The effectiveness of asking behaviors among 9-11 year-old children in increasing home availability and children's intake of fruit and vegetables : results from the Squire's Quest II self-regulation game intervention

Background: Home environment has an important influence on children's fruit and vegetable (FV) consumption, but children may in turn also impact their home FV environment, e.g. by asking for FV. The Squire's Quest II serious game intervention aimed to increase asking behaviors to improve home FV availability and children's FV intake. This study's aims were to assess: 1) did asking behaviors at baseline predict home FV availability at baseline (T0) (RQ1); 2) were asking behaviors and home FV availability influenced by the intervention (RQ2); 3) did increases in asking behaviors predict increased home FV availability (RQ3); and 4) did increases in asking behaviors and increases in home FV availability mediate increases in FV intake among children (RQ4)? Methods: This is a secondary analysis of a study using a randomized controlled trial, with 4 groups (each n = 100 child-parent dyads). All groups were analyzed together for this paper since groups did not vary on components relevant to our analysis. All children and parents (n = 400 dyads) received a self-regulation serious game intervention and parent material. The intervention ran for three months. Measurements were taken at baseline, immediately after intervention and at 3-month follow-up. Asking behavior and home FV availability were measured using questionnaires; child FV intake was measured using 24-h dietary recalls. ANCOVA methods (research question 1), linear mixed-effect models (research question 2), and Structural Equation Modeling (research questions 3 and 4) were used. Results: Baseline child asking behaviors predicted baseline home FV availability. The intervention increased child asking behaviors and home FV availability. Increases in child asking behaviors, however, did not predict increased home FV availability. Increased child asking behaviors and home FV availability also did not mediate the increases in child FV intake. Conclusions: Children influence their home FV environment through their asking behaviors, which can be enhanced via a serious game intervention. The obtained increases in asking behavior were, however, insufficient to affect home FV availability or intake. Other factors, such as child preferences, sample characteristics, intervention duration and parental direct involvement may play a role and warrant examination in future research

Is participatory design associated with the effectiveness of serious digital games for healthy lifestyle promotion? : a meta-analysis

Background: Serious digital games can be effective at changing healthy lifestyles, but large differences in their effectiveness exist. The extent of user involvement in game design may contribute to game effectiveness by creating a better fit with user preferences. Participatory design (PD), which represents active user involvement as informant (ie, users are asked for input and feedback) or codesigner (ie, users as equal partners in the design) early on and throughout the game development, may be associated with higher game effectiveness, as opposed to no user involvement or limited user involvement. Objective: This paper reports the results of a meta-analysis examining the moderating role of PD in the effectiveness of serious digital games for healthy lifestyle promotion. Methods: Four databases were searched for peer-reviewed papers in English that were published or in press before October 2014, using a (group-) randomized controlled trial design. Effectiveness data were derived from another meta-analysis assessing the role of behavior change techniques and game features in serious game effectiveness. Results: A total of 58 games evaluated in 61 studies were included. As previously reported, serious digital games had positive effects on healthy lifestyles and their determinants. Unexpectedly, PD (g=0.075, 95% CI 0.017 to 0.133) throughout game development was related to lower game effectiveness on behavior (Q=6.74, P<.05) than when users were only involved as testers (g=0.520, 95% CI 0.150 to 0.890, P<.01). Games developed with PD (g=0.171, 95% CI 0.061 to 0.281, P<.01) were also related to lower game effectiveness on self-efficacy (Q=7.83, P<.05) than when users were not involved in game design (g=0.384, 95% CI 0.283 to 0.485, P<.001). Some differences were noted depending on age group, publication year of the study, and on the specific role in PD (ie, informant or codesigner), and depending on the game design element. Games developed with PD were more effective in changing behavioral determinants when they included users in design elements on game dynamics (beta=.215, 95% CI .075 to .356, P<.01) and, more specifically, as an informant (beta=.235, 95% CI .079 to .329, P<.01). Involving users as informants in PD to create game levels was also related to higher game effectiveness (Q=7.02, P<.01). Codesign was related to higher effectiveness when used to create the game challenge (Q=11.23, P<.01), but to lower game effectiveness when used to create characters (Q=4.36, P<.05) and the game world (Q=3.99, P<.05). Conclusions: The findings do not support higher effectiveness of games developed with PD. However, significant differences existed among PD games. More support was found for informant roles than for codesign roles. When PD was applied to game dynamics, levels, and game challenge, this was associated with higher effectiveness than when it was applied to game aesthetics. Since user involvement may have an important influence on reach, adoption, and implementation of the intervention, further research and design efforts are needed to enhance effectiveness of serious games developed with PD

Distance to food stores & adolescent male fruit and vegetable consumption: mediation effects

