““Eat This, Not That!”: Eat This, Not That!”: Using Avatars and the Community Using Avatars and the Community Readiness Model to Teach Healthy Readiness Model to Teach Healthy Food Choices to Native American Food Choices to Native American

Children Children

Phyllis Nsiah-Kumi, MD, MPHDepartment of Internal Medicine

Internal Medicine-PediatricsCollege of Medicine

~~

Health Promotion, Social and Behavioral HealthCollege of Public Health (Courtesy)

Nebraska Center for Integrative Nutrition and Metabolic Processes CoBRE Retreat

October 28, 2010 - Ashland, NE

Project Team

MentorsTerry T.K. Huang, PhD, MPH, UNMC College of Public Health

Jennifer L. Larsen, MD, UNMC College of Medicine, Associaate Vice Chancellor for Clinical Research

Co-InvestigatorsDeepak Khazanchi, PhD, UNO College of Information Science & Technology

Susan Raatz, PhD, MPH, MS, United States Department of Agriculture, Grand Forks Nutrition Center, ND

Ronald J. Shope, PhD, Educational Psychology, UNL

Obesity in Native American Children

•Two-fold risk of being

obese compared to

their white counterparts

•Increased risk of pre-diabetic states in childhood and adulthood.

•Increased risk of early death from cardiovascular and other causes.

Northern Plains Tribes

Eighteen tribal nations in

•Iowa

•Nebraska

•North Dakota

•South Dakota

Ponca Tribe Pilot Data

•Prevalence of obesity in children•Parental perceptions of children’s risk of diabetes and weight related problems

•Health literacy of parents

•Family Health Behavior data

Type 2 Diabetes Risk in Rosebud Sioux Children (n=161)

Age 5-18 5-11 12-18 P-valueFemale 55.3% 51.6% 60.3% 0.27

Abd Circ (cm)

77.1+/-18.6 69.4 +/-14.2 87.8+/-18.9 <0.0001

% OW 23.0% 25.8% 19.1% 0.32

% Obese 31.1% 32.3% 29.4% 0.70

2 hr glu 93.2+/-21.3 92.55+/-19.8 94.08+/-23.3 0.79

Fasting insulin

22.3+/-26.5 17.97+/-22.9 28.37+/-29.8 <0.0001

HOMA-IR 4.8+/-5.7 3.9+/-5.3 5.92+/-6.1 <0.0001

Nsiah-Kumi et al. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 102, NO. 10, OCTOBER 2010

Predictors of Pre-Diabetes/Diabetes in Rosebud Sioux Children (n=201)

Prediabetes/Diabetes

Yes No P-value

N, % 14, 7.0% 187, 93.0% --

Systolic BP (mm Hg) 113.4+/- 14.3 102.1+/-12.5 0.005

Abd Circ (cm) 77.1+/-18.6 69.4 +/-14.2 <0.0001

BMI-%-for age-sex 90.3+/-16.1 76.4+/-23.9 0.004

Triglycerides (mg/dl) 135.3+/-42.9 80.2+/-38.6 <0.0001

hsCRP (mg/L) 3.5+/-4.2 2.7+/-6.7 0.05

Fasting insulin (U/ml) 49.4+/-44.8 20.8+/-22.3 0.0002

HOMA-IR 13.3+/-12.7 4.3+/-4.6 <0.0001

Nsiah-Kumi et al. Pre-diabetes in Native American Children. (In Review)

Socio-Ecological Model:Factors Affecting Childhood Obesity

Dietary Guidelines for AmericansTranslating nutritional science to community settings is essential

to enhance healthy diets and weights.

University of Nebraska Medical Center

Community Readiness

Assessment

Development of Metaverse and

Training Scenarios

Train 8-10 yo children fr Northern Plains Tribes (n=25)

Evalute impact of metaverse training

program

Project Approach

Phase 1 Phase 2 Phase 3 Phase 4

Specific Aim 1

University of Nebraska Medical Center

Assess readiness of participating Native

American community to take action on

childhood obesity and type 2 diabetes

prevention using the six dimension

Community Readiness Model.

Phase 1: Community Readiness Assessment

•Identify community and youth leaders

•Train youth on obesity, citizenship, CRM

•Key Respondent interviews

•Determine community readiness

Dimensions of Community Readiness

1. Community Efforts (programs, activities, policies, etc.)

2.Community Knowledge of the Efforts

3.Leadership (formal and informal)

4.Community Climate

5.Community Knowledge About the Issue

6.Resources Related to the Issue (people,

time, money, space, etc.)

University of Nebraska Medical Center

Community Readiness Scoring

University of Nebraska Medical Center

Specific Aim 2

Develop a culturally-appropriate metaverse

environment including theory-driven

interactive activities and simulation(s)

designed to teach healthy food choices and

portion size selection (based on the

Dietary Guidelines for Americans) to Native

American children.

University of Nebraska Medical Center

Phase 2: Development of Second Life Training

•Avatar Development

•Environment Development

•Scenario Development with feedback

incorporated

•Scoring System Development

Decision-Making Training for Behavior Change

• Teaching guidelines alone is not enough.

