HEROs: Design of a Mixed-Methods Formative Research Phase for an Ecocultural Intervention to Promote Healthy Eating and Activity Behaviors in Rural Families With Preschoolers.

OBJECTIVE: To describe the mixed-methods formative research phase in the development of the Healthy Environments Study (HEROs), a technology-based, interactive family intervention to promote healthy eating and activity behaviors for young children in the home environment. DESIGN: A mixed-method iterative approach, using ecocultural theory as a framework, will guide the development of both quantitative and qualitative formative research assessments. SETTING: Rural eastern Colorado. PARTICIPANTS: Low-income families (n = 200) with preschool-aged children enrolled at 6 Head Start/preschool centers. MAIN OUTCOME MEASURES: Quantitative and qualitative methodologies will garner insights into 4 key topic areas: (1) food behaviors and environments (Remote Food Photography Method, parent focus group, and survey), (2) physical activity behaviors and environments (parent interview and survey), (3) mobile device use (parent survey and interview), and (4) daily life (ecocultural family interview and teacher/staff group discussions). ANALYSIS: Results will be interpreted in combination to allow for a holistic understanding of participant behaviors, beliefs, attitudes and values related to each of the 4 topic areas. Collectively, outcomes will provide a comprehensive picture of preschoolers' daily life and inform intervention design and strategies to enhance preschoolers' eating and activity behaviors in the home environment.

Mobile Device Use Among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschoolers' Physical Activity: Qualitative Study.

BACKGROUND: As mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, questions remain about the feasibility and acceptability of intervention delivery via mobile apps in low-income, rural settings and among families with preschoolers. OBJECTIVE: The aims of this study were to understand the content and context of mobile device use for preschoolers; explore parent beliefs on this topic, including the acceptability of intervention delivery via mobile devices; and test a prototype of an app to encourage preschoolers' physical activity with both parents and children. METHODS: Parents (n=29) were recruited from 5 preschool centers in eastern, rural Colorado to complete a semistructured telephone interview regarding preschoolers' mobile device use. A second sample of parents (n=31) was recruited from the same preschool centers to view the app prototype independently and provide feedback. A third sample of preschool children (n=24) was videotaped using the app in small groups to measure engagement and record their responses to the app. RESULTS: Five key content areas emerged from the telephone interviews: (1) mobile devices are an important part of families' everyday routines, and parents have parameters governing their use; (2) parents often use mobile devices as a tool for behavior management; (3) parents clearly distinguish between mobile device use for learning versus entertainment; (4) parents have an overarching desire for balance in regard to their child's mobile device use; and (5) parents were generally supportive of the idea of using mobile apps for intervention delivery. From the app prototype testing with parents, participants reacted positively to the app and felt that it would be useful in a variety of situations. Testing with preschoolers showed the children were highly engaged with the app and a majority remained standing and/or actively moving through the entire length of the app. CONCLUSIONS: Mobile devices are already integrated into most families' daily routines and appear to be an acceptable method of intervention delivery in low-income families in rural Colorado. The physical activity app represents an innovative way to reach these families and, with further improvements based on participant feedback, will provide children with a unique opportunity to practice key movement skills.

Parent Perceptions of Mobile Device Use Among Preschool-Aged Children in Rural Head Start Centers.

OBJECTIVE: To describe child use and parents' beliefs and comfort with young children's use of mobile devices in low-income, rural communities. METHODS: This was a descriptive, cross-sectional study. The survey, which consisted of 18 multiple-part questions, was distributed to families at 5 Head Start/preschool centers in Colorado. RESULTS: In total, 192 surveys were returned (28.5% response rate). Most children (92%) used a smartphone or tablet at some frequency and most parents (90%) had downloaded apps specifically for their child. Education and ethnicity were related to parents' technology beliefs. Parent comfort with technology was positively associated with greater child use of technology (P < .001). CONCLUSIONS AND IMPLICATIONS: Mobile device use was relatively high in this sample. Mobile devices appear to be a feasible platform to offer nutrition and physical activity education for this audience. Ensuring parent comfort with technology and apps will be important.

Levels in Games for Health.

There is a time-honored procedure in games for pure entertainment wherein games challenge their players by offering successfully higher levels of difficulty. An eminent researcher proposed that player engagement and enjoyment require the player being constantly challenged, but at a level she or he can handle. A game's difficulty levels enable the player to face more difficult challenges as she or he builds gameplaying skills. Although levels work in games for entertainment, it is not clear how effective or important levels are in games for health, or how they are designed. We invited several accomplished games for health designers and researchers to discuss levels.

The power of play: Innovations in Getting Active Summit 2011: a science panel proceedings report from the American Heart Association.

BACKGROUND: To examine the influence active-play video gaming (also referred to as exergaming, exertainment, and active gaming) might have on improving health-related skills, enhancing self-esteem and self-efficacy, promoting social support, and ultimately motivating positive changes in health behaviors, the American Heart Association convened The Power of Play: Innovations in Getting Active Summit. The summit, as well as a follow-up science panel, was hosted by the American Heart Association and Nintendo of America. METHODS AND RESULTS: The science panel discussed the current state of research on active-play video gaming and its potential to serve as a gateway experience that might motivate players to increase the amount and intensity of physical activity in their daily lives. The panel identified the need for continued research on the gateway concept and on other behavioral health outcomes that could result from active-play video games and considered how these games could potentially affect disparate populations. CONCLUSIONS: The summit represented an exciting first step in convening healthcare providers, behavioral researchers, and professionals from the active-play video game industry to discuss the potential health benefits of active-play video games. Research is needed to improve understanding of processes of behavior change with active games. Future games and technologies may be designed with the goal to optimize physical activity participation, increase energy expenditure, and effectively address the abilities and interests of diverse and targeted populations. The summit helped the participants gain an understanding of what is known, identified gaps in current research, and supported a dialogue for continued collaboration.