Engaging low-income African American adolescents in a virtual avatar-based nutrition education program
- UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
- Basheerah R. Enahora (Creator)
- Institution
- The University of North Carolina at Greensboro (UNCG )
- Web Site: http://library.uncg.edu/
- Advisor
- Jared McGuirt
Abstract: Childhood obesity is a serious public health concern, with minority, low-income adolescents disproportionately affected and at the greatest risk. In addition, as adolescents gain independence, dietary quality declines with youth eating more energy-dense foods away from home, increasing the risk of overweight and obesity, and other adverse health conditions. Studies have demonstrated that African American adolescents consume more added sugar, fried foods, sweetened beverages, and snack foods than non-Hispanic White adolescents. Effective, culturally tailored interventions to improve African American adolescents’ dietary intake are limited. In addition, implementing in-person community-based nutrition programs often requires significant labor and financial resources. However, compared with traditional face-to-face nutrition education, youth have reported a preference for digital health promotion programs. The use of digital technology and media is pervasive among youth, with low-income adolescents using digital devices roughly two hours more per day than adolescents of higher income. Adolescents communicate via digital technology and view it as a source of entertainment, socialization, and active learning. Youth avidly use avatars, or digital characters, to engage with digital media and strongly identify with avatars as extensions of themselves. Thus, this research examines the use of a technology-based virtual reality (VR) avatar-led health promotion program among adolescents. The specific objectives of this research are to (1) assess the appeal of a VR avatar-based nutrition education program among African American adolescents and their parents and, identify necessary modifications to impact dietary behaviors, (2) identify factors associated with the adoption and dissemination of a VR avatar-based nutrition education program among community agency partners and (3a) quantitatively assess the acceptability of the VR avatar-based nutrition education program among African American youth and (3b) explore if interaction with the avatar impact’s dietary responses. This research utilized a mixed-method approach, consisting of formative research, a cross-sectional survey, and a quantitative formative process evaluation to address these objectives. Focus groups and in-depth interviews with predominantly (84.6%) low-income African American adolescents age 12.38 ± 1.02 (n=37) and parents (n=11) revealed positive interest in the VR avatar-based nutrition education program. Adolescents found the use of avatars to provide health guidance appealing. Most youth and parents agreed that the program would impact their dietary behaviors. Adolescents also suggested a theme-based storyline, a points-based reward system, challenges, music customization, and avatar customization to increase and sustain program engagement. Parents desired exploration of cultural foods, cooking skills development, and for youth to see themselves reflected in the program to foster cultural identity. For the cross-sectional survey, one hundred community agency partners who served families in all one hundred counties in North Carolina responded. The majority of community partners were affiliated with hospital systems (27%), school systems (27%), or health departments (16%). Overall perceptions of the VR avatar nutrition education program were favorable among community partners. Community partners who perceived the VR avatar nutrition program as a relative advantage to current programs (p < 0.05) and compatible (p < 0.001) with organizational and personal values had significantly higher future use intention. There were no statistically significant differences in future use intention observed by agency type, the age range of youth served, current use of digital tools to teach nutrition education (NE), early adopter status, organizational support for technology, or role in the adoption of new nutrition programs. Finally, we conducted a quantitative formative process evaluation with thirty-nine low-income youth, who were majority African American (79.5%), and an average age of 11.06 ± 1.79 years old. Findings revealed that overall program appeal and usability were favorable, with the majority of youth reporting the VR avatar program was fun to use (84.6%), overall easy to use (92.3%), would be useful in daily life (79.4%), would use the program often if it becomes available (71.8%), intend to use when it becomes available (66.7%), and would recommend the VR avatar program to a friend (92.3%). Significantly more youth with smartphones agreed the VR avatar program would increase confidence to eat healthy (p=0.013, d=0.322), would be useful in daily life (p=0.020, d=0.298), and intend to regularly use the program when it becomes available (p=0.002, d=0.415), compared to youth without smartphones. There was a weak positive statistically significant association between VR avatar program fruit servings and the FV screener fruit servings (r = 0.363, p = 0.023), indicating the VR avatar program does not appear to impact responses regarding fruit intake among low-income youth. These findings demonstrate the appeal of the VR avatar nutrition education program among African American adolescents and the potentiality of the program to impact dietary behaviors. Community organizations also view the VR avatar nutrition education program as an advantage compared to current programs and as compatible with organizational and personal values. Utilizing these findings can help guide the development of a culturally tailored-avatar-led digital nutrition program, as well as future nutrition education and health promotion research and programming. Furthermore, considering the factors identified in this study will help the adoption and dissemination of digital nutrition education programs among community partners who serve low-income families.
Engaging low-income African American adolescents in a virtual avatar-based nutrition education program
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Created on 8/1/2022
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Additional Information
- Publication
- Dissertation
- Language: English
- Date: 2022
- Keywords
- Adolescent nutrition, Digital health, Mobile health, Nutrition education, Obesity prevention, Pediatric obesity
- Subjects
- Obesity in children $x Prevention
- African American teenagers $x Nutrition
- Nutrition counseling
- Mobile apps