=Paper=
{{Paper
|id=Vol-2497/paper8
|storemode=property
|title=The Power of Gamification to Learn and Promote Healthy Habits among Children
|pdfUrl=https://ceur-ws.org/Vol-2497/paper8.pdf
|volume=Vol-2497
|authors=Leire Bastida,Ana Moya,Eugenio Gaeta,José Eurico de Vasconcelos Filho,Felicia Gabler
|dblpUrl=https://dblp.org/rec/conf/gamilearn/BastidaMGFG19
}}
==The Power of Gamification to Learn and Promote Healthy Habits among Children==
https://ceur-ws.org/Vol-2497/paper8.pdf
The Power of Gamification to Learn and Promote Healthy
Habits among Children
Leire Bastida Ana Moya Eugenio Gaeta
TECNALIA TECNALIA LifeSTech (UPM)
Derio, Spain Derio, Spain Madrid, Spain
leire.bastida@tecnalia.com ana.moya@tecnalia.com eugenio.gaeta@lst.tfo.upm.es
José Eurico de Vasconcelos Filho Felicia Gabler
University of Fortaleza (UNIFOR) University of Fortaleza (UNIFOR)
Fortaleza, Brazil Fortaleza, Brazil
euricovasconcelos@unifor.br feliciagabler@edu.unifor.br
ABSTRACT children in countries like Spain, Brazil and Greece3.
Childhood obesity is one of the biggest paediatric public
health concern, affecting more than one in three school- Behavioural treatment helps individuals to develop a set of
aged children in countries like Spain, Brazil and Greece. skills to achieve a healthier lifestyle. It is more than helping
This paper describes the gamification approach used in the people to decide what to change; it is helping them identify
OCARIoT project in order to promote a long-term how to change [1]. And the most effective prevention
behavioral change towards healthy habits in children strategy to grow in good health is to promote a healthy
between 9 and 12 years old. This gamification approach has lifestyle, with adequate nutrition and active physical
been designed and validated following a user centric- activity condition from early age. Proving that point,
approach, with a gender-balanced population of around 100 training of children up to 12 years of age to eat and move in
children aged 9 to 12, in four schools in Spain, Greece and a non-pathological way has been demonstrated effective
Brazil. against obesity and changing behaviours in randomized
control trials [2, 3]. So, childhood is an important period for
Author Keywords forming healthy behaviours in order to reduce obesity
Childhood obesity; Gamification; Healthy habits; IoT; inequities. Besides, schools and families provide good
Playful learning. opportunities to ensure that children understand the
ACM Classification Keywords importance of good nutrition and physical activity habits,
H.5.m. Information interfaces and presentation: User- and how they can benefit both children and families.
centered design; Prototyping; GUI. To promote the adoption of healthy habits as well as to
INTRODUCTION prevent obesity of children in ages from 9 to 12 years, the
Bad long-term habits in eating and lack of physical activity OCARIoT project takes advantage of the Internet of Things
causes an energy imbalance between consumed and (IoT) in order to provide a digital health coaching platform
expended calories. This is the primary cause of obesity. to empower children (and also both families and
Therefore, obesity is largely preventable by making educational staff) in taking control of their lifestyle. For
healthier eating choices and exercising regularly1. In the doing so, OCARIoT is developing a gamified [4] app
case of children, childhood obesity is one of the biggest specifically for children, to drive their engagement and
health problems worldwide and the major paediatric public behavioural change while having a clear focus on treating
health concern, affecting around 224 million school-age obesity. The gamified app integrates data from several IoT
children in the world2. Its prevalence has shot up since 1980 devices related to healthy parameters (such as a wristband
even tripling in many European countries. Childhood to measure physical and sleep patterns or a weighstcale) in
obesity already affects more than one in three school-aged order to provide a close follow-up of child’s activities while
adapting the coaching plan based on the progress.
Copyright © 2019 for this paper by its authors. Use permitted under
This paper provides a detailed description on how we have
Creative Commons License Attribution 4.0 International (CC BY 4.0).
