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Supporting Social Innovation in Children: Developing a Game to Promote Health Eating

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Two things often observed in children: (1) many do not eat a healthy diet and (2) they like playing video-games. Game-based learning has proven to be an effective method for attitude change, and thus has the potential to influence children's eating habits. This study looks at how, through a series of workshop activities, children themselves can inform the design of such games. Using a co-constructive approach, the study's format promotes creativity and control, enabling children to act as valuable informants for its design. Patterns emerging from the study show that children do indeed understand the concept of healthy eating. Future phases of this work will explore whether they understand how various foods affect their bodies. This information will then inform the design of a video-game that encourages healthy eating.
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Supporting Social Innovation in
Children: Developing a Game to
Promote Health Eating
Abstract
Two things often observed in children: (1) many do not
eat a healthy diet and (2) they like playing video-
games. Game-based learning has proven to be an
effective method for attitude change, and thus has the
potential to influence children’s eating habits. This
study looks at how, through a series of workshop
activities, children themselves can inform the design of
such games. Using a co-constructive approach, the
study’s format promotes creativity and control,
enabling children to act as valuable informants for its
design. Patterns emerging from the study show that
children do indeed understand the concept of healthy
eating. Future phases of this work will explore whether
they understand how various foods affect their bodies.
This information will then inform the design of a video-
game that encourages healthy eating.
Author Keywords
Co-Design; Social Innovation; Children Games; Healthy
Eating
ACM Classification Keywords
H.5.m. Information interfaces and presentation (e.g.,
HCI): Miscellaneous.
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Copyright is held by the owner/author(s).
IDC '16, June 21-24, 2016, Manchester, United Kingdom
ACM 978-1-4503-4313-8/16/06.
http://dx.doi.org/10.1145/2930674.2935980
Nora Ptakauskaite
University of Edinburgh
Informatics Forum, Crichton St
Edinburgh EH8 9AB, UK
s1111477@sms.ed.ac.uk
Priscilla Chueng-Nainby
University of Edinburgh
Informatics Forum, Crichton St
Edinburgh EH8 9AB, UK
p.chuengnainby@ed.ac.uk
Helen Pain
University of Edinburgh
Informatics Forum, Crichton St
Edinburgh EH8 9AB, UK
helen.pain@ed.ac.uk
688
Introduction
The rising number of obese children worldwide,
combined with an increasing prevalence of type 2
Diabetes, underscores the presence of a public health
issue related to children’s poor eating habits [1].
Numerous policies have been put forward to promote
healthy eating in children. Unfortunately, only a few
such standard interventions have been effective [2].
Game-based technology has been shown to be a
successful tool for teaching children, and has also been
shown to impact their attitudes [3]. Children are more
motivated to spend time interacting with serious video-
games (designed for learning) than with standard
learning tools due to the gamesentertaining and
engaging properties. They allow users to interact with
learning materials through exploring virtual
environments and engaging with in-game characters
and the gamesnarratives [4]. Some of these games
empower children by enabling them to make their own
choices in a safe and controlled environment. The
children can see how the decisions they make in the
game influence their outcomes, in turn giving them a
sense of control over their own learning [5].
The particular focus of this research is on designing
Healthy-Eating Games for Children that support the
National Health Service’s (NHS) change4life initiative
(see http://www.nhs.uk/change4life). It is currently an
exploratory study that forms the foundation for the
design of an educational game that will help children
better understand what healthy eating is and its impact
on them. This paper describes the design approach
used in the research and how it relates to workshop
activities. A brief summary of the results and their
analysis are also given.
Design Approach
In the first phase of this research, co-construction
activities were implemented through which the
following questions were addressed:
1. What are children's ideas in relation to healthy
eating?
2. If they were to design a game to encourage
healthy eating, what form might that game take?
These questions were addressed through a workshop
involving co-construction by children aged between 7
and 12 years. The children were given the opportunity
to participate in social innovation by actively
contributing to the design of the game. Of the many
different roles they could have been assigned (i.e.,
design informants, full-design partners, testers, etc.),
in this study their task was to inform the design,
contributing their own perspectives on the questions in
focus [6, 7].
In this workshop, instead of using conventional social
research methods such as interview or questionnaire,
we adopt visualisation tools from the Collective
Imagery Framework [6, 7] to engage the children in
telling their stories, thereby informing more specific
design goals. In this framework the researchers act as
facilitators of the design process, encouraging
contributions from child participants whilst enabling
creativity. Working with their peers, the children
interacted with Collective Imagery Weave (see Figure
1) to tell their stories (in keywords, drawings or verbal
narration) to express their opinions about healthy
eating. These were then analyzed to identify ideas for
game development.
