Mobile game approach to prevent childhood obesity using persuasive technology

Mobile Game Approach to Prevent Childhood Obesity Using Persuasive Technology Eman Almonani1, Wahidah Husain2, Oh Ying San3 Ammar Almomani4, Mohammed Al-Betar5 School of Computer Sciences, Universiti Sains Malaysia 11800 Penang, Malaysia 1 eman19830@yahoo.com, 2wahidah@cs.usm.my, 3 oysan@student.usm.my Dept. of Information Technology, Al-Huson University College, Al-Balqa Applied University, P.O. Box 50, Irbid, Jordan, 4 ammarnav6@gmail.com, 5mohbetar@cs.usm.my Abstract—Obesity is a condition in which the body has excess fat. Childhood obesity has become an important public health issue because affects every aspect of the life of a child. More specifically, the condition leads to poor health and negative social perceptions. Many risk factors are linked to obesity. The varying aspects of the problem and its serious implications for future health and well-being of children are enormous. The most effective solution can be achieved via programs geared to prevent such diseases. Children spend an average of more than three hours daily in front of the television, an hour at the computer, and 30 minutes playing video games, which opens major opportunities for us to propose a mobile game approach to prevent childhood obesity (MACO) using persuasive technology. MACO is a game-based persuasive mobile technology designed to inspire children to apply healthy eating habits as well as to begin and continue being physically active. This technology also introduces fun activities to motivate children to exercise more and encourage them to choose healthier food in appropriate amounts. A study on persuasive technologies application and childhood obesity prevention is conducted to determine the best persuasive technology application for MACO. The study proposes a framework and develops a system prototype. Keywords—Childhood Technology Obesity; I. Mobile Phone; Persuasive INTRODUCTION The combined average of overweight and obese children in Malaysia is 9.6%, which represents a high percentage [1]. A survey revealed that the incidence of obesity is increasing gradually with age. Obesity is prevalent among 6.6% of children aged seven years and 13.8% of children aged 10 years old [2], indicating that childhood obesity is increasing through the years. Persuasive technology is often developed to shift the attention of people to particular information to modify their thoughts and actions. Persuasive technology is computer system, device, or application that is voluntarily designed to modify the attitude or behavior of a person [3]. The tools include devices (e.g., pedometer or balance board), media (e.g., video, audio, or both), and social interaction (e.g., playing with another person) to enable the individual to change his behavior without being conscious of the change. 978-1-4799-0059-6/13/$31.00 ©2014 IEEE Children spend an average of more than three hours daily in front of the TV, an hour at the computer, and 30 minutes playing video games. They also send almost 100 text messages daily [4]. Approximately more than 50% of children use mobile phones. The majority of the children use mobile phones daily at home and at school in periods ranging from less than one year to more than four years. Moreover, most children believe that mobile technologies are easy to use, and most of them enjoy playing mobile games. To deal with health-related problems, children can be reached through the media in which they are most familiar. Although studies on the application of persuasive technologies to prevent childhood obesity are numerous, studies that combine persuasive technology to promote physical activity and healthy eating habits in mobile game application are scarce. Therefore, a mobile game approach to prevent childhood obesity (MACO) application is proposed by utilizing persuasive mobile game technology to prevent childhood obesity. The main goal of MACO is to persuade children to practice healthy lifestyles by eating the right food and to be physically active. The objectives of the study are: • To identify the most suitable persuasive technology to be applied in MACO. • To identify the user requirements of MACO. • To propose the framework for MACO. • To design the prototype of MACO that matches the needs and preferences of users. The rest of the paper is organized as follows: Section 2 presents the related works. Sections 3 and 4 discuss the proposed framework and system prototype, respectively. Section 5 presents the conclusions and future work. II. RELATED WORK Persuasive technology is commonly developed to attract the attention of people to specific information in an attempt to modify their thoughts and actions. The computer screen displays warnings in the form of prompts for software guidance [5]. Persuasive technology can be used to modify human behavior to improve healthcare and fitness [3]. Such technologies are also employed in sales, diplomacy, politics, religion, military training, public health, and management. The most common persuasive technology analysis concentrates on interactive, computational technologies, along with desktop computers, web services, video games, and mobile technology [6]. Persuasive technologies exist in many domains, but attention to the modification of behavior in health domains was only given recently. A. Persuasive Mobile Technologies Fogg described mobile technology as the “kairos factor” [7]. The substantial information on a mobile phone regarding its owner facilitated the delivery of messages tailored to the current location, calendar, habits, and preferences of the user. This description also led to the very personal relationship