Effectiveness of Healthy Foodie Nutrition Game Application as Reinforcement Intervention to Previous Standard Nutrition Education of School-Aged Children

A Randomized Controlled Trial





nutrition, health education, video games, nutrition questionnaire


Objective. Games promoting nutrition education are helpful tools to improve nutrition knowledge. Healthy Foodie is an interactive web-based nutrition game for Filipino children. This study aimed to determine the effectiveness of Healthy Foodie on the nutrition knowledge of children aged 7 to 10 years old.

Methodology. This study had 2 phases. In Phase 1, we developed and validated the Healthy Foodie nutrition game application and Nutrition Knowledge Questionnaire involving 46 participants. The Nutrition Knowledge Questionnaire was divided into 2 15-item questionnaires: Part 1 pertained to Food Group Knowledge and Part 2 on Food Frequency Knowledge. Phase 2 was the implementation of the game and questionnaire. This was a randomized controlled trial conducted in two elementary schools in Manila, involving 360 participants divided equally into control and experimental groups.

Results.For Phase 1, internal consistency of the questionnaire using the Kuder-Richardson Formula 20 was 0.75 for part 1 and 0.70 for Part 2. In Phase 2, comparing the adjusted posttest mean Food Group Knowledge scores, there was statistically higher score (F=111.84, p=0.0001) in the experimental group (11.57±0.20) compared to the control (8.51±0.20). In the adjusted posttest mean Food Frequency Knowledge scores, there was a statistically higher score (F=56.12, p=0.0001) in the experimental group (10.70±0.15) compared to the control (9.07±0.15).

Conclusion. nutrition game-based intervention such as Healthy Foodie is effective as a reinforcement intervention to previous standard nutrition education of school-aged children.


Download data is not yet available.

Author Biographies

Florence Rochelle Gan, University of Santo Tomas Hospital

Section of Endocrinology, Department of Internal Medicine

Elaine Cunanan, University of Santo Tomas Hospital

Section of Endocrinology, Department of Internal Medicine

Rebecca Castro, University of Santo Tomas Hospital

Section of Gastroenterology, Department of Internal Medicine


Food and Nutrition Research Institute, Department of Science and Technology. 8th National Nutrition Survey; 2013. http://www.fnri.dost.gov.ph/index.php/nutrition-statistic/19-nutrition-statistic/118-8th-national-nutrition-survey. Accessed June 16, 2017.

Cua SC. Prevalence of metabolic syndrome in overweight and obese Filipino adolescents based on IDF definition. J ASEAN Fed Endocr Soc. 2012;27(1):82-6.https://doi.org/10.15605/jafes.027.01.13.

Grant-Guimaraes J, Feinstein R, Laber E, Kosoy J. Childhood overweight and obesity. Gastroenterol Clin North Am. 2016;45(4):715–728. https://www.ncbi.nlm.nih.gov/pubmed/27837784. https://doi.org/10.1016/j.gtc.2016.07.007.

American Academy of Pediatrics Institute for Healthy Childhood Weight. 5, 2, 1, 0 Strategies. https://ihcw.aap.org/Documents/Additional%20Resources/5210_strategies.pdf. Accessed June 18, 2017.

Department of Education, Republic of the Philippines. DO 13, s. 2017: Policy and guidelines on healthy food and beverage choices in Schools and in DepEd offices. http://www.deped.gov.ph /orders/do-13-s-2017. Accessed June 18, 2017.

Department of Education, Republic of the Philippines. K to 12 health curriculum guide. http://www.deped.gov.ph/wp-content/uploads/2019/01/Health-CG_with-tagged-math-equipment.pdf. Accessed May 5, 2019.

Baranowski T, Blumberg F, Buday R, et al. Games for health for children—current status and needed research. Games Health J. 2016;5(1):1-12. https://www.ncbi.nlm.nih.gov/pubmed/26262772. https://doi.org/10.1089/g4h.2015.0026.