<p>Abstract</p> <p>Background</p> <p>The physical environments in which adolescents reside and their access to food stores may influence their consumption of fruit and vegetables. This association could either be direct or mediated via psychosocial variables or home availability of fruit and vegetables. A greater understanding of these associations would aide the design of new interventions. The purpose of this study was to examine associations between distance to food stores and restaurants and fruit and vegetable consumption and the possible mediating role of psychosocial variables and home availability.</p> <p>Methods</p> <p>Fruit and vegetable consumption of 204 Boy Scouts was assessed by a food frequency questionnaire in 2003. Participant addresses were geo-coded and distance to different types of food stores and restaurants calculated. Fruit and vegetable preferences, home availability and self-efficacy were measured. Regression models were run with backward deletion of non-significant environmental and psychosocial variables. Mediation tests were performed.</p> <p>Results</p> <p>Residing further away from a small food store (SFS) (convenience store and drug store) was associated with increased fruit and juice and low fat vegetable consumption. Residing closer to a fast food restaurant was associated with increased high fat vegetable and fruit and juice consumption. Vegetable preferences partially mediated (26%) the relationship between low fat vegetable consumption and distance to the nearest SFS.</p> <p>Conclusion</p> <p>Distance to SFS and fast food restaurants were associated with fruit and vegetable consumption among male adolescents. Vegetable preferences partially mediated the distance to low fat vegetable relationship. More research is needed to elucidate how environmental variables impact children's dietary intake.</p

Individual, social and environmental determinants of sleep among women : protocol for a systematic review and meta-analysis

Introduction: Sleep is important to promote optimal health and avoid negative health outcomes. Short-duration and low-quality sleep may be more common and more detrimental among women compared with men. Identifying the determinants of behaviour is one of the first steps in designing effective interventions. To our knowledge, no systematic review has identified the individual, social and environmental determinants of sleep among adult women. Methods and analysis: Studies reporting data on adult women from 18 to 64 years of age will be included. On the basis of ecological models of health behaviour and sleep, the types of determinants that will be included in the review are individual (eg, demographic, psychological and behavioural), social (eg, family) and environmental (eg, physical environment and policies) determinants. Observational (cross-sectional and longitudinal) and experimental studies will be included. MEDLINE/PubMed, PsycINFO, CINAHL, EMBASE and Proquest Dissertations and Theses will be investigated. Data will be extracted independently by two reviewers using a standardised data extraction form. The quality of observational studies will be assessed using the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the quality of experimental studies will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Study. If there is a sufficient number of studies reporting data on a similar determinant among a similar population (k>5), a meta-analysis of the results will be performed with a random-effects model. If between-study heterogeneity is high (I² ≥75%), it will be investigated through sensitivity analyses and meta-regression. Ethics and dissemination: Formal ethical approval is not required as no primary data will be collected. The results will be published in a peer-reviewed journal. This review will provide valuable information to those interested in developing empirically based sleep interventions among women

Effects of goal setting on dietary and physical activity changes in the Boy Scout badge projects.

Background: This study evaluates the relationship of goal setting to low-fat vegetable (LV) and fruit/100% juice (FJ) consumption and physical activity (PA) change. Methods: A total of 473 10- to 14-year-old Boy Scouts from Houston took part in a 9-week intervention. A two-group (LV and FJ or PA) intervention design was used with each group serving as the control for the other. Internet-based activities included goal setting at home. Food frequencies measured dietary intake. Results: Goals attained were not related to LV intake or PA. Immediate posttest FJ consumption increased about 0.7 servings as home FJ availability increased, but social desirability of response appeared to confound reports of FJ intake at posttest 6 months assessment. Conclusions: Goals attained were not related to LV intake or PA but was related to FJ intake, but only when home FJ availability was high and the relationship was confounded by social desirability of response. Further research is needed with higher quality measures of dietary intake to clarify these relationships

Relating Use of Effective Responsive, Structure, and Non-Directive Control Vegetable Parenting Practices to Subscales from the Model of Goal Directed Behavior

Parents may positively influence children’s vegetable consumption through effective vegetable parenting practices (VPP). Research has demonstrated three dimensions of effective VPP: Effective Responsiveness, Structure, and Non-Directive Control, but there is limited research investigating each separately. This study presents the modeling of Effective Responsive, Structure, and Non-Directive Control VPP using constructs from the Model of Goal Directed Vegetable Parenting Practices (MGDVPP). Parents (n=307) completed a survey on demographics, MGDVPP constructs, and effective VPP. Block regression modeling tested three models: one for each dimension of effective VPP as the dependent variable. Independent variables included validated subscales representing MGDVPP constructs: Intention, Desire, Perceived Barriers, Autonomy, Relatedness, Self-Efficacy, Habit, Anticipated Emotions, Perceived Behavioral Control, Attitudes, and Norms. Participants were racially diverse, and a majority was female, of higher socioeconomic status, and with a male child. Effective Responsive VPP was positively related to a Habit subscale. Effective Structure VPP was positively related to a Barrier, two Habit, and an Attitude subscales. Effective Non-Directive Control VPP was positively related to being a high school or GED graduate, having younger children, a Habit, and two Intentions subscales, and negatively related to an Intentions and a Perceived Behavioral Control subscales. The adjusted R2 for the Effective Responsive, Structure, and Non-Directive Control VPP models were 0.432, 0.310, and 0.515, respectively. This was the first study to relate constructs from a theoretical model to effective VPP dimensions. Research is needed to longitudinally assess the MGDVPP and test its utility in vegetable-related interventions