• Curricula have been developed for delivery of content

in classroom settings.

• Decision-making skills are crucial for adoption of

healthy dietary habits.

 

University of Nebraska Medical Center

Metaverses

• Metaverses are immersive 3D virtual worlds (VWs)

in which people interact as avatars with each other

and with software agents, using the metaphor of

the real world but without its physical limitations.

• Second Life is among the most common.

Virtual Worlds

Computer based

Available via internet

3 dimensional recreation of “reality”

Visual

Static

Motion

Audio

University of Nebraska Medical Center

UNO/CON Pilot ResultsPresence Questionnaire

Mean total score: 134.67 + 15.62 (max – 224)

Min/Max: 121/157

Mean item score: 4.27 out of 7Summary of identified themes

Realistic scenario

For right now “good as it gets”

Gives sense of home visit

Inconsistencies (in environment)

• Modern house – too many broken windows

• Furniture too nice for run down neighborhood

• Clutter in real homes is much worse

• Too many homes with water damage

Benefits of avatars for skills training

• Nearly unlimited freedom. Highly adapatable.

• Can design and integrate content with engaged

learning.

• Experiment with decision-making safely in the virtual

world.

• Health related information exchange and teaching can

occur with this type of educational delivery.

• Successful transfer to the real world of skills practiced

in a virtual environment.

My Second Life Avatar – Pink Lapis

Phase 3: Second Life Training Program Implementation

8-10 year olds from Northern Plains Tribes

(n=25) will complete Second Life training.

Training scenarios will include food choices in:

•Home

•School

•Community event

•Restaurant

Conceptual Model for Metaverse Research

Source: Davis, A., Owens, D., Murphy, J., Khazanchi, D. and Zigurs, I. (2009, February). "Avatars, People, and Virtual Worlds: Foundations for Research in Metaverses." Journal of the Association for Information Systems, Volume 10, Issue 2 , Article 2, pp. 90-117.

Specific Aim 3

Evaluate the impact of metaverse-based

decision-making training on:

1. Knowledge of Dietary Guidelines for Americans

2. Metaverse-based food choices and real-world

choices

3. Anthropometric and biomarkers related to

childhood obesity and cardiovascular disease risk

over time

University of Nebraska Medical Center

Targeted Behavior(s)/Guideline Recommendations:

a.) increasing water consumption

b.) decreasing SSB consumption

c.) decreasing intake of fatty foods

d.) increasing fruit and vegetable consumption,

e.) decreasing portion size.

University of Nebraska Medical Center

Phase 4: Evaluation of Decision-Making Skills and Second Life Experience

•Second Life Test Scenarios

•Food and Beverage Logs

•Pre-post DGA knowledge testing

•Focus Groups

Anthropometric and biomarker dataPre-post-6mos-12mos

• Height, weight, BMI percentile, waist

circumference, blood pressure

• hsCRP

• Glucose

• Insulin

• Lipids

University of Nebraska Medical Center

Innovation

•Use of Second Life, as a platform for learning simulations through role plays with the intent to improve the development of decision-making.

•No web-based, metaverse-based trainings focused on teaching this type of decision-making currently exist.

•The impact of using 3D environments such as virtual worlds that integrate theory-driven pedagogy to teach effective decision-making to younger children is not very well studied.

University of Nebraska Medical Center

Percentage of Overweight or Obese Children: 2003*

Source: The National Survey of Children's Health.

Percentage of Overweight or Obese Children: 2005*

Source: The National Survey of Children's Health.

Percentage of Overweight or Obese Children: 2007*

Source: The National Survey of Children's Health.

Source: The National Survey of Children's Health.

Percentage of Overweight or Obese Children: 2003, 2005, and 2007

2003 2005

2007

Dietary Guidelines for Americans

GRAINSVEGETABLE

SFRUITS OILS MILK

MEAT & BEANS

Translating nutritional science to community settings is essential to enhance healthy diets and weights.

Hypothesis 1

Community readiness to address the issue

of childhood obesity and type 2 diabetes

prevention can be improved using avatar-

based decision making training.

University of Nebraska Medical Center

Hypothesis 2

A culturally-appropriate metaverse

environment including interactive activities and

simulation(s) can teach healthy food choices and

portion size selection (based on the Dietary

Guidelines for Americans) to

Native American youth and can help them

translate these skills into their real world

decision-making.

Games, Simulations and Virtual Worlds

Games

Fun, engaging

activities usually used

purely for entertainment, but

they may also allow people

to gain exposure to

a particular set of

tools, motions, or ideas.

Simulations

Use rigorously

structured scenarios

carefully designed to

develop specific

competencies that can be

directly transferred into the

real world.

University of Nebraska Medical Center

Virtual Worlds

Multiplayer (and often massively multiplayer),

3D persistent social environments with easy-to-

access building capabilities. They share with

games and simulations the 3D

environment, but they do not have the focus on

a particular goal, such as advancing to the next

level or successfully navigating the scenario.

University of Nebraska Medical Center