4 logging sessions/day | Standard Error 2.8 |
| Gamification | Number of Logging Sessions, Overall | 23.7 logging sessions/day | Standard Error 2.9 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: >0.05ANOVA
p-value: >0.05ANOVA
Primary
Number of Logging Sessions, Weekly
The average number of logging sessions per day. Sessions were considered distinct tracking events if they occurred \>15 minutes apart.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| No Caregiver Praise | Number of Logging Sessions, Weekly | Week 1 | 7.0 logging sessions/day | Standard Error 0.6 |
| No Caregiver Praise | Number of Logging Sessions, Weekly | Week 3 | 5.0 logging sessions/day | Standard Error 0.8 |
| No Caregiver Praise | Number of Logging Sessions, Weekly | Week 2 | 8.1 logging sessions/day | Standard Error 1.2 |
| No Caregiver Praise | Number of Logging Sessions, Weekly | Week 4 | 4.5 logging sessions/day | Standard Error 0.7 |
| Caregiver Praise | Number of Logging Sessions, Weekly | Week 2 | 5.2 logging sessions/day | Standard Error 1.3 |
| Caregiver Praise | Number of Logging Sessions, Weekly | Week 1 | 7.2 logging sessions/day | Standard Error 0.7 |
| Caregiver Praise | Number of Logging Sessions, Weekly | Week 4 | 3.3 logging sessions/day | Standard Error 0.7 |
| Caregiver Praise | Number of Logging Sessions, Weekly | Week 3 | 5.6 logging sessions/day | Standard Error 0.9 |
| No Gamification | Number of Logging Sessions, Weekly | Week 2 | 7.2 logging sessions/day | Standard Error 1.2 |
| No Gamification | Number of Logging Sessions, Weekly | Week 3 | 5.0 logging sessions/day | Standard Error 0.8 |
| No Gamification | Number of Logging Sessions, Weekly | Week 1 | 7.1 logging sessions/day | Standard Error 0.6 |
| No Gamification | Number of Logging Sessions, Weekly | Week 4 | 3.1 logging sessions/day | Standard Error 0.7 |
| Gamification | Number of Logging Sessions, Weekly | Week 2 | 6.1 logging sessions/day | Standard Error 1.3 |
| Gamification | Number of Logging Sessions, Weekly | Week 1 | 7.1 logging sessions/day | Standard Error 0.7 |
| Gamification | Number of Logging Sessions, Weekly | Week 4 | 4.7 logging sessions/day | Standard Error 0.7 |
| Gamification | Number of Logging Sessions, Weekly | Week 3 | 5.6 logging sessions/day | Standard Error 0.9 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: <0.0001ANOVA
Primary
Proportion of Items Tracked on Day of Intake, Overall
Proportion of food/beverage items that were tracked on the day of intake across the 4-week DSM period
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Proportion of Items Tracked on Day of Intake, Overall | 0.73 proportion of items tracked | Standard Error 0.05 |
| Caregiver Praise | Proportion of Items Tracked on Day of Intake, Overall | 0.69 proportion of items tracked | Standard Error 0.06 |
| No Gamification | Proportion of Items Tracked on Day of Intake, Overall | 0.70 proportion of items tracked | Standard Error 0.05 |
| Gamification | Proportion of Items Tracked on Day of Intake, Overall | 0.73 proportion of items tracked | Standard Error 0.06 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: >0.05ANOVA
p-value: >0.05ANOVA
Primary
Proportion of Items Tracked on Day of Intake, Weekly
Proportion of food/beverage items that were tracked on the day of intake by week
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| No Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 1 | 0.84 proportion of items tracked | Standard Error 0.06 |
| No Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 2 | 0.71 proportion of items tracked | Standard Error 0.09 |
| No Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 3 | 0.69 proportion of items tracked | Standard Error 0.09 |
| No Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 4 | 0.67 proportion of items tracked | Standard Error 0.12 |
| Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 2 | 0.68 proportion of items tracked | Standard Error 0.09 |
| Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 3 | 0.61 proportion of items tracked | Standard Error 0.09 |
| Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 4 | 0.52 proportion of items tracked | Standard Error 0.13 |
| Caregiver Praise | Proportion of Items Tracked on Day of Intake, Weekly | Week 1 | 0.82 proportion of items tracked | Standard Error 0.07 |
| No Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 3 | 0.64 proportion of items tracked | Standard Error 0.09 |