In: J. Arnedo-Moreno, C.S. González, A. Mora (eds.): Proceedings of the designed and validated the gamified app following a user
3rd International Symposium on Gamification and Games for Learning centric-approach and based on a gamification strategy
(GamiLearn’19), Barcelona, Spain, 22-10-2019, published at http://ceur- developed ad-hoc to the OCARIoT’s target group to
ws.org
motivate and engage them while they acquire healthy
habits.
1
http://www.who.int/mediacentre/factsheets/fs311/en/
2 3
https://www.worldobesity.org/what-we-do/aboutobesity/ www.oecd-ilibrary.org/docserver/health_glance-2015-en.pdf
The final implementation is still ongoing and will be sections provide details about the different steps and results
validated to support a clinical study that will be performed during the design process of the gamified app.
in three pilot sites in Europe and Brazil following standard
All the procedures followed in the project were in
methodologies already adopted in similar studies [5, 6].
accordance with the ethical standards of the OCARIoT
THE CONTEXT OF THE PROJECT Ethics Board (national and international) and with the
In order to be able to define a suitable gamification Helsinki Declaration of 1995, as revised in 2008. The
strategy, it is important to understand the context related to parents and/or legal representatives of children has signed a
healthy habits in children according to what the experts say, consent form for participating in the project.
especially which type of activities we should promote in the
INITIAL DESIGN OF THE OCARIOT EXPERIENCE
gamified app. There are some simple recommendations for
The goal of the gamification strategy is to promote children
families to lead a healthy lifestyle and get back on track4 5:
between 9 and 12 years old to acquire healthy habits in the
Distribute meals along the day: eat small amounts nutritional and physical activity areas while engaging them
several times a day; using fun and easy mechanisms. The expected results aimed
Lots of fruit and vegetables; to be achieved are:
Water as a drink to quench the thirst, avoiding Children embracing healthy habits.
sugary and industrial drinks; Children acquire knowledge about healthy habits and
Get active each day: at least 1 hour of physical activity understand how to apply them in their daily life.
every day; Make the learning process about healthy habits as
Limit screen time: sedentary time is associated with an memorable as possible while using the app.
increased risk of becoming overweight; Although the target audience are children between 9 and 12
Sleep quality: associations between short sleep duration years old, families, educators and health professionals also
in early childhood and obesity are consistently play a very important role, promoting the use of the
encountered. application among children, participating in some activities
and setting example in feeding, physical activity and
Using as basis these recommendations and with the support healthy lifestyle. This will clearly reinforce each of the
of health professionals, we have also defined a set of KPIs activities proposed by the app while achieving the proposed
to validate scientifically the outcomes of the project. These goal.
KPIs will be measured with the final version of the
gamified app ready for the last piloting phase: During this gamification strategy design and according to
the motivators of the target group, we identified four core
Reduction rate of obesity childhood >=50%; elements to be integrated in the OCARIoT gamified
Improvement of adherence to suggested healthy experience:
activities >=60%; The storytelling and the world where the experience
Increment of physical activity for end-users >=50% takes place. Considering the requirements previously
collected from the pilot sites and the differences
Satisfaction from end-users >=95% between age ranges (mainly between children aged 9-10
USER-CENTRIC DESIGN years and 11-12 years) about their preferences and what
The aim of OCARIoT is to educate and empower children they like, we designed 5 potential worlds and
to become the protagonists of changes in the family storytelling (story 1: ninja warriors; story 2: classical
environment. That is why we have applied a user-centric mythology; story 3: secret agents; story 4: sci-fi; story 5:
approach, involving children from the beginning in the superheroes).
definition of the gamification strategy and gamified app The coach avatar represents the mentor who challenges
design. children with healthy activities while providing
The validation and assessment approach during the design guidance during the whole experience. We designed 19
stage of the gamified app has focused on the technical potential models covering humanoid, pet or monster
usability, engagement and acceptance from the User appearance and combining cartoon and realistic art
Experience (UX) and User Interface (UI) perspectives. A styles.
set of validation workshops with children have been done The items for personalization will be used by children
with the two releases of the gamified app design. The next to personalize their mentor. Different types of potential
predefined candidates were developed (e.g. clothes,
glasses, accessories).
