Kiddio-Food Fight™ A Vegetable Parenting Video Game
1. Kiddio-Food Fight™
A Vegetable Parenting
Video Game
NICHD
NATIONAL INSTITUTE
OF HEALTH
Eunice Kennedy Shriver
Tom Baranowski, PhD
Professor of Pediatrics (Behavioral Nutrition & PA)
USDA/ARS Children’s Nutrition Research Center
Baylor College of Medicine
Houston, Texas, 77030, USA
www.bcm.edu/cnrc/faculty/?PMID=9519
Pediatrics
2. Games for Health
June 13, 2012
High vegetable intake
Related to lower…
CVD
Several cancers
Type II Diabetes
Maybe Obesity
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June 13, 2012
Child Food Preferences
A primary determinant of intake
Kids tend to eat what they like
Formed early in life
Parents are primary influences on children’s
food preferences and intake
Common parent complaint – “I can’t get my
child to eat vegetables”
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Parenting Practices
Behaviors that influence child’s behavior
Recent research identifies parenting
practices as either:
Effective
Ineffective
Our Goal - Train parents of preschool
children to enable their child to eat more
vegetables
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Skilled Behaviors can be learned
Simulations have been used to teach how
to…
Fly an airplane
Do surgery
Interact with patients
Video games can employ simulations
Adult learning requires
Self-selected practice
Feedback
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June 13, 2012
Issues for Casual Game
What are important parenting practices
36-item child temperament measure too
long for game
Not clear how to word Value/Reasons
statements
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June 13, 2012
Formative Research (1)
International Survey of Pediatricians, Health
Care Providers and Educators for food
parenting
36 food parenting statements
Cause short or long term harm?
Short term effectiveness?
Long term effectiveness?
Basis for food parenting selections
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Formative Research (2)
Child Temperaments – Created three short
statements:
He/She likes to listen to rhymes and songs. When
working on a project he/she concentrates deeply and
carefully follows rules and instructions. When
something changes, he/she quickly notices.
He/She often shows his/her frustration or discomfort
and easily becomes sad when not able to finish a
project. He/She is often afraid of the dark and when
upset may be difficult to calm down.
He/She has lots of energy, is easily excited and often
goes fast on the playground. He/She enjoys meeting
new people and going to new places.
Validated against 36-item questionnaire
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June 13, 2012
Formative Research (3)
Self Determination Theory
Values / Reasons Intrinsically Motivated
Behavior
Relatedness
People make decisions consistent with values
Reasons tie values to behaviors
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Cognitive testing of Values for
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Vegetable Parenting
Most commonly selected Values:
“Raising a wholesome child”
“Raising a healthy child”
“Being a role model”
“Being respected by others”
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Reasons linking “Raising a healthy
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child” Value to VPP
“Encouraging my child to eat vegetables
helps my child to be healthy because it
helps…”
Keep them from getting sick, so they don’t miss
school
Keep them from getting… cancer (… heart
disease, …obese, …diabetes)
Them be in good shape
My child learn healthy eating habits
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June 13, 2012
Kiddio – Game Mechanics
7 stage game
Enter at neutral with Kiddio refusing veggie offered
Select effective parenting - move 1 step towards
winning
Select ineffective parenting – move 1 step towards
losing
Turn off TV, remove toys, close door to outside –
move 1 step towards winning
Time out option
Works only at Level 7
Otherwise lose points
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June 13, 2012
Kiddio-Food Fight™
Casual video game (5-15
minutes per session or
episode)
Played anywhere, any time
G4 iPhone app
Audience – Parents of pre-
schoolers (3-5 year olds) who
have difficulty getting their
child to eat vegetables
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Game Storyline
Dottie (best friend) has a
child just a little older that
yours
She has faced all these
problems with her child and
“knows” what works
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Simulate parent-child
interactions
Select from
alternative parenting
statements
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Feedback to parents
is immediate
Kiddio’s facial expressions
and reactions to parent
statement selections
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Additional Game
Activities
Change environment
(TV, door, toys, timeout)
Choose vegetable to serve
Kiddio
Talk to Dottie for help
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June 13, 2012
Formative Research (4)
Alpha testing (qualitative)
16 parents of 3 to 5 year olds, 3 ethnic groups
Most parents enjoyed
Need tutorial or directions woven into game
Improve feedback
More Kiddio facial gestures
End of episode feedback
No website feedback
Abbreviate number and wording of Values &
Reasons
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June 13, 2012
Behavior Change
components
Feedback on parenting selections
“Oreo” – positive comment, what was
wrong, positive comment
Goal Setting to do effective parenting
with own child
Select parenting practice, day, meal
Identify likely problems
Identify likely problem specific solution
Tailored motivational statement
Values, reasons
Earn points with optional leader
board
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June 13, 2012
Future (1)
Create 24 more episodes
5 levels of difficulty
Use same game design /
engine
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June 13, 2012
New Kiddio Menu (2)
Based on qualitative
research, made changes to
make more user friendly
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June 13, 2012
Future (3)
Conduct outcome evaluation RCT
Primary outcome:
Child vegetable intake
Secondary outcomes:
Child BMI
Vegetable parenting practices
Home vegetable availability
Moderating variables:
