Performing Department
Nutritional Sciences
Non Technical Summary
Seventy-five percent of high school students in Vermont are not physically active for 60 minutes/day, the guideline from the Centers for Disease Control and Prevention. Physical activity is an important behavior for weight control and optimal health. Establishing a physically active lifestyle during adolescence is desirable, as adolescence is a critical period for obesity development. Very few physical activity interventions have focused on adolescents and even fewer have been effective, indicating that new strategies are needed. As many high school students are familiar with and enjoy games on either their mobile devices, tablets, or gaming systems, incentivizing physical activity within a gaming context may be a novel and age-appropriate way to encourage high school students to meet physical activity goals.The proposed study intends to nudge junior and senior high school students to meet physical activity goals by using a mobile gaming app to incentivize 60 minutes of physical activity throughout the entire day and 30 minutes throughout the school day. A mixed-methods approach will be used to design and carryout the intervention. Year one will involve youth participatory development of the gaming intervention, which will take place as a randomized-controlled trial with 100 students in year two.
Animal Health Component
0%
Research Effort Categories
Basic
(N/A)
Applied
50%
Developmental
50%
Goals / Objectives
Objectives: The proposed study is designed to nudge high school students to achieve the CDC guideline of 60 minutes of physical activity/day, as well as the VT State Board of Education mandate of 30 minutes of physical activity/day during school hours by using a gamification model to incentivize physical activity. After a one-year planning and game development phase, the intervention will be pilot tested in a 12-week randomized-controlled trial. Along with minutes of physical activity/day, outcome measures will include Body Mass Index, school engagement and academic performance.Aim 1: Employ a youth participatory action research (YPAR) method to develop an effective and appropriate gaming model to incentivize physical activity for high school students.Hypothesis 1: Student involvement in intervention planning will result in an age-appropriate, culturally based and contextually tailored intervention that facilitates maximal participation and perceived saliency by the target population to ensure desired program impact and sustainability. Aim 2: Increase daily moderate-vigorous physical activity of high school students through the use of a mobile gaming program available on each student's iPad.Hypothesis 2: During the course of the intervention, students in the intervention condition will accumulate more minutes of MVPA per day and more minutes MVPA during school than those in the control condition.Aim 3: Evaluate change in body mass index (BMI)Hypothesis 3: Students in the intervention condition will show maintenance or improvement in weight/BMI status from baseline to post-intervention compared to students in the control condition.Aim 4: Positively influence indicators of school engagement and academic performance.Hypothesis 4: Students in the intervention condition will see gains on measures of school engagement including, attendance and sense of belonging, as well as perform at a higher level on measures of academic achievement than students in the control condition.
Project Methods
Research Plan and Methodology This research project will employ a mixed methods design across three main phases of 1) Program Design, 2) Program Implementation and Evaluation, and 3) Analysis and Dissemination. Junior and senior students at Burlington High School (BHS) will be invited to participate in this pilot study, which will use a gamification model to incentivize physical activity.Study InterventionsPhase 1 - Intervention Development using the Youth Participatory Action Research (YPAR) ModelIn order to design a physical activity gamification program for diverse adolescents, partnering with youth in the design, implementation and evaluation of the program is necessary to ensure relevancy, sustainability and program ownership. YPAR is a methodology in which youth are recruited as research partners at the outset of the program, to collaboratively assess the needs/assets of their community, inform program design and implementation as well as assist in data analysis and dissemination activities. YPAR has been an effective methodology among adolescents in school transformation initiatives and students engaged in YPAR projects have increased motivation to impact their schools and communities. To this end, YPAR will serve as an overarching theoretical and methodological framework for our program design and evaluation. In order to systematically ensure that our program planning and design activities will lead to the development of an efficacious mobile game for high school students, Intervention Mapping, which is a program planning framework, will guide this process. During Y1 of the project, the researchers will work with sophomore and junior students in TA periods to form the YPAR teams.Also during Y1, 20 members of the YPAR team will wear Fitbits daily for one month. Conducting this small Fitbit pilot testing will help researchers gather information about whether students can reliably wear Fitbits daily and how to trouble shoot non-compliance. This testing period will also provide an idea of how many minutes of physical activity BHS students actually do both in school and over the entire day.Phase 2 - Using a Gamification