Powers AR, Struempler BJ, Guarino A, Parmer SM. Effects of a nutrition education program on the dietary behavior and nutrition knowledge of second-grade and third-grade students. J Sch Health. 2005;75(4):129-133. https://www.ncbi.nlm.nih.gov/pubmed/15987006.

Hermans RCJ, van den Broek N, Nederkoorn C, Otten R, Ruiter ELM, Johnson-Glenberg MC. Feed the alien! The effects of a nutrition instruction game on children’s nutritional knowledge and food intake.Games Health J. 2018;7(3):164-74. https://www.ncbi.nlm.nih.gov/pubmed/29634366. https://doi.org/10.1089/g4h.2017.0055.

Deater-Deckard K, Chang M, Evans ME. Engagement states and learning from educational games. New Dir Child Adolesc Dev. 2013;2013(139):21-30. https://www.ncbi.nlm.nih.gov/pubmed/23483690. https://doi.org/10.1002/cad.20028.

Thompson D. Designing serious video games for health behavior change: current status and future directions. J Diabetes Sci Technol. 2012;6(4):807-811. https://www.ncbi.nlm.nih.gov/pubmed/ 22920806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440151. https://doi.org/10.1177/193229681200600411.

Food and Nutrition Research Institute, Department of Science and Technology. Pinggang Pinoy. https://www.fnri.dost.gov.ph/images/sources/PinggangPinoy-Kids.pdf. Accessed November 14, 2017.

Tookoian J. What is the right number of test questions? https://edulastic.com/blog/the-right-number-of-test-questions. Accessed May 7, 2019.

Trakman, GL, Forsyth A, Hoye R, Belski R. Developing and validating a nutrition knowledge questionnaire: key methods and considerations. Public Health Nutr. 2017;20(15): 2670-9. https://www.ncbi.nlm.nih.gov/pubmed/28735598. https://doi.org/10.1017/S1368980017001471.

Salkind NJ, ed. Encyclopedia of research design. Thousand Oaks: SAGE Publications, Inc., 2010.

Baranowski T, Baranowski J, Thompson D, Buday R. Behavioral science in video games for children’s diet and physical activity change: key research needs. J Diabetes Sci Technol. 2011;5(2):229-33. https://www.ncbi.nlm.nih.gov/pubmed/2157086. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125909. https://doi.org/10.1177/193229681100500204.

Ledoux T, Griffith M, Thompson D, et al. An educational video game for nutrition of young people: theory and design. Simul Gaming. 2016;47(4):490-516. https://www.ncbi.nlm.nih.gov/pubmed/27547019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987000.https://doi.org/10.1177/1046878116633331.

Eberly Center. Creating exams. https://www.cmu.edu/teaching/assessment/assesslearning/creatingexams.html. Accessed May 7, 2019.

Anderson AS, Bell A, Adamson A, Moynihan P. A questionnaire assessment of nutrition knowledge—validity and reliability issues. Public Health Nutr. 2002;5(3):497-503. https://www.ncbi.nlm.nih.gov/pubmed/12003663. https://doi.org/10.1079/PHNPHN2001307.

Doustmohammadian A, Omidvar N, Keshavarz-Mohammadi N, Abdollahi M, Amini M, Eini-Zinab H. Developing and validating a scale to measure Food and Nutrition Literacy (FNLIT) in elementary school children in Iran. PLoS One. 2017;12(6):e0179196. https://www.ncbi.nlm.nih.gov/pubmed/28654646. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487019.

Wilson AM, Magarey AM, Mastersson N. Reliability and relative validity of a child nutrition questionnaire to simultaneously assess dietary patterns associated with positive energy balance and food behaviours, attitudes, knowledge and environments associated with healthy eating. Int J Behav Nutr Phys Act. 2008;5:5. https://www.ncbi.nlm.nih.gov/pubmed/18226268. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2268941. https://doi.org/10.1186/1479-5868-5-5.

