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      HelperFriend, a Serious Game for Promoting Healthy Lifestyle Behaviors in Children: Design and Pilot Study

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          Abstract

          Background

          The use of health games is a promising strategy for educating and promoting healthy lifestyle behaviors among children.

          Objective

          We aimed to describe the design and development of a serious game, called HelperFriend, and evaluate its feasibility, acceptability, and preliminary effects in children in a pilot study. HelperFriend is a vicarious experiential video game designed to promote 3 lifestyle behaviors among young children: physical activity, healthy eating, and socioemotional wellness.

          Methods

          Participants aged 8 to 11 years were recruited from an elementary school and randomized to receive a healthy lifestyle behavior educational talk (control) or play six 30-minute sessions with HelperFriend (intervention). Assessments were conducted at baseline (T0) and after the intervention (ie, 4 weeks) (T1). The primary outcome was gain in knowledge. The secondary outcomes were intention to conduct healthy behaviors, dietary intake, and player satisfaction.

          Results

          Knowledge scores of intervention group participants increased from T0 to T1 for physical activity ( t 14=2.01, P=.03), healthy eating ( t 14=3.14, P=.003), and socioemotional wellness ( t 14=2.75, P=.008). In addition, from T0 to T1, the intervention group improved their intention to perform physical activity ( t 14=2.82, P=.006), healthy eating ( t 14=3.44, P=.002), and socioemotional wellness ( t 14=2.65, P=.009); and there was a reduction in their intake of 13 unhealthy foods. HelperFriend was well received by intervention group.

          Conclusions

          HelperFriend appears to be feasible and acceptable for young children. In addition, this game seems to be a viable tool to help improve the knowledge, the intention to conduct healthy behaviors, and the dietary intake of children; however, a well-powered randomized controlled trial is needed to prove the efficacy of HelperFriend.

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          Most cited references66

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          The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

          CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.
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            Numerous theories in social and health psychology assume that intentions cause behaviors. However, most tests of the intention- behavior relation involve correlational studies that preclude causal inferences. In order to determine whether changes in behavioral intention engender behavior change, participants should be assigned randomly to a treatment that significantly increases the strength of respective intentions relative to a control condition, and differences in subsequent behavior should be compared. The present research obtained 47 experimental tests of intention-behavior relations that satisfied these criteria. Meta-analysis showed that a medium-to-large change in intention (d = 0.66) leads to a small-to-medium change in behavior (d = 0.36). The review also identified several conceptual factors, methodological features, and intervention characteristics that moderate intention-behavior consistency.
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              Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study

              A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior.
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                Author and article information

                Contributors
                Journal
                JMIR Serious Games
                JMIR Serious Games
                JSG
                JMIR Serious Games
                JMIR Publications (Toronto, Canada )
                2291-9279
                Apr-Jun 2022
                6 May 2022
                : 10
                : 2
                : e33412
                Affiliations
                [1 ] Centro de Investigación Científica y de Educación Superior de Ensenada Unidad de Transferencia Tecnológica Tepic Tepic, Nayarit Mexico
                [2 ] Centro de Estudios e Investigaciones en Comportamiento Universidad de Guadalajara Guadalajara, Jalisco Mexico
                Author notes
                Corresponding Author: Ismael Edrein Espinosa-Curiel ecuriel@ 123456cicese.mx
                Author information
                https://orcid.org/0000-0002-3136-3256
                https://orcid.org/0000-0002-6241-8600
                https://orcid.org/0000-0001-9759-7189
                https://orcid.org/0000-0001-6338-3561
                https://orcid.org/0000-0002-4090-9644
                https://orcid.org/0000-0001-5081-8212
                https://orcid.org/0000-0002-2331-1800
                Article
                v10i2e33412
                10.2196/33412
                9123542
                35522474
                b06034e1-13a5-495f-9a58-55789fa30639
                ©Ismael Edrein Espinosa-Curiel, Edgar Efrén Pozas-Bogarin, Maryleidi Hernández-Arvizu, Maria Elena Navarro-Jiménez, Edwin Emeth Delgado-Pérez, Juan Martínez-Miranda, Humberto Pérez-Espinosa. Originally published in JMIR Serious Games (https://games.jmir.org), 06.05.2022.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on https://games.jmir.org, as well as this copyright and license information must be included.

                History
                : 6 September 2021
                : 29 September 2021
                : 14 December 2021
                : 7 April 2022
                Categories
                Original Paper
                Original Paper

                serious game,children,education and behavior change,healthy lifestyle behaviors,physical activity,healthy eating,socioemotional wellness

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