Figure 1. The installation used
during the workshop activity
(top) and children interacting
with the installation (bottom).
689
Workshop Activity
The goal of the workshop activities was to gain insight
into children’s attitudes towards healthy eating and
video-games.
Selection and Participation of Children
The participants were 10 children (7 males, 3 females)
aged between 7 and 12. They were recruited through a
database of families willing to participate in such
studies. All were white Caucasian, from higher SES
backgrounds. University ethical approval was obtained.
Materials
A physical installation termed Collective Imagery
Weaves was used to gather the data (see Figure 1) [6,
7]. A series of questions was presented on paper tags
that were tied on to a physical installation made of
bamboo sticks and rattan loops. Unlike standard
questionnaires and interviews, this interactive method
presents questions in short sentences, and in a child
friendly manner. The content is drawn or written by
hand (see Figure 2 for example questions). This allows
for the questions to be visually deconstructed into a
smaller number of queries, facilitating short narratives.
These in turn make it easier for young responders to
address the questions directly from their own
experiences, as well as to relate their experiences to
them.
Furthermore, by presenting the questions as tags on
the installation, rather than being asked directly by the
facilitator, there is decreased likelihood of response
bias, that is, of children responding with what they
believe the facilitator wants to hear [8].
Four sub-groups of questions were used to prime
children in their thinking about healthy eating, and to
help orient them to designing games to support this.
The questions related to their favourite foods, what
they perceived healthy eating to be, attitudes towards
video-games and designing a game for healthy eating.
Additionally, there was a set of questions asking
children about their favourite sweets and benefits or
dangers of playing video-games. The tags with
questions on eating habits also included pictures of
both healthy and unhealthy foods (see Figure 2), acting
as reminders of what children tend to eat, which might
not always be healthy. These questions and the
drawings should further guard against socially desirable
responding.
Procedure
The participants were instructed to choose and answer
as many questions as they liked. They were asked to
start from the left side of the structure (the beginning)
since the questions presented at the start acted as
primes for the more conceptually difficult ones, which
were presented later. If the child could not read, the
questions were read aloud by the facilitator. Again, the
goal here was to get the children to think about healthy
eating.
After choosing a question, the children took a blank tag
and wrote down or drew (to avoid any issues with
literacy levels) their answers, together with the
question number and their names or initials.
Alternatively, if children could not express their ideas in
writing or drawing at all, the facilitator could write the
answers for them. The child was instructed to attach
Favourite
foods:
1. What is your
favourite food?
2. What is your
favourite fruit?
3. What is your
favourite
vegetable?
4. What is your
favourite sweet?
Attitudes
towards video
games:
1. Do you like
playing
videogames?
2. What do you
use to play
videogames:
phone, tablet,
computer?
3. Name some
videogames that
you like to play?
Figure 2. Examples of questions
presented to the children.
690
their tag to the weave next to the tag containing the
question after they completed their answer.
To promote collective and collaborative creativity, the
children were free to talk and discuss their answers
with other participants and the facilitators. The
children’s interactions with the installation and each
other were video recorded for later analysis.
Results
The prime data source was the answers written or
drawn on the tags (see Figure 3). These were
supplemented by the transcribed comments from the
video recordings. The actions of the children and their
interactions with the installation were not analysed for
the purposes of this study. The responses in relation to
the questions posed were collated across children, as
summarised below.
At the beginning of the workshop the children answered
questions related to their attitudes towards food in
general, and healthy eating in particular. For example,
in response to ‘What is healthy eating?’, two of the
children replied:
“A balanced diet overall”
“Healthy eating is when you eat a minimum of
fat, sugar, etc…”
Additionally, responses to the question ‘What is junk
food’ were:
“KFC, Burger King, McDonald’s”
“Everything with a high content of fat”
When asked what they would pick if they had to choose
between sweets and fruit, all of the children indicated
they would select fruit.
When asked if they were trying to eat healthily, the
answers were more mixed:
“Yes”
“I try to eat healthily every day”
“Only if I like it”
One of the children drew scales to indicate that she
tried to balance healthy food with unhealthy food (i.e.,
eat enough vegetables as well as some sweets).
Notably, an answer given to the question ‘Is meat good
for you?’ by a vegetarian child was:
“Not too good”
Another set of questions focused on the children’s
attitudes towards video-games. When asked if they
played or liked playing video-games the answer was
unanimously “Yes”, where all of the children had the
experience of playing Minecraft.