between a phone and its owner. Fogg even used the term “marriage” to describe the relationship of a person with their mobile phone. Users are confident about the quality and relevance of information found in phone messages and the amount of accessible mobile phone games because the mobile phone is always connected, and the user, in many cases, has constant access to the Internet. The emphasis of persuasive mobile technologies is to modify the habits or to improve the health of the individual by monitoring his or her behavior. B. Education Game Design Cordova and Lepper revealed that learning could be fun and effective, especially with the help of simple educational tasks [8]. They showed that learning in a setting that motivates enhances learning outcomes, and that interaction helps children learn. Learning can only occur when the learner is interactively involved with the game; in other words, balance between challenge and action is possible [8]. Based on the study of Alessi and Trollip, an educational game can be divided into three main parts, namely, the introduction, the body of the game, and the conclusion [9] as shown in Figure 1. In the introduction section, the scenario of the game is presented to the students. Then, the students need to accomplish the games as planned. Finally, the reaction is evaluated and updated. C. Game in Healthcare Game for healthcare is a game that moves beyond the educational phase toward the long-term support for children who suffer from chronic conditions, such as obesity. Games can motivate the healthy eating habits of children, remind them of their treatments, direct their attention, and maintain their health status and records of treatment [10]. Pollak et al. developed “Time to Eat,” a mobile phone based game intended to improve teen eating behavior [4]. They designed the game similar to virtual pet care. The game focuses on pet care as part of the daily routine of child, which fits well with behavior change models employing repeated reinforcement. Walter et al. developed a long-term treatment game [10]. The player owns pet stored in the backpack. In case the player forgets to take care of the pet at suitable times in the day, the pet will become ill. To feed the pet, the game presents several menus to feed the pet to restore or maintain its health. The game attempts try to solve childhood obesity by organizing meal times or providing information on food while the children will require more physical activity to make this game more realistic. Integrating persuasive mobile technologies in games for physical and eating habit activities is vital. A persuasive game to prevent childhood obesity based on the background study, the combination of education courseware on good eating habit, and the importance of physical activity is proposed. III. PROPOSED FRAMEWORK The main role of MACO is to prevent childhood obesity by teaching children to eat healthy food and suggest physical activities, with or without the Internet connection. A survey regarding the expectations of the MACO is developed to support the proposed work. The survey is divided into two parts. Part one pertains to the demographic information, family background, knowledge related to mobile usage, and behavior of children toward mobile games and its effectiveness to prevent obesity. Part two of the survey extracts the user requirement for MACO. This survey successfully obtained feedback from 93 respondents. Based on the background study of persuasive technologies, education courseware, and the survey results, a framework for MACO is designed and the prototype of the system is developed. MACO is a game based persuasive mobile technology designed to inspire children to apply healthy eating habits, as well as to encourage them to be physically active. The aim is to design a fun game courseware to motivate the children to start exercising and to empower them to choose the proper type and amount of food. Figure 2 shows the two main components of MACO. The first component includes a courseware that consists of “My healthy food,” “It is time to eat,” and “My active kids,” whereas the second component includes two games, namely, healthy food and physical activity games. Fig. 1: The general structure and flow of the games [9] The first part of MACO shows the first step of the persuasive mobile game, which requires the user to input their profile data. The data includes the name, gender, age, weight, and height of the user. Then, the system will ask the user to select a game and level from the options using real picture, animation, music, sound effects, and mind games. The final choice is the default system, which includes the dynamic and static user options. All the data will be loaded onto the MACO game system before starting the game. The second step is to calculate the points accumulated by the user. The user gains a point for every correct answer. Collecting 10 points entitles the user access to the next part of MACO, which are physical activity games. Otherwise, the user will have to play the same healthy food game again until he gains the full 10 points. The persuasive approach is applied in this game component to encourage children to eat healthy food and to exercise in an enjoyable manner. Fig. 2: Proposed Framework of MACO IV. SYSTEM PROTYPE A system prototype is developed to evaluate the functionalities of the proposed framework. The two components of the system prototype are persuasive mobile courseware and persuasive mobile game. A. Persuasive Mobile Courseware Persuasive mobile courseware has two learning modules. The first module is on healthy foods and the best time to eat, whereas the second teaches children the importance of physical activities to make them healthy. 