Choi ES, Shin NR, Jung EI, Park HR, Lee HM, Song KH. A study on nutrition knowledge and dietary behavior of elementary school children in Seoul. Nutr Res Pract.2008;2(4):308-316. https://www.ncbi.nlm.nih.gov/pubmed/20016735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788182.https://doi.org/10.4162/nrp.2008.2.4.308.

Asakura K, Todoriki H, Sasaki S. Relationship between nutrition knowledge and dietary intake among primary school children in Japan: Combined effect of children's and their guardians' knowledge. J Epidemiol. 2017;27(10):483-91. https://www.ncbi.nlm.nih.gov/pubmed/28576447. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602805.https://doi.org/10.1016/j.je.2016.09.014.

Katz DL, Katz CS, Treu JA, et al. Teaching healthful food choices to elementary school students and their parents: The Nutrition Detectives™ Program. J Sch Health. 2011;81(1):21-8. https://www.ncbi.nlm.nih.gov/pubmed/21158862. https://doi.org/10.1111/j.1746-1561.2010.00553.x.

Rockett HR, Breitenbach M, Frazier, AL, et al. Validation of a youth/adolescent food frequency questionnaire. Prev Med. 1997;26(6):808-16. https://www.ncbi.nlm.nih.gov/pubmed/9388792. https://doi.org/10.1006/pmed.1997.0200.

Gormanley S. Audio immersion in games—a case study using an online game with background music and sound effects. Comput Game J. 2013;2:103-124. https://doi.org/10.1007/BF03392344.

Ermi L, Mäyrä F. “Fundamental Components of Gameplay Experience: Analysing Immersion.” In: DIGAREC Keynote-Lectures 2009/10, edited by Stephan Günzel, Michael Liebe and Dieter Mersch, 88-115. Potsdam: University Press, 2011. https://publishup.unipotsdam.de/opus4ubp/frontdoor/deliver/index/docId/5046/file/digarec06_S088_115.pdf.

Baranowski T, Thompson D, Buday R, Lu AS, Baranowski J. Design of video games for children’s diet and physical activity behavior change. Int J Comp Sci Sport. 2010;9(2):3-17. https://www.ncbi.nlm.nih.gov/pubmed/25364331. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214274.

Crookall D. Serious games, debriefing, and simulation/gaming as a discipline. Simul Gaming.2010;41(6): 898-920. https://doi.org/10.1177%2F1046878110390784.

Lederman L. Debriefing: Toward a systematic assessment of theory and practice. Simul Gaming. 1992;23(2):145-60. https://doi.org/10.1177/1046878192232003.

Malala J, Major A, Maunez-Cuadra J, McCauley-Bell P. The use of rewards in instructional digital games: An application of positive reinforcement. Proceedings of the Annual Conference of the International Academy of Business Disciplines, 2007. https://www.learntechlib.org/p/58865/.

Gentile DA, Anderson CA, Yukawa S, et al. The effects of prosocial video games on prosocial behaviors: International evidence from correlational, longitudinal, and experimental studies. Pers Soc Psychol Bull. 2009;35(6):752-63. https://www.ncbi.nlm.nih.gov/pubmed/19321812. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678173. https://doi.org/10.1177/0146167209333045.

Roberts LS, Sharma S., Hudes ML, Fleming SE. Nutrition and physical

activity knowledge assessment: Development of questionnaires and evaluation of reliability in African American and Latino Children. J Child Nutr Manag. 2012;36(2). https://schoolnutrition.org/5--News-and-Publications/4--The-Journal-of-Child-Nutrition-and-Management/Fall-2012/Volume-36,-Issue-2,-Fall-2012---Roberts,-Sharma,-Hudes,-Fleming/.



How to Cite

Gan, F. R., Cunanan, E., & Castro, R. (2019). Effectiveness of Healthy Foodie Nutrition Game Application as Reinforcement Intervention to Previous Standard Nutrition Education of School-Aged Children: A Randomized Controlled Trial. Journal of the ASEAN Federation of Endocrine Societies, 34(2), 144–152. https://doi.org/10.15605/jafes.034.02.04



Original Articles

Most read articles by the same author(s)