They were using computers, tablets, and smartphones
for playing video-games, where some of the older
children were also using game consoles. One of the
children’s answer to the question of ’What do you
like/dislike the most about video-games’ was:
Like: “Pause reality”
Dislike: “Addictive”
Interestingly, for the question ‘Do you like playing
video-games with others?’ her answer was:
How often do you try to eat
healthily?
What is junk food?
What is your favourite fruit?
Figure 3. Example answers given
by the children.
691
“Okay, if others know the game”
Finally, when asked to choose between different
interfaces for a game on healthy eating, the children
said that it would have to be either similar to Minecraft
or to another RPG or flash mini-game. One of the
children suggested using Minecraft or a similar game in
which the players could grow and cook food, and the
information on healthy eating could be incorporated
into the game’s narrative. Another child suggested that
the effects of different types of food could be
communicated through influencing the in-game
character’s abilities based on what they eat.
Discussion
The children in this study displayed a general
understanding of what healthy eating is and indicated
that they try to eat healthily most of the time. Some of
them have even displayed knowledge involving
nutritional information, such as that a healthy diet
should be nutritionally balanced and include fewer
foods that are high in sugar and fats. In this study, the
children here were not asked questions directly about
how unhealthy foods might affect their bodies.
In order to provide all children with the opportunity to
contribute, they were encouraged to draw their
answers, as some of them did not have the required
level of literacy. The ability to draw their answers
promoted inclusion and confidence, which in turn made
it easier for them to relate the questions to their own
experiences and express themselves.
It was observed that the Collective Imagery Weaves
Framework used in this study promoted interaction and
collaboration between children. It gave them the means
to connect through participation in the same activity.
The children exchanged and discussed their answers
vocally, and in writing, as well as in drawing (they
could see each other’s tags on the weaves). They
appeared to find it easy to understand how to engage
with the installation, which added to the creative and
rather informal atmosphere of the workshop. The
approach served to facilitate their contribution to the
design process, and to support their creativity. The
installation has therefore enhanced the children’s
interactive experiences and by doing so, enriched the
study’s results.
The answers and comments given by the children can
also be used to inform the design of a healthy eating
video-game. For example, one of the children
suggested that the game could use a system where the
character’s performance in the game would be
influenced by the types of foods it consumed. One of
the ways this advice could be used is by showing
children how sugar consumption can result in
hyperactivity and difficulty in paying attention [10].
Additionally, one of the children indicated that it can
sometimes be frustrating when the other person does
not know how to play the game. Therefore, the game’s
interface will need to be simple and intuitive, especially
if it will include a multiplayer option.
Finally, a key issue to consider when investigating
children’s eating habits is to find out whether they are
vegan or vegetarian. Dietary biases such as these could
influence responses. Not all of the children will view
meat or other animal-related products in the same
way, for example. Equally importantly, it is necessary
to include participants from all SES groups, since
692
children from lower SES backgrounds are more likely to
have less access to information relating to healthy
eating, as well as having poorer diets [11].
Interim Conclusion
Overall, children in this study exhibited a general
understanding of what healthy eating is. They knew
that they should eat a balanced diet in order to stay
healthy. Some of them even knew the nutritional
aspects of healthy foods. The next question to be
considered is whether children understand the impact
and consequences of unhealthy eating habits.
As such, future research relating to this study will
explore what children believe the consequences of
eating different types of food to be. This information
will then be used to design a video-game for children
about healthy eating, and how different types of food
(i.e., sugar) affect their bodies. A longer term research
question is whether this translates into action in daily
eating, and what features can be incorporated into
games to influence this.
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Objectives: This study aimed to gain an in-depth understanding of children's perceptions of sugar-sweetened beverages (SSBs). Design: Nine focus groups were conducted in grade 5 and 6 elementary schoolchildren. Setting: Nine urban and rural elementary schools in London, Ontario, Canada. Participants: Fifty-one children, 58% of which were male, 52% of whom were in grade 5, and 84% of whom were Caucasian. Phenomenon of interest: Children's views on sugar-sweetened beverages. Analysis: Three researchers conducted inductive content analysis on the data independently using the principles of the immersion-crystallization method. Results: Participants had a high level of awareness of beverages and their health effects, which was primarily targeted at the sugar content. Dominant factors that influenced children's beverage choices and consumption patterns included taste, parental control practices, accessibility, and advertising. Participants identified a wide array of strategies to reduce SSB consumption in children, including educational strategies for both children and parents and policy-level changes at both the government and school levels. Conclusions and implications: Despite a high level of awareness of SSBs, children believed that further education and policies regarding SSBs were warranted. These data may prove helpful in designing effective interventions targeted at children and parents to reduce SSB consumption by children.
