Using a gamified monitoring app to change adolescents’ snack intake: the development of the REWARD app and evaluation design

Abstract

BackgroundAs the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents’ eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the ‘Snack Track School’ app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds.MethodsThe development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents.DiscussionWhen this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs).Trial registrationNCT02622165 registrated November 15, 2015 on clinicaltrials.gov.

Feasibility and impact study of a reward-based mobile application to improve adolescents’ snacking habits

“…Following previous process evaluations of mHealth interventions in adolescents and young adults, the process evaluation focused on reach and dose received (exposure and satisfaction) (65)(66)(67) . According to Saunders et al, 'reach' refers to degree to which the intended priority audience participates in the intervention; 'exposure' refers to the extent to which the participants use the intervention; and 'satisfaction' refers to the satisfaction of the participants with the programme (45,47) . Within the current intervention, reach was evaluated as the number of adolescents who downloaded the app and exposure by the frequency of use of the app.…”

Rango Cards, a digital game designed to promote a healthy diet: a randomized study protocol

“…Although this study innovates in terms of design and aims, it also has some limitations, especially because social or environmental factors may interfere with the acceptance of the game [29]. Therefore, in the process of developing Rango Cards, a comprehensive experience was designed considering target audience characteristics, autonomy, motivation, and pleasure of learning, which may increase the effectiveness of the intervention in establishing sustainable behavior changes [62,69,70].…”

“…In the first phase, a dynamic tutorial explains the function of energy in the matches. This system is fed back by the player's choices; thus, the use of healthy food/meal cards is a positive reinforcement and provides rewards (energy) to influence automatic behavior [62]. The cards for foods/meals, dietary practices, and characters are named and subdivided as follows:…”

“…An exception is the third to last phase, when a new concept is explained and a new card is introduced to the game. The possibility of making choices that lead to different endings and having performance indicators provides autonomy and increases skills and intrinsic motivation [62]. The second factor is the adopted strategy.…”

“…To increase the intervention group's motivation, an environment of challenge and social interaction will be created among the students of each school, based on a competition of time spent to finish the game. These aspects are considered important by adolescents who play games [33,62,64]. The students will be able to play Rango Cards at school and also at the time and place which are more convenient for them.…”