| No Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 2 | 0.68 proportion of items tracked | Standard Error 0.09 |
| No Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 4 | 0.59 proportion of items tracked | Standard Error 0.12 |
| No Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 1 | 0.82 proportion of items tracked | Standard Error 0.06 |
| Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 4 | 0.59 proportion of items tracked | Standard Error 0.13 |
| Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 2 | 0.71 proportion of items tracked | Standard Error 0.09 |
| Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 1 | 0.84 proportion of items tracked | Standard Error 0.07 |
| Gamification | Proportion of Items Tracked on Day of Intake, Weekly | Week 3 | 0.66 proportion of items tracked | Standard Error 0.09 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: 0.01ANOVA
Secondary
Child Dietary Intake, Fruit
The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Child Dietary Intake, Fruit | 1.2 cup equivalents | Standard Error 0.2 |
| Caregiver Praise | Child Dietary Intake, Fruit | 0.9 cup equivalents | Standard Error 0.2 |
| No Gamification | Child Dietary Intake, Fruit | 0.9 cup equivalents | Standard Error 0.2 |
| Gamification | Child Dietary Intake, Fruit | 1.2 cup equivalents | Standard Error 0.2 |
p-value: >0.05ANCOVA
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: >0.05ANCOVA
Secondary
Child Dietary Intake, Potatoes
The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Child Dietary Intake, Potatoes | .2 cup equivalents | Standard Error 0.04 |
| Caregiver Praise | Child Dietary Intake, Potatoes | .2 cup equivalents | Standard Error 0.04 |
| No Gamification | Child Dietary Intake, Potatoes | .1 cup equivalents | Standard Error 0.03 |
| Gamification | Child Dietary Intake, Potatoes | .3 cup equivalents | Standard Error 0.04 |
p-value: >0.05ANCOVA
p-value: 0.02ANCOVA
Secondary
Child Dietary Intake, Sugar-sweetened Beverages
The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Child Dietary Intake, Sugar-sweetened Beverages | 28.1 kilocalories | Standard Error 7.8 |
| Caregiver Praise | Child Dietary Intake, Sugar-sweetened Beverages | 26.0 kilocalories | Standard Error 8.2 |
| No Gamification | Child Dietary Intake, Sugar-sweetened Beverages | 33.2 kilocalories | Standard Error 7.7 |
| Gamification | Child Dietary Intake, Sugar-sweetened Beverages | 20.9 kilocalories | Standard Error 8.2 |
p-value: >0.05ANCOVA
p-value: >0.05ANCOVA
Secondary
Child Dietary Intake, Sweet & Salty Snack Foods
The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Child Dietary Intake, Sweet & Salty Snack Foods | 36.5 g | Standard Error 7.9 |
| Caregiver Praise | Child Dietary Intake, Sweet & Salty Snack Foods | 46.5 g | Standard Error 8.4 |
| No Gamification | Child Dietary Intake, Sweet & Salty Snack Foods | 38.3 g | Standard Error 8 |
| Gamification | Child Dietary Intake, Sweet & Salty Snack Foods | 44.7 g | Standard Error 8.5 |
p-value: >0.05ANCOVA
p-value: >0.05ANCOVA
Secondary
Child Dietary Intake, Vegetables Excluding Potatoes
The act of self-monitoring a behavior may result in reactivity, or improvements in the monitored behavior in the absence of other intervention. Thus, child dietary intake will also be assessed at baseline and follow-up using the Block Food Screener for Ages 2-17 2007. The instrument asks about intake in the last week and focuses on take of fruit, fruit juices, vegetables, potatoes (including French fries), whole grains, animal-based proteins, dairy, legumes, saturated fat, added sugars (in sweetened cereals, sugar sweetened beverages), glycemic load and glycemic index. It takes approximately 10-12 minutes to complete.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Child Dietary Intake, Vegetables Excluding Potatoes | .6 cup equivalents | Standard Error 0.1 |
| Caregiver Praise | Child Dietary Intake, Vegetables Excluding Potatoes | .6 cup equivalents | Standard Error 0.1 |
| No Gamification | Child Dietary Intake, Vegetables Excluding Potatoes | .4 cup equivalents | Standard Error 0.1 |
| Gamification | Child Dietary Intake, Vegetables Excluding Potatoes | .8 cup equivalents | Standard Error 0.1 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: >0.05ANCOVA
p-value: 0.03ANCOVA
Secondary
Child Intrinsic Motivation