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Children have participated in the design of new technologies intended for children using diverse methods, in differing contexts, with varying degrees of involvement. This participation can be characterized as involving children as users, testers, informants, or design partners. Only relatively recently have researchers around the world begun to work more substantively with children to design technologies for children. Methods and Techniques for Involving Children in the Design of New Technology for Children synthesizes prior work involving children as informants and design partners, and describes the emergence of participatory design methods and techniques for children. It considers the various roles children have played in the design process, with a focus on those that integrally involve children throughout the process. It summarizes and provides a pragmatic foundation for researchers and practitioners to use several methods and techniques for designing technologies with and for children. It relates the techniques to the design goals they help fulfil and concludes with a consideration of working with children in technology design processes as we move into the future.
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Designers of children's technology and software face distinctive challenges. Many design principles used for adult interfaces cannot be applied to children's products because the needs, skills, and expectations of this user population are drastically different than those of adults. In recent years, designers have started developing design principles for children, but this work has not been collected in one place. This paper takes a first step towards this goal: based on an analysis of a wide range of research into children's technology, we present a catalogue of design principles for children's technology that are oriented towards the needs of designers.
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Video games designed to promote behavior change are a promising venue to enable children to learn healthier behaviors. Evaluate outcome from playing "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) video games on children's diet, physical activity, and adiposity. Two-group RCT; assessments occurred at baseline, immediately after Diab, immediately after Nano, and 2 months later. Data were collected in 2008-2009, and analyses were conducted in 2009-2010. 133 children aged 10-12 years, initially between 50th percentile and 95th percentile BMI. Treatment group played Diab and Nano in sequence. Control Group played diet and physical activity knowledge-based games on popular websites. Servings of fruit, vegetable, and water; minutes of moderate to vigorous physical activity. At each point of assessment: 3 nonconsecutive days of 24-hour dietary recalls; 5 consecutive days of physical activity using accelerometers; and assessment of height, weight, waist circumference, and triceps skinfold. A repeated measures ANCOVA was conducted (analyzed in 2009-2010). Children playing these video games increased fruit and vegetable consumption by about 0.67 servings per day (p<0.018) but not water and moderate-to-vigorous physical activity, or body composition. Playing Diab and Nano resulted in an increase in fruit and vegetable intake. Research is needed on the optimal design of video game components to maximize change.
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When examining health risks associated with the BMI, investigators often rely on the customary BMI thresholds of the 1995 World Health Organization report. However, within-interval variations in morbidity and mortality can be substantial, and the thresholds do not necessarily correspond to identifiable risk increases. Comparing the prevalence of hypertension, diabetes, coronary heart disease (CHD), asthma, and arthritis among non-Hispanic whites, blacks, East Asians and Hispanics, we examine differences in the BMI-health-risk relationships for small BMI increments. The analysis is based on 11 years of data of the National Health Interview Survey (NHIS), with a sample size of 337,375 for the combined 1997-2007 Sample Adult. The analysis uses multivariate logistic regression models, employing a nonparametric approach to modeling the BMI-health-risk relationship, while relying on narrowly defined BMI categories. Rising BMI levels are associated with higher levels of chronic disease burdens in four major racial and ethnic groups, even after adjusting for many socio-demographic characteristics and three important health-related behaviors (smoking, physical activity, alcohol consumption). For all population groups, except East Asians, a modestly higher disease risk was noted for persons with a BMI <20 compared with persons with BMI in the range of 20-21. Using five chronic conditions as risk criteria, a categorization of the BMI into normal weight, overweight, or obesity appears arbitrary. Although the prevalence of disease risks differs among racial and ethnic groups regardless of BMI levels, the evidence presented here does not support the notion that the BMI-health-risk profile of East Asians and others warrants race-specific BMI cutoff points.
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One of the main primary data collection instruments in social, health and epidemiological research is the survey questionnaire. Modes of data collection by questionnaire differ in several ways, including the method of contacting respondents, the medium of delivering the questionnaire to respondents, and the administration of the questions. These are likely to have different effects on the quality of the data collected. This paper is based on a narrative review of systematic and non-systematic searches of the literature on the effects of mode of questionnaire administration on data quality. Within different modes of questionnaire administration, there were many documented potential, biasing influences on the responses obtained. These were greatest between different types of mode (e.g. self-administered versus interview modes), rather than within modes. It can be difficult to separate out the effects of the different influences, at different levels. The biasing effects of mode of questionnaire administration has important implications for research methodology, the validity of the results of research, and for the soundness of public policy developed from evidence using questionnaire-based research. All users of questionnaires need to be aware of these potential effects on their data.