Enhancing Child Dietary Self-monitoring

NCT06193967 | Completed Results

• 1 other identifier: UTK IRB-23-07903-XP
• Study Type: interventional
• Target: 19
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial was to test the preliminary efficacy of a digital dietary self-monitoring (dDSM) log that uses positive reinforcement strategies (caregiver praise and gamification) to improve child engagement in DSM. The main aims were to:

• Conduct a proof-of-concept trial that examines the effects of positive reinforcement on child DSM behaviors.
• Explore differences in children's intrinsic motivation. Participating children will be instructed to self-monitor their daily intake of targeted food groups (fruits, vegetables, sweet and salty snack foods, and sugar-sweetened beverages) for 4 weeks using a personal web-based DSM log. Each child-caregiver dyad will be randomly assigned to 1 of 4 conditions: BASIC, PRAISE, GAME, or PRAISE+GAME. For PRAISE and PRAISE+GAME conditions, caregivers will be instructed to provide daily process praise to their child related to DSM behaviors. For GAME and PRAISE+GAME conditions, logs will integrate three game mechanics: points, levels, and a virtual pet. Points will be accumulated for engaging in DSM behaviors, and accrual of points will evolve a virtual pet over time.

Conditions

Nutrition, Healthy

Outcome Measures

Primary Outcomes (6)

• Dietary Self-monitoring Frequency, Overall

  I.e., number of days with any logging. DSM frequency has been shown to predict success in family-based based childhood overweight and obesity programs. A day will be counted as "tracked" if any food or beverage is logged on that day or, if no food or beverage is logged, the "Logging Complete" button is clicked.

  4 weeks

• Dietary Self-monitoring Frequency, Weekly

  I.e., number of days with any logging per week

  4 weeks

• Proportion of Items Tracked on Day of Intake, Overall

  Proportion of food/beverage items that were tracked on the day of intake across the 4-week DSM period

  4 weeks

• Proportion of Items Tracked on Day of Intake, Weekly

  Proportion of food/beverage items that were tracked on the day of intake by week

  4 weeks

• Number of Logging Sessions, Overall

  The average number of logging sessions per day. Sessions were considered distinct tracking events if they occurred \>15 minutes apart.

  4 weeks

• Number of Logging Sessions, Weekly

  The average number of logging sessions per day. Sessions were considered distinct tracking events if they occurred \>15 minutes apart.

  4 weeks

Secondary Outcomes (7)

• Child Intrinsic Motivation

  4 weeks

• Child Motivation to Change Eating Behaviors

  4 weeks

• Child Dietary Intake, Fruit

  4 weeks

• Child Dietary Intake, Vegetables Excluding Potatoes

  4 weeks

• Child Dietary Intake, Potatoes

  4 weeks

Study Arms (4)

BASIC

NO INTERVENTION

Children will be asked to track their intake of fruits, vegetables, sweet and salty snack foods, and sugary drinks in the web-based dietary self-monitoring (DSM) log for 4 weeks. Each child will be provided with a personal URL to access their log, which can be accessed from any internet-capable device (computer, phone, etc.). Caregivers will be asked to review their child's log each day and complete a caregiver check-in in the DSM log.

PRAISE

EXPERIMENTAL

In addition to conditions of the BASIC group, caregivers will also be asked to provide praise to their child for engaging in DSM over the 4 weeks. Additionally, when the caregiver completes caregiver check-ins in the DSM log, they will receive a prompt to also complete a praise check-in.

Behavioral: Caregiver Praise

GAME

EXPERIMENTAL

In addition to the conditions of the BASIC group, the child's log will also include a virtual pet that evolves over time as he/she uses the log. As the child earns points, the pet will level up and grow over time.

Behavioral: Gamification

PRAISE+GAME

EXPERIMENTAL

In addition to conditions of the BASIC group, caregivers will also be asked to provide praise to their child for engaging in DSM over the 4 weeks. Additionally, when the caregiver completes caregiver check-ins in the DSM log, they will receive a prompt to also complete a praise check-in. The child's log will also include a virtual pet that evolves over time as he/she uses the log. As the child earns points, the pet will level up and grow over time.

Behavioral: Caregiver Praise; Behavioral: Gamification

Interventions

Caregiver Praise BEHAVIORAL

Caregivers will provide praise for child's engagement in dietary self-monitoring behaviors as a form of positive reinforcement

PRAISE; PRAISE+GAME

Gamification BEHAVIORAL

DSM logs will include gamification (points, levels, virtual pets) as positive reinforcement for child's engagement in dietary self-monitoring behaviors

GAME; PRAISE+GAME

Eligibility Criteria

• Age: 8 Years - 100 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Families with children ages 8-12 years with body mass index (BMI)-for-age ≥ 5th percentile who report eating foods/beverages (any serving size) from ≥2 targeted food groups (fruits, vegetables, sweet and salty snack foods, and SSBs) on ≥3 days/week each and who have an adult caregiver ≥18 years of age willing to participate
• Family has reliable access to the internet via phone, computer, or another device that the child is able and permitted to operate

You may not qualify if:

• Child has major psychiatric diseases or organic brain syndromes
• Family does not live in the greater Knoxville area
• Family does not speak English

Sponsors & Collaborators

• The University of Tennessee, Knoxville: lead

Study Sites (1)

University of Tennessee

Knoxville, Tennessee, 37996, United States

Location

Related Publications (18)

• Germann JN, Kirschenbaum DS, Rich BH. Child and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children. J Pediatr Psychol. 2007 Jan-Feb;32(1):111-21. doi: 10.1093/jpepsy/jsl007. Epub 2006 Jun 14.

