Engaging low-income African American adolescents in a virtual avatar-based nutrition education program

Childhood obesity is a serious public health concern, with minority, low-income adolescents disproportionately affected and at the greatest risk. In addition, as adolescents gain independence, dietary quality declines with youth eating more energy-dense foods away from home, increasing the risk of overweight and obesity, and other adverse health conditions. Studies have demonstrated that African American adolescents consume more added sugar, fried foods, sweetened beverages, and snack foods than non-Hispanic White adolescents. Effective, culturally tailored interventions to improve African American adolescents’ dietary intake are limited. In addition, implementing in-person community-based nutrition programs often requires significant labor and financial resources. However, compared with traditional face-to-face nutrition education, youth have reported a preference for digital health promotion programs. The use of digital technology and media is pervasive among youth, with low-income adolescents using digital devices roughly two hours more per day than adolescents of higher income. Adolescents communicate via digital technology and view it as a source of entertainment, socialization, and active learning. Youth avidly use avatars, or digital characters, to engage with digital media and strongly identify with avatars as extensions of themselves. Thus, this research examines the use of a technology-based virtual reality (VR) avatar-led health promotion program among adolescents. The specific objectives of this research are to (1) assess the appeal of a VR avatar-based nutrition education program among African American adolescents and their parents and, identify necessary modifications to impact dietary behaviors, (2) identify factors associated with the adoption and dissemination of a VR avatar-based nutrition education program among community agency partners and (3a) quantitatively assess the acceptability of the VR avatar-based nutrition education program among African American youth and (3b) explore if interaction with the avatar impact’s dietary responses. This research utilized a mixed-method approach, consisting of formative research, a cross-sectional survey, and a quantitative formative process evaluation to address these objectives. Focus groups and in-depth interviews with predominantly (84.6%) low-income African American adolescents age 12.38 ± 1.02 (n=37) and parents (n=11) revealed positive interest in the VR avatar-based nutrition education program. Adolescents found the use of avatars to provide health guidance appealing. Most youth and parents agreed that the program would impact their dietary behaviors. Adolescents also suggested a theme-based storyline, a points-based reward system, challenges, music customization, and avatar customization to increase and sustain program engagement. Parents desired exploration of cultural foods, cooking skills development, and for youth to see themselves reflected in the program to foster cultural identity. For the cross-sectional survey, one hundred community agency partners who served families in all one hundred counties in North Carolina responded. The majority of community partners were affiliated with hospital systems (27%), school systems (27%), or health departments (16%). Overall perceptions of the VR avatar nutrition education program were favorable among community partners. Community partners who perceived the VR avatar nutrition program as a relative advantage to current programs (p < 0.05) and compatible (p < 0.001) with organizational and personal values had significantly higher future use intention. There were no statistically significant differences in future use intention observed by agency type, the age range of youth served, current use of digital tools to teach nutrition education (NE), early adopter status, organizational support for technology, or role in the adoption of new nutrition programs. Finally, we conducted a quantitative formative process evaluation with thirty-nine low-income youth, who were majority African American (79.5%), and an average age of 11.06 ± 1.79 years old. Findings revealed that overall program appeal and usability were favorable, with the majority of youth reporting the VR avatar program was fun to use (84.6%), overall easy to use (92.3%), would be useful in daily life (79.4%), would use the program often if it becomes available (71.8%), intend to use when it becomes available (66.7%), and would recommend the VR avatar program to a friend (92.3%). Significantly more youth with smartphones agreed the VR avatar program would increase confidence to eat healthy (p=0.013, d=0.322), would be useful in daily life (p=0.020, d=0.298), and intend to regularly use the program when it becomes available (p=0.002, d=0.415), compared to youth without smartphones. There was a weak positive statistically significant association between VR avatar program fruit servings and the FV screener fruit servings (r = 0.363, p = 0.023), indicating the VR avatar program does not appear to impact responses regarding fruit intake among low-income youth. These findings demonstrate the appeal of the VR avatar nutrition education program among African American adolescents and the potentiality of the program to impact dietary behaviors. Community organizations also view the VR avatar nutrition education program as an advantage compared to current programs and as compatible with organizational and personal values. Utilizing these findings can help guide the development of a culturally tailored-avatar-led digital nutrition program, as well as future nutrition education and health promotion research and programming. Furthermore, considering the factors identified in this study will help the adoption and dissemination of digital nutrition education programs among community partners who serve low-income families

Assessment of Interest in a Virtual Avatar-Based Nutrition Education Program Among Youth-Serving Community Partners

Objective Examine the appeal of a virtual avatar-led nutrition education program among youth-serving community partners in North Carolina. Methods We surveyed community partners using the Diffusion of Innovation Theory constructs of relative advantage, compatibility, and complexity. Logistic regression evaluated the appeal and likelihood of the program\u27s future use. Results Community partners (n = 100) agreed that the program was an innovative (87%) and convenient (85%) way for youth and parents to learn about nutrition. Partners who perceived the program as a relative advantage to current programs had significantly higher odds of future use intention (P = 0.005). Those who found it compatible with organizational and personal values had significantly higher odds of future use (P \u3c 0.001). Conclusions and implications A nutrition education virtual avatar program is of interest to youth-engaged community partners. Future research examining the potential integration of this type of program within community organizations is warranted

EatWellNow: Formative Development of a Place-Based Behavioral “Nudge” Technology Intervention to Promote Healthier Food Purchases among Army Soldiers

Approximately 17% of military service members are obese. Research involving army soldiers suggests a lack of awareness of healthy foods on post. Innovative approaches are needed to change interactions with the military food environment. Two complementary technological methods to raise awareness are geofencing (deliver banner ads with website links) and Bluetooth beacons (real-time geotargeted messages to mobile phones that enter a designated space). There is little published literature regarding the feasibility of this approach to promote healthy behaviors in retail food environments. Thus, we conducted a formative feasibility study of a military post to understand the development, interest in, and implementation of EatWellNow, a multi-layered interactive food environment approach using contextual messaging to improve food purchasing decisions within the military food environment. We measured success based on outcomes of a formative evaluation, including process, resources, management, and scientific assessment. We also report data on interest in the approach from a Fort Bragg community health assessment survey (n = 3281). Most respondents agreed that they were interested in receiving push notifications on their phone about healthy options on post (64.5%) and that receiving these messages would help them eat healthier (68.3%). EatWellNow was successfully developed through cross-sector collaboration and was well received in this military environment, suggesting feasibility in this setting. Future work should examine the impact of EatWellNow on military service food purchases and dietary behaviors

Extended Reality Technologies in Nutrition Education and Behavior: Comprehensive Scoping Review and Future Directions

The use of Extended Reality (XR) (i.e. Virtual and Augmented Reality) for nutrition education and behavior change has not been comprehensively reviewed. This paper presents findings from a scoping review of current published research. Articles (n = 92) were extracted from PubMed and Scopus using a structured search strategy and selection approach. Pertinent study information was extracted using a standardized data collection form. Each article was independently reviewed and coded by two members of the research team, who then met to resolve any coding discrepancies. There is an increasing trend in publication in this area, mostly regarding Virtual Reality. Most studies used developmental testing in a lab setting, employed descriptive or observational methods, and focused on momentary behavior change like food selection rather than education. The growth and diversity of XR studies suggest the potential of this approach. There is a need and opportunity for more XR technology focused on children and other foundational theoretical determinants of behavior change to be addressed within nutrition education. Our findings suggest that XR technology is a burgeoning approach in the field of nutrition, but important gaps remain, including inadequate methodological rigor, community application, and assessment of the impact on dietary behaviors