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Citation:

Turnin MC, Tauber MT, Couvaras O, Jouret B, Bolzonella C, Bourgeois O, Buisson JC, Fabre D, Cance-Rouzaud A, Tauber JP, Hanaire-Broutin H. Evaluation of microcomputer nutritional teaching games in 1,876 children at school. Diabetes Metab. 2001 Sep;27(4 Pt 1):459-64.


PubMed ID: 11547219
Study Design:
Group Randomized Controlled Trial
Class:
A - Click here for explanation of classification scheme.
NEUTRAL: See Research Design and Implementation Criteria Checklist below.
Research Purpose:

This study evaluated microcomputer nutrition teaching games to improve children's nutrition knowledge and eating habits. 

Inclusion Criteria:

All 16 schools in one state school district were included in the study. 

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment All 16 schools in one state school district near a medium-sized city in southwestern France were included in the study. 

Design Group randomized controlled trial.  The schools were randomized into two groups, a control with nutrition teaching by the teacher and a games group who used computer learning games.

Blinding used (if applicable) The 3 questionnaires (knowledge, diet records, eating habits) were filled out anonymously and no connection could be easily established between each one. 

Intervention (if applicable) Microcomputer-based nutrition games were played by students for 1 hour twice a week for 5 weeks (10 hours).

Statistical Analysis Analysis included t-test and variance analysis (ANOVA) for quantitative variables and the chi-squared test for qualitative variables. 

 

Data Collection Summary:

Timing of Measurements  Students in the control and games groups were given 2 hours weekly of nutrition education for 5 weeks during the 1996-97 school year.  The evaluation (3 questionnaires) was completed after the 5 week program. 

Dependent Variables

  • Nutrition knowledge test
  • Dietary intake (diet record completed at home for three consecutive days)
  • Eating habits questionnaire

Independent Variables

  • Microcomputer-based nutrition education games

Control Variables

 

Description of Actual Data Sample:

Initial N: 1,876 pupils in 3 grades, 52.5% girls

Attrition (final N): Not all students completed all three of the questionnaires, so the N varies as indicated

  • 1,876 completed nutritional knowledge tests (1003 in the games group and 873 in the control group)
  • 1,576 completed diet records (827 in the games group and 749 in the control group)
  • 1,566 completed the questionnaire on dietary habits (846 in the games group and 720 in the control group)

Age:  Mean age 9 years (7-12 years)

Ethnicity: Not described

Other relevant demographics:

Anthropometrics BMI normal in 76.3%, 23.7% were overweight (11.1% were obese)

Location: Medium-sized city in southwestern France

 

Summary of Results:

Key Findings

  • The mean nutrition knowledge test score (N=1,876) of the games group was significantly better than the mean score of the control group (48.8 ±0.4 points vs 46.1± 0.4 points, P<0.001).
  • The diet record was completed by 1,576 children.  There was no significant difference in mean daily energy intake between the two groups.  The children in the games group ingested significantly more carbohydrate (46.4± 0.2% vs 45.7 ±0.2%, P<0.001) less fat (37.1 ±0.1% vs 37.6 ±0.2%, P<0.05) and less protein (16.5± 0.1% vs 16.7± 0.1%, P<0.05.)
  • Children in the games group also ate significantly more calcium (P < 0.001) and fiber (P < 0.05).
  • For children at normal or overweight BMI, there was no significant difference in diet records.  Obese children had a significantly lower energy intake than the others (1,806 ±33 kcal vs 1,950± 27 kcal vs 1.915±12 kcal, P<0.005).
  • Obese children in the games group (N=75) tended to have a better balanced diet than the control group (N=66).
  • Dietary habits questionnaire was answered by 1,566 students.  22.8% of the children in the games group said they changed their snacks vs 17.8% in the control group (P<0.05).  80.4% of the children in the games group said they ate fruits and vegetables every day versus 76.1% of children in the control group (P=0.05).
  • The children in the games group had a better snack at 10 am, a less copious lunch and less nibbling (P < 0.001).

 

Author Conclusion:

The children in the games group had slightly but significantly better nutrition knowledge and dietary intake compared to children in the control group.  Microcomputer nutrition games are suitable for use in schools and they appear to improve nutrition education. 

Reviewer Comments:

Measurements not made in all subjects - some children were absent on the day when knowledge questionnaires were filled out, some children did not bring back their diet record, and one school in the control group was excluded because of a methodology error.


Research Design and Implementation Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)
Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?
Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to nutrition or dietetics practice?
Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies)
Yes
 
Validity Questions
1. Was the research question clearly stated?
Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?
Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated?
Yes
  1.3. Were the target population and setting specified?
Yes
2. Was the selection of study subjects/patients free from bias?
Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?
Yes
  2.2. Were criteria applied equally to all study groups?
Yes
  2.3. Were health, demographics, and other characteristics of subjects described?
Yes
  2.4. Were the subjects/patients a representative sample of the relevant population?
Yes
3. Were study groups comparable?
Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)
Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?
Yes
  3.3. Were concurrent controls used? (Concurrent preferred over historical controls.)
Yes
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?
N/A
  3.5. If case control or cross-sectional study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable. Criterion may not be applicable in some cross-sectional studies.)
N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?
N/A
4. Was method of handling withdrawals described?
???
  4.1. Were follow-up methods described and the same for all groups?
???
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)
???
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for?
???
  4.4. Were reasons for withdrawals similar across groups?
???
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study?
N/A
5. Was blinding used to prevent introduction of bias?
Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?
N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)
Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?
N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status?
N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results?
N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?
Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied?
Yes
  6.2. In observational study, were interventions, study settings, and clinicians/provider described?
N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?
Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured?
Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described?
N/A
  6.6. Were extra or unplanned treatments described?
N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?
Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient?
N/A
7. Were outcomes clearly defined and the measurements valid and reliable?
???
  7.1. Were primary and secondary endpoints described and relevant to the question?
Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern?
Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur?
N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?
???
  7.5. Was the measurement of effect at an appropriate level of precision?
Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes?
Yes
  7.7. Were the measurements conducted consistently across groups?
Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators?
Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately?
Yes
  8.2. Were correct statistical tests used and assumptions of test not violated?
Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals?
Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?
N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?
Yes
  8.6. Was clinical significance as well as statistical significance reported?
Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error?
N/A
9. Are conclusions supported by results with biases and limitations taken into consideration?
Yes
  9.1. Is there a discussion of findings?
Yes
  9.2. Are biases and study limitations identified and discussed?
Yes
10. Is bias due to study’s funding or sponsorship unlikely?
Yes
  10.1. Were sources of funding and investigators’ affiliations described?
Yes
  10.2. Was the study free from apparent conflict of interest?
Yes
 
 

Copyright American Dietetic Association (ADA).