1. Kiddio-Food Fight™
A Vegetable Parenting
Video Game
NICHD
NATIONAL INSTITUTE
OF HEALTH
Eunice Kennedy Shriver
Tom Baranowski, PhD
Professor of Pediatrics (Behavioral Nutrition & PA)
USDA/ARS Children’s Nutrition Research Center
Baylor College of Medicine
Houston, Texas, 77030, USA
www.bcm.edu/cnrc/faculty/?PMID=9519
Pediatrics

2. Games for Health
June 13, 2012
High vegetable intake
 Related to lower…
 CVD
 Several cancers
 Type II Diabetes
 Maybe Obesity

3. Games for Health
June 13, 2012
Child Food Preferences
 A primary determinant of intake
 Kids tend to eat what they like
 Formed early in life
 Parents are primary influences on children’s
food preferences and intake
 Common parent complaint – “I can’t get my
child to eat vegetables”

4. Games for Health
June 13, 2012
Parenting Practices
 Behaviors that influence child’s behavior
 Recent research identifies parenting
practices as either:
 Effective
 Ineffective
 Our Goal - Train parents of preschool
children to enable their child to eat more
vegetables

5. Games for Health
June 13, 2012
Skilled Behaviors can be learned
 Simulations have been used to teach how
to…
 Fly an airplane
 Do surgery
 Interact with patients
 Video games can employ simulations
 Adult learning requires
 Self-selected practice
 Feedback

6. Games for Health
June 13, 2012
Issues for Casual Game
 What are important parenting practices
 36-item child temperament measure too
long for game
 Not clear how to word Value/Reasons
statements

7. Games for Health
June 13, 2012
Formative Research (1)
 International Survey of Pediatricians, Health
Care Providers and Educators for food
parenting
 36 food parenting statements
 Cause short or long term harm?
 Short term effectiveness?
 Long term effectiveness?
 Basis for food parenting selections

8. Games for Health
June 13, 2012
Formative Research (2)
 Child Temperaments – Created three short
statements:
 He/She likes to listen to rhymes and songs. When
working on a project he/she concentrates deeply and
carefully follows rules and instructions. When
something changes, he/she quickly notices.
 He/She often shows his/her frustration or discomfort
and easily becomes sad when not able to finish a
project. He/She is often afraid of the dark and when
upset may be difficult to calm down.
 He/She has lots of energy, is easily excited and often
goes fast on the playground. He/She enjoys meeting
new people and going to new places.
 Validated against 36-item questionnaire

9. Games for Health
June 13, 2012
Formative Research (3)
 Self Determination Theory
 Values / Reasons Intrinsically Motivated
Behavior
 Relatedness
 People make decisions consistent with values
 Reasons tie values to behaviors

10. Games for Health
Cognitive testing of Values for
June 13, 2012
Vegetable Parenting
 Most commonly selected Values:
 “Raising a wholesome child”
 “Raising a healthy child”
 “Being a role model”
 “Being respected by others”

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Reasons linking “Raising a healthy
June 13, 2012
child” Value to VPP
 “Encouraging my child to eat vegetables
helps my child to be healthy because it
helps…”
 Keep them from getting sick, so they don’t miss
school
 Keep them from getting… cancer (… heart
disease, …obese, …diabetes)
 Them be in good shape
 My child learn healthy eating habits

12. Games for Health
June 13, 2012
Kiddio – Game Mechanics
 7 stage game
 Enter at neutral with Kiddio refusing veggie offered
 Select effective parenting - move 1 step towards
winning
 Select ineffective parenting – move 1 step towards
losing
 Turn off TV, remove toys, close door to outside –
move 1 step towards winning
 Time out option
 Works only at Level 7
 Otherwise lose points

13. Games for Health
June 13, 2012
Kiddio-Food Fight™
 Casual video game (5-15
minutes per session or
episode)
 Played anywhere, any time
 G4 iPhone app
 Audience – Parents of pre-
schoolers (3-5 year olds) who
have difficulty getting their
child to eat vegetables

14. Games for Health
June 13, 2012
 Tailored to child’s
temperament

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June 13, 2012
Game Storyline
 Dottie (best friend) has a
child just a little older that
yours
 She has faced all these
problems with her child and
“knows” what works

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June 13, 2012
 Simulate parent-child
interactions
 Select from
alternative parenting
statements

17. Games for Health
June 13, 2012
Feedback to parents
is immediate
 Kiddio’s facial expressions
and reactions to parent
statement selections

18. Games for Health
June 13, 2012
Additional Game
Activities
 Change environment
(TV, door, toys, timeout)
 Choose vegetable to serve
Kiddio
 Talk to Dottie for help

19. Games for Health
June 13, 2012
Formative Research (4)
 Alpha testing (qualitative)
 16 parents of 3 to 5 year olds, 3 ethnic groups
 Most parents enjoyed
 Need tutorial or directions woven into game
 Improve feedback
 More Kiddio facial gestures
 End of episode feedback
 No website feedback
 Abbreviate number and wording of Values &
Reasons

20. Games for Health
June 13, 2012
Behavior Change
components
 Feedback on parenting selections
 “Oreo” – positive comment, what was
wrong, positive comment
 Goal Setting to do effective parenting
with own child
 Select parenting practice, day, meal
 Identify likely problems
 Identify likely problem specific solution
 Tailored motivational statement
 Values, reasons
 Earn points with optional leader
board

21. Games for Health
June 13, 2012
Future (1)
 Create 24 more episodes
 5 levels of difficulty
 Use same game design /
engine

22. Games for Health
June 13, 2012
New Kiddio Menu (2)
 Based on qualitative
research, made changes to
make more user friendly

23. Games for Health
June 13, 2012
Future (3)
 Conduct outcome evaluation RCT
 Primary outcome:
 Child vegetable intake
 Secondary outcomes:
 Child BMI
 Vegetable parenting practices
 Home vegetable availability
 Moderating variables:
 Parent BMI
 Parent vegetable intake
 Parenting style

24. Games for Health
June 13, 2012
Dêkuji! (Czeck)
DANKE! (German)
MUITO OBRIGADO! (Portuguese)
M G I! (Chinese, Cantonese)
ARIGATŌ! (Japanese)
MERCI BEAUCOUP! (French)
MUCHAS GRACIAS! (Spanish)
SERDECZNIE DZIĘKUJĘ! (Polish)
SHUKRAN! (Arabic, Middle East)
TACK SÅMYCKET! (Swedish)
TAKK! (Norwegian)
EFcHARISTo! (Greek)
Xie Xie! (Chinese, Mandarin)
Dank u wel (Dutch)
Khawp Khun maxh! (Thai)
Grazie! (Italian)

25. Games for Health
June 13, 2012
Formative Research
 Model of Goal Directed Behavior
Attitudes toward VPP
Positive anticipated Desire (motivation) Intentions to use
emotions regarding VPP to use VPP VPP
Negative anticipated
emotions regarding VPP
Subjective norms Perceived behavioral
related to VPP control regarding VPP

26. Games for Health
June 13, 2012
Future (1)
 Offer as an app in the
iTunes App store to get
consumer feedback