4
https://www.who.int/behealthy The type of educational games will especially focus on
5
https://kidshealth.org/en/parents/overweight-obesity.html promoting the acquisition of knowledge by children.
The following types of educational games were he children have to develop three abilities related
where the
identified: Questions-Answer
Answer quizzes (e.g. wheel of with the healthy habits.
fortune, Trivia) and Matching/memory games.
The look & feel of the app has followed the aesthetics of
Based on this initial design, we organised the first this agent secret storytelling, challenging children with a set
workshops with the objective of collecting
collect the children of missions to be completed in the real-world
real about healthy
preferences and feedback about those ose four gamification habits (e.g. physical activity, food intaking).
elements. Five workshops were organized in four schools
(Spain, Greece and Brazil). A total of 56 children between 9
and 12 years old were involved organized by groups of 3, 4
5 children (depending on the total children per workshop)
with 29 girls and 27 boys to balance gender aspects. The
number of votes for the five different stories provided to
children is shown in Table 1 (children had to select two
stories, their favorite one as option 1 and the second as
option 2). Each vote weights 1 and the votes as Option 1
apply an extra 5% weight to the selected story. The selected
storytelling and world were thehe secret agent with a total
weighted score of 9,3.
Story Story Story Story Story
1 2 3 4 5
Votes 5 2 9 5 3
As Option 1 5 0 6 1 0
As Option 2 0 2 3 4 3
Weighted 5.25 2 9.3 5.05 3
Score
Table 1. Votes for every story
The number of votes for the three different type of mentors
provided to children is shown in Table 2 (children had to
select two types of mentors, their
ir favorite one as option 1
Figure 1. Secret agent storytelling
and the second as option 2).. The score calculation is the
same as the one used with the story. The Human-type The missions can be individual, if they are performed by
mentor was selected with a total score of 15,4. the child alone, or social, if they are performed together
with family or at school. And each mission is associated at
Animal Monster Human least with one of the abilities to be developed:
Votes 7 1 15 Dexterity: It is related to physical activity.
As Option 1 3 1 8 Intelligence: It is used to teach children all the
As Option 2 4 0 7 knowledge related to healthy habits in nutrition and
physical activity mainly.
Weighted 7.15 1.05 15.4
Discipline: It is used for providing children awareness
Score
control over the impulses for eating and actions
and self-control
Table 2. Votes for every type of mentor lated to sleep, especially to promote better choices
related
And the human-type
type mentor most voted was the hologram with daily food and on weekends.
man which is the final design implemented in the gamified In order to provide personalized missions to each child, it is
app. important to establish a baseline to know the current status
of the child. To do so, we use the baseline da data collected
Regarding the items for personalizing the mentor, all types
through questionnaires (such as Physical Activity
of the items were welcome; and finally, the proposed types
Questionnaire for Children - PAQ-C [7] or Child Eating
of educational games were well-accepted.
accepted.
Behaviour Questionnaire – CEBQ [8]), IoT devices (e.g. a
FINAL DESIGN OF THE OCARIOT EXPERIENCE wearable for physical activity) and specific info collected
Based on the feedback from the first validation workshops, directly in the app about food and physical activity habits.
the design of the OCARIoT experience was refined around
the storytelling of becoming a secret agent (see Figure 1),
To involve families in the OCARIoT experience, families order to show the advancement and current state of child
have access to a dashboard,, where children evolution and every moment.
recommendations related to the missions are shown so they
Based on this final design, we arranged the second
can help children to fulfil them
m (e.g. a mission can be not to
validation workshops to evaluate how the children interact
eat industrial bakery for one week; and a recommendation
with the app, if the graphical interface was easy to use and
could be to send families a homemade cake recipe). These
understand and if they could perform the proposed activities
recommendations will also serve as knowledge information
autonomously. Three workshops were organized in the
to teach families about healthy habits.