  PMID: 16775083 BACKGROUND

• Mockus DS, Macera CA, Wingard DL, Peddecord M, Thomas RG, Wilfley DE. Dietary self-monitoring and its impact on weight loss in overweight children. Int J Pediatr Obes. 2011 Aug;6(3-4):197-205. doi: 10.3109/17477166.2011.590196. Epub 2011 Jul 4.

  PMID: 21722068 BACKGROUND

• Saelens BE, McGrath AM. Self-monitoring adherence and adolescent weight control efficacy. Children's Health Care. 2003;32(2):137-152.

  BACKGROUND

• Dalle Grave R, Centis E, Marzocchi R, El Ghoch M, Marchesini G. Major factors for facilitating change in behavioral strategies to reduce obesity. Psychol Res Behav Manag. 2013 Oct 3;6:101-10. doi: 10.2147/PRBM.S40460.

  PMID: 24124398 BACKGROUND

• Guideline Development Panel for Treatment of Obesity, American Psychological Association. Summary of the clinical practice guideline for multicomponent behavioral treatment of obesity and overweight in children and adolescents. Am Psychol. 2020 Feb-Mar;75(2):178-188. doi: 10.1037/amp0000530.

  PMID: 32052993 BACKGROUND

• Favell JE. The power of positive reinforcement: a handbook of behavior modification. Charles C Thomas; 1977.

  BACKGROUND

• Griffiths LA, Douglas SM, Raynor HA. The role of structure in dietary approaches for the treatment of pediatric overweight and obesity: A critical review. Obes Rev. 2021 Sep;22(9):e13266. doi: 10.1111/obr.13266. Epub 2021 May 5.

  PMID: 33955110 BACKGROUND

• Henggeler SW, Sheidow AJ. Empirically supported family-based treatments for conduct disorder and delinquency in adolescents. J Marital Fam Ther. 2012 Jan;38(1):30-58. doi: 10.1111/j.1752-0606.2011.00244.x. Epub 2011 Sep 20.

  PMID: 22283380 BACKGROUND

• Freeman JB, Garcia AM. Family based treatment for young children with OCD: therapist guide. Oxford University Press; 2008.

  BACKGROUND

• Garett R, Young SD. Health care gamification: a study of game mechanics and elements. Technology, Knowledge and Learning. 2019;24(3):341-353.

  BACKGROUND

• Kumar VS, Wentzell KJ, Mikkelsen T, Pentland A, Laffel LM. The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. Diabetes Technol Ther. 2004 Aug;6(4):445-53. doi: 10.1089/1520915041705893.

  PMID: 15320998 BACKGROUND

• Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res. 2012 May 8;14(3):e70. doi: 10.2196/jmir.2058.

  PMID: 22564332 BACKGROUND

• Klingensmith GJ, Aisenberg J, Kaufman F, Halvorson M, Cruz E, Riordan ME, Varma C, Pardo S, Viggiani MT, Wallace JF, Schachner HC, Bailey T. Evaluation of a combined blood glucose monitoring and gaming system (Didget(R)) for motivation in children, adolescents, and young adults with type 1 diabetes. Pediatr Diabetes. 2013 Aug;14(5):350-7. doi: 10.1111/j.1399-5448.2011.00791.x. Epub 2011 Jun 23.

  PMID: 21699639 BACKGROUND

• Swartwout E, El-Zein A, Deyo P, Sweenie R, Streisand R. Use of Gaming in Self-Management of Diabetes in Teens. Curr Diab Rep. 2016 Jul;16(7):59. doi: 10.1007/s11892-016-0754-2.

  PMID: 27155609 BACKGROUND

• Debong F, Mayer H, Kober J. Real-World Assessments of mySugr Mobile Health App. Diabetes Technol Ther. 2019 Jun;21(S2):S235-S240. doi: 10.1089/dia.2019.0019.

  PMID: 31169427 BACKGROUND

• Deci EL, Koestner R, Ryan RM. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol Bull. 1999 Nov;125(6):627-68; discussion 692-700. doi: 10.1037/0033-2909.125.6.627.

  PMID: 10589297 BACKGROUND

• Mekler ED, Brühlmann F, Opwis K, Tuch AN. Do points, levels and leaderboards harm intrinsic motivation? An empirical analysis of common gamification elements. 2013:66-73.

  BACKGROUND

• Linehan C, Kirman B, Roche B. Gamification as behavioral psychology. The Gameful world: Approaches, Issues, Applications. MIT Press; 2015:81-105.

  BACKGROUND

Results Point of Contact

• Title: Dr. Hollie Raynor
• Organization: University of Tennessee, Knoxville

hraynor@utk.edu

865-974-9126

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Executive Associate Dean of Research & Operations, College of Education, Health, and Human Sciences

Model Details: 2 x 2 factorial design

Study Record Dates

• First Submitted: December 21, 2023
• First Posted: January 5, 2024
• Study Start: April 4, 2024
• Primary Completion: December 4, 2024
• Study Completion: December 4, 2024
• Last Updated: December 3, 2025
• Results First Posted: December 3, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)