Development and Evaluation of Interactive Multimedia-Based ... 03.pdf · designed by using PowToon Video Maker and recorded with Screencast-o-Matic software and it was then converted

Wan Dali et al. 2017 Health and the Environment Journal, 2017, Vol 8 No 1

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Development and Evaluation of Interactive Multimedia-Based Nutrition

Education Package (IMNEP) to Promote Healthy Diet

for Overweight and Obese Children

Wan Putri Elena Wan Dali, Hamid Jan Jan Mohamed, Hafzan Yusoff

Nutrition Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Corresponding author: [email protected]

________________________________________________________________________________________

ABSTRACT: The integration of interactive multimedia has been widely used especially in

medical and education fields, allowing the learning process to become easier and more effective

than the traditional approach. The present study describes some of the theoretical backgrounds,

development, and validation of Interactive Multimedia-based Nutrition Education Package

(IMNEP). The IMNEP was developed and delivered through education video, healthy food flash

game, and PC Dance Mat. The feasibility, acceptability, and applicability of IMNEP were then

evaluated, involving school children (n=50), researchers (n=10), and parents (n=8) by

distributing the evaluation questionnaire of IMNEP (EQ-IMNEP). The majority of the

respondents gave positive responses and felt that IMNEP was interesting and engaging with

regards to graphics, contents, animations, and its usage as a new medium in teaching nutrition for

children and parents. Most of the students (96%) had some prior experiences in playing

computer or mobile games and strongly felt that they would repeatedly play this healthy food

flash game. These initial findings indicate early evidence that IMNEP was feasible, acceptable,

and applicable with some modifications for the purpose of controlling obesity in the intervention

phase later.

Keywords: obesity, school children, nutrition education, interactive multimedia-based


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Introduction

A number of studies have indicated significant evidences of the association between co-

morbidities with obesity during childhood including hypertension, coronary heart disease, insulin

resistance, diabetes, lipid abnormalities, and sleep-disordered breathing (Daniels et al., 2005;

Din-Dzietham et al., 2007; Uli et al., 2008). International recommendations suggest that the core

elements of any initiatives taken to address paediatric obesity should involve family members’

intervention in the form of appealing attitude, behaviour modification, and the promotion of

physical activities (Sacher et al., 2010; Spear et al., 2007).

As suggested in previous studies (Kim and Hyun 2006; Matheseon and Achterberg 2001),

computer-assisted instruction or education could be an effective way for changing the nutrition

knowledge and the behaviour among children. Application of educational games as a teaching

strategy can be an effective method to create active learning environments by reinforcing

knowledge as well as motivating learners in a fun and exciting environment (Strickland &

Kaylor, 2016). Indeed, there were a few studies abroad (Baranowski et al., 2011; Maddison et al.,

2011; Trost et al., 2014) which evaluating the effects of nutrition education through active video

games and they reported significant increases in daily physical activity and reduction in body

weight. The Nutrition Division of the Ministry of Health Malaysia has taken many initiatives to

encourage the population of Malaysia to eat and live better. Following the technology trends, the

Nutrition Division has launched the MyNutriApps application for mobile to disseminate

knowledge of healthy eating and living to Malaysians. In September 2016, the Nutrition Division

had recently launched another app called MyNutriDiari. MyNutriDiari has more advanced

functions. These include a complete nutrition resource center in an app in mobile consisting of

literatures, videos, guidelines, tutorials and even healthy cooking recipes, a built-in calculator to

calculate Body Mass Index (BMI) and a built-in estimator that will estimate your daily calorie

intake needs based on individual’s age, gender and program (e.g. if you want to lose a kg a

week). This app is very useful especially to health enthusiast and those who are in the healthcare

world. However, not everyone has smartphone to download this free application especially those

from low income families.


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In Malaysia, various programmes and initiatives have been implemented among primary school

children to help them improve their knowledge on nutrition, promote positive attitude towards

good health and nutrition, as well as to practice a healthy lifestyle (Ministry of Education, 1998;

Sahari, 1992). This includes School Health Education Programme, School Supplementary

Feeding Programme, School Milk Programme, and Physical and Health Education Syllabus.

However, the effectiveness of these implementations is still doubtful as the rate of obesity,

according to statistics, keep increasing. For example, based on the studies conducted by Mohd

Ismail et al. (2009) and Anuar Zaini et al. (2005), the obesity and overweight prevalence was

ranged from 18.4% to 22.6% among school children. A study done in Kelantan reported 13.1%

of overweight and obese cases among Malay children (Manan et al., 2012) while another study

done among Chinese children recorded way higher prevalence of overweight and obesity at

24.8% (Soo et al., 2011). These data demonstrate a worrying trend of obesity in this country.

Validation and reliability testing of all intervention tools prior to delivery to the target population

is a compulsory procedure in any intervention study to ensure that it is modifiable and can be

used as an example of good practice (Joshi et al., 2001; Perkins, 2000). Therefore, the purposes

of this study are; (1) to describe the content knowledge and summarise its development process,

(2) to structure the Interactive Multimedia-based Nutrition Education Package (IMNEP), and (3)

to test whether this IMNEP is feasible, acceptable, and practical as an effective tool for nutrition

education and weight management intervention. Researchers hypothesised that IMNEP would be

positively accepted among our respondents for its applicable nature besides being feasible for the

obese and overweight children during the next intervention phase.