Parent BMI
Parent vegetable intake
Parenting style
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June 13, 2012
Dêkuji! (Czeck)
DANKE! (German)
MUITO OBRIGADO! (Portuguese)
M G I! (Chinese, Cantonese)
ARIGATŌ! (Japanese)
MERCI BEAUCOUP! (French)
MUCHAS GRACIAS! (Spanish)
SERDECZNIE DZIĘKUJĘ! (Polish)
SHUKRAN! (Arabic, Middle East)
TACK SÅMYCKET! (Swedish)
TAKK! (Norwegian)
EFcHARISTo! (Greek)
Xie Xie! (Chinese, Mandarin)
Dank u wel (Dutch)
Khawp Khun maxh! (Thai)
Grazie! (Italian)
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June 13, 2012
Formative Research
Model of Goal Directed Behavior
Attitudes toward VPP
Positive anticipated Desire (motivation) Intentions to use
emotions regarding VPP to use VPP VPP
Negative anticipated
emotions regarding VPP
Subjective norms Perceived behavioral
related to VPP control regarding VPP
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June 13, 2012
Future (1)
Offer as an app in the
iTunes App store to get
consumer feedback
Notas del editor
Lots of interest in increasing vegetable intake in U.S.Dietary guidelines emphasizes FV intakePart of the Healthy People 2020 recommendationsAnd our new My Plate logo – ½ meal from FV (not including dairy)Reason for all this interest…related to V decreasing the risk for all these diseases
Research from Leann Birch (70’s-80’s) showed:What you eat is what you preferKids eat what they likePreferences are formed early in lifeParents are huge influences with all things related to their young child, including foodCommon parent complaint…can’t get child to eat FVmore for V not F, since F is sweet
Our group at CNRC doing extensive research on parenting practices in relationship to dietary, PA and screen media behaviors.We are capitalizing on that research to develop KiddioParenting Style (authoritarian, authoritative, permissive, neglectful) is not amenable to changeIt is the attitude the parent brings to parentingParenting practices are specific behaviors that parents use to influence their child’s behavior – Practices appear amenable to changeWe also know from our research that there are effective and ineffective parenting practicesOur goal – to help parents use the effective pp to get their child to eat V
So, how do we train parents in using effective parenting practices?PP are skilled behaviors and simulation methods have been used in the training of skilled behaviorsEx: airplane, surgery, patientsVideo games can and many do include simulations as part of the game experienceSo we created a prototype of a fun game using simulations to help parents learn VPPWe also know that the literature on adult learning suggests that adults learn best if they select the behaviors they work on and then give them feedback
In our initial planning for the game, we found there wasn’t much literature on what are effective and ineffective pp to include in a game such as oursWe know that children differ in temperaments and parents likely need to take this into account to be effectiveSince temperament is a key child variable - we wanted child in game to respond like theirsBut the shortest child temp Q is 36-items - too long for a short casual gameWe wanted to include motivational variables to motivate parents to do the behaviorsSelf Determination Theory indicates that people do behaviors consistent with their valuesSo need identify values related to VPP and identify reasons statement that link behaviors to values and test to make sure they make sense to parents
In our first formative study, we took pp from nominal group research done by Hughes, et al and asked Pediatricians and other health practitioners and educators to rate these practicesQ we asked….Information from this survey identified the effective and ineffective pp we used in the Kiddio game
In our 2nd formative study we tackled the 36-item Child Temperament Q and distilled the key points in each of the 3 child temperament scalesNarrowed down characteristics into 3 simple statements. Tested our 3 short statements against the 36-item to validate.Got good patterns of correlation, so 3 short statements will work in game to identify the child temperament
Our 3rd formative study, we took value statements from those most commonly used with research done with teenagers.And took our related reason statements we tested and adapted from DIAB & NANO game with kidsAsked parents to evaluate themBased on parents comments, we adapted them to VPP
Based on parents comments, we narrowed it down to these 4 values adapted to VPP
And from our research with the parents we adapted these reasonsThis is an example of the reason statements for the value “Raising a healthy child”
Taking all of our formative research we developed a pilot VPP game with the following features:
And this is what our initial VPP game looked like
Here’s an example of one of our shortened child temperament statements that we tested with parents
Tested 3 storylines with parents and they liked the “Friend Dottie” best to give them help with getting their 3- 5 year old child to eat vegetables
Parents were able to scroll through a number of options to choose to say to try to get Kiddio to taste the vegetable on their plate
Kiddio immediately reacted to the selected statements according to the child temperament the parent selected during the game set-up
In addition, other things they could do in the game to influence the outcome…
Our formative study 5 had parents play Kiddio and give us feedback
Based on FS#5 we want to develop better feedback for the parents Research suggests that negative feedback works best when “sandwiched” between positive feedback.And since goal setting appears to be important behavior change procedure with adultsWe want to enhance this part of the gameSince GS allows parents to use what they learned in game to practice in real world with their childMajor part of “gamification” is competition, so if parents want they can subscribe to leader board to compete against themselves or others.
Based on our pilot research and hopefully feedback from the iTune store purchasers…
Some of the things currently in the works for refining the game’s interface include…
Once we have all 25 episodes developed we want to do a randomized clinical trial to test Kiddio’s effectiveness
ThanksAny questions?
So what are our future plans?Look for Kiddio-Lite in the iTunes app store in the next month