Model to Incentivize Physical ActivityOne-hundred juniors and seniors will be invited to participate in phase two of the study. After four weeks of baseline data collection in the fall, participants will be randomized to either a control or intervention condition. Those in the intervention condition will receive rewards in a customized gaming platform for recording 30 minutes of MVPA on their Fitbit during school each day and/or 60 minutes of MVPA over the entire day. Students who meet both physical activity targets will be the most highly rewarded. In-game rewards will be determined by the YPAR group and game designers but could include points, "money," tools, lives, clues, leaderboard status, etc as detailed below in the "Mobile Game Incentivizing Physical Activity" section. The intervention will take place over two six-week time blocks with suspensions during the first block for the Thanksgiving and Christmas school breaks, and a suspension in the second block for the April school break.Control Group - Minimal gamification provided for physical activityFifty participants in the control condition will each receive a Fitbit to track their physical activity. Control condition participants will have the same physical activity options as the incentive condition detailed below. Instead of interfacing with a gaming app on their iPads to track physical activity, control condition participants will interface with a minimalist activity tracker showing them only how many minutes of MVPA they've done over the course of the day. The four-week baseline period at the beginning of the intervention will be used as a time for any novelty effects of just having a FItbit to washout for control condition participants.Intervention Group - Incentivizing Physical Activity Using A Gamification ModelFifty participants will be randomized to the intervention condition, which will use a gaming application to encourage physical activity, as physical activity goal achievement will translate into rewards in the game. Physical activity will be tracked using a Fitbit activity monitor and in order to encourage intervention condition participants to wear their Fitbits at school daily, they will receive one entry into a monthly lottery for each day they wear the Fitbit that month.Physical Activity Goals and OptionsTwo physical activity goals will be reinforced during the intervention. First, reinforcement will be delivered contingent on achieving the CDC target of 60 minutes of MVPA over the whole day. Because in-school activity is important for student health,9,10 participants will also earn in-game reinforcement for achieving 30 minutes of MVPA during the school day as targeted by the VT State Board of Education. Students who meet both goals will receive the most in-game rewards.In order to help students achieve the physical activity targets, opportunities for completing short bouts of physical activity or taking extra steps throughout the school day and before/after school will need to be offered. The YPAR group as well as BHS teacher and staff input will be integral in determining which types of additional activity opportunities are feasible. Other Vermont schools have integrated physical activity into Teacher Advisor time as well as offering physical activity breaks during or between academic classes.43 Active transport to school, or taking advantage of before and after school activity options already offered at BHS will be additional ways for students to meet the 60 minutes/day target. The gamification aspect of the intervention will allow students to use the layout of BHS to accumulate more minutes of physical activity throughout the day. Students will be able to check-in at various locations around the high school using QR codes to earn physical activity points in the game. MVPA accumulation will be tracked automatically using a Fitbit, which indicates the number of minutes the student was active at a moderate or vigorous level during the day. The Fitbit will then automatically and wirelessly communicate with the gaming app on the student's iPad to determine the quantity of game rewards awarded daily. Rewards will be available immediately upon meeting MVPA goals.Mobile Game Incentivizing Physical ActivityThe specific game elements to be used in the game will be determined during Y1 with the YPAR students and the game developers, Game Theory, a local game development company with experience designing games that transform tedious tasks into fun ones (gametheoryco.com). However, basic game theory suggests certain gaming elements that are especially effective at encouraging engagement, which will be incorporated into any game design. Elements of effective games such as self-representation with avatars, 3D environments, narrative context, unpredictability, leaderboards, options to work in teams or clans, and check-in based mechanisms where the game continues to evolve even when the player is not logged in will all be integrated into the game design.44 The game design will also incorporate theories of behavioral economics that can be capitalized on in a game environment such as present-bias and loss aversion.32,38 Lastly, principles of monetary incentive interventions successfully used to promote sustained accomplishment of various health behaviors in previous research, such as escalating rewards with a reset contingency for missed goals and random ratio reinforcement schedules will be integrated.45 Game "points" will be awarded for achieving the two physical activity daily goals, with an extra daily bonus for meeting both goals. GameTheory has provided a letter of support, which is attached.