EatWellNow: Formative Development of a Place-Based Behavioral "Nudge" Technology Intervention to Promote Healthier Food Purchases among Army Soldiers.

Approximately 17% of military service members are obese. Research involving army soldiers suggests a lack of awareness of healthy foods on post. Innovative approaches are needed to change interactions with the military food environment. Two complementary technological methods to raise awareness are geofencing (deliver banner ads with website links) and Bluetooth beacons (real-time geotargeted messages to mobile phones that enter a designated space). There is little published literature regarding the feasibility of this approach to promote healthy behaviors in retail food environments. Thus, we conducted a formative feasibility study of a military post to understand the development, interest in, and implementation of EatWellNow, a multi-layered interactive food environment approach using contextual messaging to improve food purchasing decisions within the military food environment. We measured success based on outcomes of a formative evaluation, including process, resources, management, and scientific assessment. We also report data on interest in the approach from a Fort Bragg community health assessment survey (n = 3281). Most respondents agreed that they were interested in receiving push notifications on their phone about healthy options on post (64.5%) and that receiving these messages would help them eat healthier (68.3%). EatWellNow was successfully developed through cross-sector collaboration and was well received in this military environment, suggesting feasibility in this setting. Future work should examine the impact of EatWellNow on military service food purchases and dietary behaviors.

Virtual Avatar Coaching With Community Context for Adult-Child Dyads with Low Income.

OBJECTIVE: Examine the acceptability of an evidence-based, contextually tailored, virtual avatar coaching approach for nutrition education among adult-child dyads with low income. DESIGN: Structured observations and semistructured interviews. SETTING: Low-income communities in 2 midsized urban areas. PARTICIPANTS: Fifteen African American adult and child (aged 5-10 years old) dyads recruited from community agencies. PHENOMENON OF INTEREST: Structured observation during the use of the virtual avatar coaching program and qualitative feedback on program experience after using the program. ANALYSIS: Transcripts were independently coded by 2 trained coders. Content analysis was conducted to determine trends and patterns in responses, and salient quotes were extracted from the manuscripts. RESULTS: The program generated dialogue between the children and adults around preferences and dietary habits. Adults and children described the program as being helpful, informative, motivational, and fun. Adults and children liked that the avatar acknowledged them at a personal level, provided accountability, and was tailored to them and their environment. Children wanted the ability to customize the avatar, more gamification, and avatar demonstration of healthy behaviors. Children felt the program would improve their health behaviors and were interested in using it again. CONCLUSIONS AND IMPLICATIONS: This study highlights information that can be used to improve avatar-based programs for nutrition education with children and their adult caregivers who have low income. Future work should assess the impact of user customization experience, program impact on dietary behaviors, and resources required to scale and maintain the program with community agencies.

Extended Reality Technologies in Nutrition Education and Behavior: Comprehensive Scoping Review and Future Directions.

The use of Extended Reality (XR) (i.e. Virtual and Augmented Reality) for nutrition education and behavior change has not been comprehensively reviewed. This paper presents findings from a scoping review of current published research. Articles (n = 92) were extracted from PubMed and Scopus using a structured search strategy and selection approach. Pertinent study information was extracted using a standardized data collection form. Each article was independently reviewed and coded by two members of the research team, who then met to resolve any coding discrepancies. There is an increasing trend in publication in this area, mostly regarding Virtual Reality. Most studies used developmental testing in a lab setting, employed descriptive or observational methods, and focused on momentary behavior change like food selection rather than education. The growth and diversity of XR studies suggest the potential of this approach. There is a need and opportunity for more XR technology focused on children and other foundational theoretical determinants of behavior change to be addressed within nutrition education. Our findings suggest that XR technology is a burgeoning approach in the field of nutrition, but important gaps remain, including inadequate methodological rigor, community application, and assessment of the impact on dietary behaviors.