title: Creating action plans in a serious video game increases and maintains child fruit-vegetable intake: a randomized controlled trial.
abstract: BACKGROUND
  Child fruit and vegetable intake is below recommended levels, increasing risk for chronic disease. Interventions to influence fruit and vegetable intake among youth have had mixed effects. Innovative, theory-driven interventions are needed. Goal setting, enhanced by implementation intentions (i.e., plans tightly connected to a behavioral goal), may offer a solution. Action plans state "how" a goal will be achieved, while coping plans identify a potential barrier and corresponding solution. The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode, theoretically-grounded serious videogame promoting fruit and vegetables. This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children.
  
  
  METHODS
  A four-group randomized design with three data collection periods (baseline, immediate post-intervention, 3 months post-intervention) was employed. Groups varied on whether children created an implementation intention (none, action, coping, both) as part of goal setting. Participants were 4th and 5th grade children (~9-11 years old) and one parent. An a priori power analysis indicated this would provide >80% power to detect a small effect (Cohen's d = 0.17). Children played a 10-episode online videogame; parents received 10 electronic newsletters and access to a parent-only website. The primary outcome was child fruit and vegetable intake, assessed via three, dietitian-assisted telephone recalls at each data collection period. The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure. Secondary analyses examined intervention effects on fruit and vegetables separately.
  
  
  RESULTS
  Four hundred parent/child dyads were recruited. A significant group-by-time interaction for fruit and vegetable intake (p < 0.001) was found in only the Action group, which had significant increases in fruit and vegetable intake at post 1 (p < 0.0001) and post 2 (p < 0.0001). No other significant interactions were observed; however, there were significant time effects for fruit (p < 0.0001).
  
  
  CONCLUSIONS
  Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children. Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01004094 .
authors.affiliation: USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, USA. dit@bcm.edu.
authors.forename: Debbe
authors.initials: D
authors.lastname: Thompson
authors.affiliation: Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX, USA. rbhatt@bcm.edu.
authors.forename: Riddhi
authors.initials: R
authors.lastname: Bhatt
authors.affiliation: USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, USA. vazquez@bcm.edu.
authors.forename: Isabel
authors.initials: I
authors.lastname: Vazquez
authors.affiliation: USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, USA. jbaranow@bcm.edu.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Cullen
authors.affiliation: USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, USA. kcullen@bcm.edu.
authors.forename: Janice
authors.initials: J
authors.lastname: Baranowski
authors.affiliation: USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, USA. tbaranow@bcm.edu.
authors.forename: Tom
authors.initials: T
authors.lastname: Baranowski
authors.affiliation: USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, Houston, TX, USA. yliu3@bcm.edu.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002648:Child; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006040:Goals; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D033182:Intention; D020407:Internet; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010290:Parents; D014675:Vegetables; D018910:Video Games