same four schools (in Spain, Greece and Brazil). A total of
To collect relevant data from children in an easy way about 75 children between 8 and 131 years old were involved; 34
their daily activity and food consumption, we have defined girls and 41 boys.
the “secret agent report”” feature. The child has to submit
an agent report weekly answering some specific questions In order to collect their feedback, we used a Software
related to the missions achieved during
uring that period. questionnaire adapted for children,
Usability Scale (SUS)-questionnaire children
ach question was rated using a scale of 1-5, 1 being
where each
The mentor design also evolved based on the feedback ), 5 being the highest (yes/great):
the lowest (no/nothing),
received from children by providing a more cartoonish
Q1: I liked the game.
design.. As explained before, the mentor will be the virtual
character that represents the agent trainer who will guide Q2: The instructions of the mentor were easy to
the child during
uring the experience. It provide
provides not only support understand.
about how to use the app through a tutorial,
tutorial but also tips, Q3: It was easy to complete the missions.
recommendations and reminders about missions.
missions The child
would personalise the mentor with a set of different items, Q4: I had some problems to complete the missions.
such as accessories, hair and colors (see Figure 2). The Q5: The navigation through the game was easy and I
personalization items can be bought using coins earned found what I was looking for.
achieving missions and playing the educational games.
Q6: I found the game complex.
Q7: The game was easy to use.
Q8: I will need the support of an adult to play the game.
The received feedback was very positive. The main
conclusions about the app were that is easy to use, the role
of the mentor is well integrated, and the tutorial will be
relevant to introduce the app and also to explain its features.
The next table shows a summary of the media results per
question and pilot site.
Questions Spain Brazil Greece
Q1 4,18 4,06 3,23
Q2 3,85 3,8 3,96
Q3 4,27 3,86 4,00
Q4 3,09 1,87 2,8
Figure 2. Mentor and personalization items
Q5 4,09 4,12 3,62
The mentor supports children on how to use the app
through a tutorial, which explains,, the rules, the objective, Q6 2,69 1,5 2,85
the rewards and all the things the child should know to go Q7 4,27 4,37 4,19
inside the experience and back again.
Q8 2,76 2,46 2,44
The educational games give the child the ability
(knowledge) to overcome a mission (actions to carry out in Table 3. Results of the SUS questionnaire from second
real life). The four types of educational games will be validation workshops.
integrated in the app: “Trivia”, “True
True or False”,
False “Matching CONCLUSION AND FUTURE WORK
pairs” and “Find them all”. By playing these educational Although gamification and game design are showing a great
games, the child will also win points that can be used to buy potential for health applications,
applications little is known whether and
the personalization items. how effectively it can drive healthy improvement and
The progress is based on the abilities achieved with each wellbeing outcomes; specially in childhood obesity domain.
mission, the earned coins and the badges achievement in This is why we started OCARIoT,
OCARIoT aiming to combine
personalised health interventions with a gamification 8. J. Wardle, CA. Guthrie, S. Sanderson, L. Rapoport.
strategy addressing the specific needs of obesity in children 2001. Development of the children’s eating behaviour
(between 9 and 12 years old). questionnaire. Journal of Child Psychology and
Psychiatry, 42, 963-970.
Besides, in order to enhance and assess the impact on the
solution, health professionals are involved as a core part of
the project. We started to design the gamification strategy
based on the health requirements provided by the
professionals and perform several validation workshops
with children. The received feedback was very promising,
with a positive engagement from children to use the app
and complete the challenges related to healthy habits.
As future work, we are working on the final piloting phase
to be completed next year in order to evaluate the empirical
evidence on the effect of gamification on childhood obesity
and healthy habits acquisition.
ACKNOWLEDGMENTS
The authors gratefully acknowledge funding from the
European Union's Horizon 2020 program under the grant
agreement nº 777082 and the Brazilian's Ministry of
Science, Technology, Innovation and Communication
through RNP, agreement nº 3007 (www.ocariot.com).
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