Gamification and caregiver praise may differentially affect child motivation to engage in DSM. The Task Evaluation Questionnaire of the Intrinsic Motivation Inventory (IMI) was used to determine whether there were differences in pre-post changes in child intrinsic motivation. This questionnaire consists of 22 items and utilizes a 5-point Likert scale (not at all true to very true) to assess interest/enjoyment, perceived choice, perceived competence, and pressure/tension. At baseline, the measure was administered after the child has practiced using the log with the research assistant so that he or she had some familiarity with the behavior before completing the measure. Scales range from 1 to 7, with a higher score indicating a greater degree of the respective motivation subdomain.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| No Caregiver Praise | Child Intrinsic Motivation | Interest/enjoyment | 4.7 Units on a scale | Standard Error 0.6 |
| No Caregiver Praise | Child Intrinsic Motivation | Perceived competence | 5.4 Units on a scale | Standard Error 0.4 |
| No Caregiver Praise | Child Intrinsic Motivation | Perceived choice | 4.8 Units on a scale | Standard Error 0.4 |
| No Caregiver Praise | Child Intrinsic Motivation | Pressure/tension | 1.8 Units on a scale | Standard Error 0.3 |
| Caregiver Praise | Child Intrinsic Motivation | Perceived competence | 4.7 Units on a scale | Standard Error 0.5 |
| Caregiver Praise | Child Intrinsic Motivation | Perceived choice | 5.5 Units on a scale | Standard Error 0.4 |
| Caregiver Praise | Child Intrinsic Motivation | Pressure/tension | 3.5 Units on a scale | Standard Error 0.3 |
| Caregiver Praise | Child Intrinsic Motivation | Interest/enjoyment | 3.9 Units on a scale | Standard Error 0.6 |
| No Gamification | Child Intrinsic Motivation | Perceived choice | 5.4 Units on a scale | Standard Error 0.4 |
| No Gamification | Child Intrinsic Motivation | Perceived competence | 4.4 Units on a scale | Standard Error 0.4 |
| No Gamification | Child Intrinsic Motivation | Pressure/tension | 1.9 Units on a scale | Standard Error 0.3 |
| No Gamification | Child Intrinsic Motivation | Interest/enjoyment | 3.3 Units on a scale | Standard Error 0.6 |
| Gamification | Child Intrinsic Motivation | Pressure/tension | 2.4 Units on a scale | Standard Error 0.3 |
| Gamification | Child Intrinsic Motivation | Perceived competence | 5.6 Units on a scale | Standard Error 0.4 |
| Gamification | Child Intrinsic Motivation | Interest/enjoyment | 5.2 Units on a scale | Standard Error 0.6 |
| Gamification | Child Intrinsic Motivation | Perceived choice | 4.8 Units on a scale | Standard Error 0.4 |
p-value: >0.05ANCOVA
p-value: >0.05ANCOVA
Secondary
Child Motivation to Change Eating Behaviors
Child's motivation to change eating habits will be measured, as this may influence engagement in DSM. Children will be asked to complete the 8-item diet subscale of the Motivation to Exercise and Diet Questionnaire-Adapted for Children (MED-C), which is based on self-determination theory. The MED-C diet subscale utilizes a 5-point Likert scale (never to always) and includes 5 items related to motivation and 3 items related to self-determination theory needs (autonomy, competence, relatedness). This validity of the questionnaire has been tested in children aged 7 to 11 years. Scale ranges from 0 to 32, with a higher score indicating greater motivation to change eating habits.
Time frame: 4 weeks
Population: Dyads were randomized by condition (BASIC, PRAISE, GAME, or PRAISE+GAME). However, factorial analysis was used to calculate the main effects of the independent variables, i.e. assignment to praise and assignment to gamification. Therefore, the table presents results for the same 19 enrolled children twice: 1) as assigned to praise versus not assigned to praise and 2) as assigned to gamification versus not assigned to gamification.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| No Caregiver Praise | Child Motivation to Change Eating Behaviors | 30.9 Units on a scale | Standard Error 0.7 |
| Caregiver Praise | Child Motivation to Change Eating Behaviors | 30.4 Units on a scale | Standard Error 0.8 |
| No Gamification | Child Motivation to Change Eating Behaviors | 30.1 Units on a scale | Standard Error 0.7 |
| Gamification | Child Motivation to Change Eating Behaviors | 31.2 Units on a scale | Standard Error 0.8 |
Comparison: A standard alpha level of ≥ 0.05 was used to determine statistical significance.p-value: >0.05ANCOVA
p-value: >0.05ANCOVA