Self efficacy for fruit, vegetable and water intakes: Expanded and abbreviated scales from item response modeling analyses

Objective To improve an existing measure of fruit and vegetable intake self efficacy by including items that varied on levels of difficulty, and testing a corresponding measure of water intake self efficacy. Design Cross sectional assessment. Items were modified to have easy, moderate and difficult levels of self efficacy. Classical test theory and item response modeling were applied. Setting One middle school at each of seven participating sites (Houston TX, Irvine CA, Philadelphia PA, Pittsburg PA, Portland OR, rural NC, and San Antonio TX). Subjects 714 6th grade students. Results Adding items to reflect level (low, medium, high) of self efficacy for fruit and vegetable intake achieved scale reliability and validity comparable to existing scales, but the distribution of items across the latent variable did not improve. Selecting items from among clusters of items at similar levels of difficulty along the latent variable resulted in an abbreviated scale with psychometric characteristics comparable to the full scale, except for reliability. Conclusions The abbreviated scale can reduce participant burden. Additional research is necessary to generate items that better distribute across the latent variable. Additional items may need to tap confidence in overcoming more diverse barriers to dietary intake

Design and Psychometrics for New Measures of Health-Related Quality of Life in Adults with Type 1 Diabetes: Type 1 Diabetes and Life (T1DAL)

AIMS: To use a three-phase process to develop and validate new self-report measures of diabetes-specific health-related quality of life (HRQOL) for adults with type 1 diabetes. We report on four versions of the Type 1 Diabetes and Life (T1DAL) measure for people age 18-25, 26-45, 46-60, and over 60 years. METHODS: We first conducted qualitative interviews to guide measure creation, then piloted the draft measures. We evaluated psychometric properties at six T1D Exchange Clinic Network sites via completion of T1DAL and validated measures of related constructs. Participants completed the T1DAL again in 4-6 weeks. We used psychometric data to reduce each measure to 23-27 items in length. Finally, we obtained participant feedback on the final measures. RESULTS: The T1DAL-Adult measures demonstrated good internal consistency (α=0.85-0.88) and test-retest reliability (r=0.77-0.87). Significant correlations with measures of general quality of life, generic and diabetes-specific HRQOL, diabetes burden, self-management, and glycemic control demonstrated validity. Factor analyses yielded 4-5 subscales per measure. Participants were satisfied with the final measures and reported they took 5-10 minutes to complete. CONCLUSIONS: The strong psychometric properties of the newly developed self-report T1DAL measures for adults with type 1 diabetes make them appropriate for use in clinical research and care

Development of new physical activity and sedentary behavior change self-efficacy questionnaires using item response modeling

BACKGROUND: Theoretically, increased levels of physical activity self-efficacy (PASE) should lead to increased physical activity, but few studies have reported this effect among youth. This failure may be at least partially attributable to measurement limitations. In this study, Item Response Modeling (IRM) was used to develop new physical activity and sedentary behavior change self-efficacy scales. The validity of the new scales was compared with accelerometer assessments of physical activity and sedentary behavior. METHODS: New PASE and sedentary behavior change (TV viewing, computer video game use, and telephone use) self-efficacy items were developed. The scales were completed by 714, 6(th )grade students in seven US cities. A limited number of participants (83) also wore an accelerometer for five days and provided at least 3 full days of complete data. The new scales were analyzed using Classical Test Theory (CTT) and IRM; a reduced set of items was produced with IRM and correlated with accelerometer counts per minute and minutes of sedentary, light and moderate to vigorous activity per day after school. RESULTS: The PASE items discriminated between high and low levels of PASE. Full and reduced scales were weakly correlated (r = 0.18) with accelerometer counts per minute after school for boys, with comparable associations for girls. Weaker correlations were observed between PASE and minutes of moderate to vigorous activity (r = 0.09 – 0.11). The uni-dimensionality of the sedentary scales was established by both exploratory factor analysis and the fit of items to the underlying variable and reliability was assessed across the length of the underlying variable with some limitations. The reduced sedentary behavior scales had poor reliability. The full scales were moderately correlated with light intensity physical activity after school (r = 0.17 to 0.33) and sedentary behavior (r = -0.29 to -0.12) among the boys, but not for girls. CONCLUSION: New physical activity and sedentary behavior change self-efficacy scales have fewer items than classical test theory derived alternatives and have reasonable validity for boys, but more work is needed to develop comparable scales for girls. Fitting the items to a underlying variable could be useful in tailoring interventions to this scale