Material and Methods

Research Design and Sample Selection

This investigation was based on a cross-sectional design which employed convenience sampling

method. The respondents consisted of university researchers from Universiti Sains Malaysia,

parents and primary school children at Kubang Kerian 3 Primary School from seven different

classes who fulfilled the following criteria; (1) standard five aged 11 years old and (2) generally

healthy without any chronic diseases. Scott (2008) argued that children are able to complete


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questionnaires given; however, there is a certain age requirement for children to participate in a

research with high level of trustworthiness and ability to complete standardised survey. This

study was carried out in two phases. The first phase was the development of IMNEP and the

second phase was the evaluation of its feasibility, acceptability, and applicability of IMNEP.

Data collection was conducted from September 2015 until October 2015.

Phase I: Development of the IMNEP

This phase involved the discussions of IMNEP among developer and researchers who were

highly experienced in nutrition and dietetics. The development and the contents of IMNEP were

adapted from the Malaysian Dietary Guideline (MDG) for Children and Adolescents 2013 and

other sources including myHealth (2008), NutriWeb portal (2014), World Health Organization

(2000), Centres for Disease Control and Prevention (2015), and National Institute for Health and

Care Excellence (2014). The development of multimedia (CD-ROM) for animation video was

designed by using PowToon Video Maker and recorded with Screencast-o-Matic software and it

was then converted into MP4 files. The education game was developed using Adobe Flash

Program and ran on Windows, Mac OS X, and Linux operating systems. This multimedia-based

intervention constitutes of multiple interactive elements including audio, text, simulation, and

graphics. The IMNEP developed in this study was applicable for desktop application (Windows)

only and was not applicable for use on smartphones and tablets.

Figure 1 illustrates the development process of IMNEP. A number of major modifications were

done in Stage 1. The steps involved scripting and evaluation of information and terms used,

sequences, characters, backgrounds, as well as sound and music. Minor modification based on

re-evaluation was done on scripting and information and it took place in Stage 2 and Stage 3.

Abbreviations or symbols were avoided in both video and game to prevent the misinterpretation

of information.


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Figure 1: Development process of IMNEP

Healthy Food Flash Game Module

Education game is a flash game format opened to all users without any specific requirement on

sex, age, education level, or experience. However, for the study purpose, this healthy food flash

game is targeted for children aged 11 who are overweight and obese. There are six user interface

screen namely start screen, body mass index (BMI) screen, a list of food screen, food table

screen, quizzes screen, and correct answer interface. This healthy food flash game teaches

players about choosing healthy food, allowing them to fill in a table of food consumption, and

identify the total amount of calories of food consumption. The players would also insert their

weight and height to obtain their BMI. Finally, the players must answer the quizzes that tested

their knowledge about healthy food. The list of foods (more than 60 Malaysian traditional food

and beverages) with total calories comprising carbohydrates, protein, and fat were yielded from

previous guidelines (Suzana et al., 2009; Tee et al., 1997). The video game developed consists of

four main activities. The details of each activity are indicated as follows in Figure 2 and Figure

3:

Identification of the requirements of an

appropriate of IMNEP

Development of IMNEP framework

First version

of IMNEP

Evaluation 1

Second version

of IMNEP

Improvement 1

Evaluation 2

Improvement 2

Third version

of IMNEP

Evaluation 3

Improvement 3


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i) Profile set up and BMI calculation

- Players enter their weight and height.

- The formula will calculate the BMI for the player.

- If the BMI is not normal, an awareness pop-up will appear and the avatar will also

change.

ii) Education on food content

- Players can hover on a food icon/art.

- A dialog box with all information about the hovered food will appear.

- Players can read the total values contained in a food.

iii) Calculation of total calories based on daily consumption

- Players can select the dishes from the table of food list.

- The table will be divided into three main categories; breakfast, lunch, and dinner.

- Player fills in the table according to the categories.

- The game will calculate the total calories consumed in a day.

- If the total calories are beyond certain limit, an awareness pop-up will appear.

iv) Quizzes section

- Players can answer quizzes regarding healthy eating.

- There are total 60 quizzes which are divided into six playing sessions (10 each)

that the players need to answer.

- Each correct answer worth 1 or 2 points while 0 points for the wrong answer.

Education Video Modules (Figure 4)

The information in the video was divided into three separate videos for parents and children with

a maximum of five minutes per video. The topics included in the parents’ video are as follows;

(1) introduction of obesity and (2) healthy guidelines for overweight and obese children part 1

and part 2. The information available for children’s education video are as follows; (1) balanced

food and healthy eating and (2) obesity and daily physical activities as stated in Table 1. The

sub-topics and expected outcomes are also presented in Table 1.


