A novel study by the USDA has found that the video game Squires Quest! II: Saving the Kingdom of Fivealot is able to help get children on board with eating their fruits and vegetables and can continue showing progress even after the game is finished.
The game is a sequel to the Squires Quest! game used in a previous USDA study, which was a type of serious video game (meaning a game not intended for pure entertainment) that had a similar goal. However, the most recent report on the study takes a somewhat niche look at the data that tries to see more meal-centric effects.
National guidelines advise children ages 9-13 eat about 7-11 servings of fruits and vegetables each day, though less than 4% of American children meet this amount. With the awareness of how popular video games were the USDA devised Squire’s Quest! in the early 2000’s to see if a serious game could be used to improve dietary habits. The game was tested on 4th graders and some improvements were observed but once the game ended the gains in fruit and vegetable consumption didn’t last. Much like in conventional video game sequels, the study for Squires Quest! II was carried out by looking at the original, seeing what worked, adjusting what didn’t, and trying to build something new. Also like most sequels, the results were mixed.
Squire’s Quest! II Study: Summary
- Squire’s Quest! II: Saving the Kingdom of Fivealot is an online serious video game divided into 10 episodes that are designed to encourage children to eat at least five servings of fruit and vegetables per day
- For the study, 400 fourth and fifth-grade children were divided into four groups and played through the game. The groups were: creating action plans, creating coping plans (recognizing obstacles and devising answers), creating action and coping plans, and creating no plans
- Parents were also supplied with newsletters and a private website link with advice for how to support and provide enough fruits and vegetables
- The children completed 24-hour dietary recalls at baseline, immediately after the study was finished, and again six months later
- 79% of the children (316) reported completing their goals and 91% (364) completed the full game
- Significant improvement was only observed in the action group, which saw an almost 50% improvement by the six month mark
The New Report: Summary
- The most recent report is a form of subgroup analysis that took the data from the Squire’s Quest! II study and tried to parse it further
- It looked at the participant groups and how their fruit and vegetable intake changed during individual meals
- The action and coping groups (but not the action plus coping group or control) showed higher vegetable intake during dinner
- The action and coping groups also showed more fruit intake during breakfast, lunch, and snacks
What This All Means
Subgroup analysis can be a double-edged sword in research. On the one hand, it can help reveal specific niche impacts that might otherwise go unnoticed. On the other hand, pulling together subgroup analysis only after the fact (as opposed to being an original intention) can be a sign that someone is trying to find a way to spin an essentially negative study into a positive. Since the subgroup analysis here is a separate report from the original study, the intentions are likely more towards the former in this case.
Understanding what these findings mean, however, is tricky. At the start of the original study, the action group had an average baseline of 1.64 fruit and vegetable servings per day. After playing Squire’s Quest! II, the average servings per day was 2.32 at the six month follow-up.
For the coping group, the baseline and six month servings were 1.83 and 2.11 respectively. Although both saw an increase, only the action group’s was considered enough to be statistically meaningful. This means any subgroup findings about the coping group need to be taken with a grain of salt since they may not have added up to anything.
- Changes in vegetable consumption may be more likely to happen if intervention efforts are focused on dinner
- Fruit consumption may be more likely to change if intervention efforts are focused on breakfast, lunch, and snacks
Thompson, D., et. al., “Creating action plans in a serious video game increases and maintains child fruit-vegetable intake: a randomized control trial,” International Journal of Behavioral Nutrition and Physical Activity, 2015; 10.1186/s12966-015-0199-z.
Thompson, D., et. al., “A Serious Video Game to Increase Fruit and Vegetable Consumption Among Elementary Aged Youth (Squire’s Quest! II): Rationale, Design, and Methods,” JMIR Research Protocols, 2012; 10.2196/resprot.2348.