1) My healthy foods and It’s time to eat These two modules introduce children to healthy food and explain the schedule of eating times, and provide reminders for healthy breakfast, lunch, and dinner as shown in Figures 3(a) and (b). Fig. 3(a): Snapshot of the best time to eat Fig.3(b): Snapshot breakfast of Healthy Before the game is played, the children are provided with some information regarding the nutrition benefits of each food through simple image and text. Finally, each course will inform the children regarding healthy and unhealthy foods as shown in Figures 4(a) and (b). At this level, MACO will inform the children regarding the importance of eating healthy food and inform them about the effects of eating unhealthy food. Fig. 4(a): Snapshot of Unhealthy foods 1) Healthy Food Game In one of the healthy food games, both healthy and unhealthy food objects will continuously drop from the top of the screen, and the children have to click on the objects before the objects reach the bottom of the screen and disappear. They need to accumulate 10 points by selecting 10 healthy foods before they can advance to the next level. Figures 6(a) and (b) show the snapshots of the Healthy Food Game. Fig.4(b): Snapshot of Unhealthy food 2) My active kids My active kids helps children become aware of the importance of being physically active and to inform them of the risk of being obese by displaying images of healthy and active children overweight and obese children, and the effect of physical activity for each type of children. For instance, active children can be funny, relaxed, and have many friends, whereas obese children tend to be lazy, have low selfesteem, easily agitated, and have few friends (Figures 5(a) and ( b)). In this module, MACO attempts to instill in the children the disadvantages of being obese, and to persuade them to exercise regularly to stay healthy. Fig. 5(a): Snapshot of My active kids B. Persuasive Mobile Games The second component is the game module, which includes healthy food and physical activity games. Fig. 5(b): Snapshot of My active kids Fig. 6(a): Snapshot I of Healthy foods game Fig. 6(b): Snapshot II of Healthy foods game If the children accumulate 10 points, the children can continue playing or advance to the next level of the game or proceed to the physical activity game. If the children failed to accumulate 10 points, they have to repeat the lesson on healthy and unhealthy foods as shown in Figures 7(a) and (b). This process will ensure that the children can distinguish between healthy and unhealthy foods, and achieves the objectives in persuasive mobile games. The children are persuaded to learn about healthy food in a fun way without realizing it. Fig. 7(a): Snapshot in healthy food game Fig.7(b): Snapshot in healthy food game 2) Physical Activities Game Games are related to the changing experience of the person, and the method of learning offers the opportunity to practice and examine the environment. The main concern is to motivate and make exercise flexible based on persuasive mobile technology. Only a simple room or space is required to activate the game. The child can easily operate the game alone, with their friends, or with their parents. The children are asked to play the games in a specific place (fixed location) or by moving based on the required physical activity. This activity has many types of games. Games involving physical activities, such as jumping or running are shown in Figures 8(a) and (b). The user is requested to update the information at the end of each activity to assess the effectiveness of the learning courseware and the games. children today use mobile phones. Most children find mobile technologies easy to use and they enjoy playing mobile games. Based on the study on the persuasive mobile game technology and the response from the potential users, MACO is developed to provide services and to assist children to apply healthy eating habits, as well as to encourage them to be physically active. Applying persuasive mobile game technology in the learning courseware will encourage children to practice healthy lifestyles. As a result, the total number of overweight and obese children can be reduced. For future work, a study on the effectiveness of the proposed system will be conducted on a group of children between the ages of six to twelve years old. The result of the study will be used to develop the full version of the mobile game approach using persuasive technology. ACKNOWLEDGMENT We would like to thanks Universiti Sains Malaysia, Penang, and Al-Huson University College, Al-Balqa Applied University, Irbid, Jordan for supporting this study. 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[1] Back Back Next Fig. 8(a): Snapshot activities Game of Physical Next Fig. 8(b): Snapshot of Physical activities Game The main roles of the learning courseware and the persuasive game are to prevent obesity among children and to overcome the childhood obesity problem. The application teaches the children about healthy and unhealthy foods and encourages them to be physically active. Moreover, collaboration and support from friends, parents, and schools are required to ensure that the process of improving the lifestyle of the children is successful. V. CONCLUSION AND FUTURE WORK Obesity can be prevented through lifestyle changes and should begin early in life. Obesity cannot be prevented or managed solely at the individual level. The communities, government, the media, and the food industry need to work together to modify and stop the unhealthy trends in diet and to encourage physical activity among children. A majority of