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Figure 2: Healthy food flash game flow


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Figure 3: Healthy food flash game


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Figure 4: Educational video (a) parents and (b) students

Table 1: Components of the education video for parents and students

Education video

Parents

Duration: 5 to

10 minutes per

video

Topics Contents Expected outcomes

Video 1 Introduction of

obesity

- Definition of obesity

- Statistics of obesity in Malaysia

- Risk of obesity

- Causes of obesity

- Importance of balanced food

- Tips to solve the obesity problem

- Importance of breakfast

- Parent’s

understanding of

healthy home

environment will

improve.

Video 2 Healthy eating

guidelines for

- How to prepare healthy eating to

(a) parents

(b) students


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overweight and

obese children

Part 1

their children

- How to encaurage their children to

choose healthy eating

- Introduce the latest of food pyramid

and serving size

- Do’s and dont’s in preparation of

food

Video 3 Healthy eating

guidelines for

overweight and

obese children

Part 2

- How to serve the healthy food at

home

- Do’s and dont’s in preparation of

food

Education video

Students

Duration: 5 to

10 minutes per

video

Topics Contents Expected outcomes

Video 1 Balanced food

and healthy eating

for overweight

and obese

children


- Food pyramid

- Different of food and nutrient

- Types of nutrient

- Types of food in each food groups

and serving sizes

- Importance of breakfast

- Participants can

make healthy food,

beverage and

exercise choices

- Children’s

understanding of

nutrition will

improve

- Participants will

show health status

improvement

- Will increase their

self-confidence, self-

esteem and self-

management of their

weight

- Recognizing foods

rich in proteins,

carbohydrates, fats

and calcium

- Knowing the body’s

requirement of

proteins,

carbohydrates, fats

and calcium

Video 2 Obesity

- Definition of obesity

- Statistics of obesity in Malaysia

- Risk of obesity

- Causes of obesity

- Body mass index (BMI) calculation


- Tips to solve the obesity problem

Video 3 Physically active

daily

- Definition of exercise

- Why must do the exercise?

- Types of exercise and advantages

- Pyramid of physical activity

- Types of sedentary activities

- How to avoid sedentary activities


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PC Dance Mat

Besides that, a short video from YouTube source showing exergame called PC Dance Mat was

also presented to the respondents. This commercially available exergame would be applied as

physical activity component during the intervention phase later. This mat usually is at an

affordable price, MYR15 per mat, and could be connected to the PlayStation 2 or computer. The

PC Dance Mat is a fitness video game involving body movement by applying the mat slide on

the floor, making it a challenge to keep in mind the position of the arrows to match the musical

cues on the video screen. In the next intervention study, the PlayStation 2 will be provided and

will be played in the schools for the study purpose.

Phase II: Feasibility, Acceptability, and Applicability of the IMNEP

This phase is aimed at evaluating the feasibility, acceptability, and applicability of the IMNEP

which was developed during Phase I – content validity was evaluated by researchers (n=10) and

face validity was evaluated by parents (n=8) and students (n=50). Each participated students was

provided with a laptop and was required to watch all the videos and play the healthy food flash

game. The parents needed to watch the educational videos only. Every video clip lasted for about

10 minutes. However, the researchers from nutrition and dietetics program needed to watch and

play all the educational videos for parents and students and healthy food flash game. Then, their

understanding of the contents, presentations, and illustrations showed in the educational video

and video games were measured by distributing the evaluation questionnaire of the IMNEP (EQ-

IMNEP).

Feasibility assessment was conducted to estimate the percentage of having computer or laptop

among students and parents in their house. The acceptability of the IMNEP was tested by

collecting data on the information and terms used, fonts, Malay language, sequences, characters,

backgrounds, voices and music for all educational videos and healthy food flash game. Examples

of questions as follow; “How would you judge the comprehension of the educational videos?”;

“How would you judge the quality of the sound effect included in the educational game?”; “In

your opinion, is the information contained in the educational enough?”. On the other hand, an


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example of question asked for applicability of the IMNEP was “Do you think this video is

helpful for you to gain new knowledge on nutrition?”

Subsequently, the intervention was modified based on the inputs, comments, and feedbacks

obtained from the respondents recruited. The overview of the study process, including its

development, acceptability, and applicability of the IMNEP is summarised in Figure 5.

Phase II: Acceptability and applicability of

the IMNEP

Modification of the IMNEP

Instruments

Information sheet

EQ-IMNEP

Phase I: Development of the IMNEP

Education videos Healthy Food Flash Game

Parents:

3 videos

5 minutes each

Students:

3 videos

5 minutes each

Students:

1 game

30 minutes each

Face validity: parents

and students

Content validity:

researchers

Sources from:

MDG for children &

adolescents

MyHealth, nutriWEB,

MASO, NICE, WHO

and CDC

Figure 5: Overview the study process


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Instruments

Evaluation Questionnaire of the IMNEP (EQ-IMNEP)

Based on previous literatures, EQ-IMNEP was developed to evaluate the feasibility,

applicability, and practicality of the IMNEP (Clayton 2010; Karupaiah et al., 2001; Ruzita and

Rasyedah 2001; Siddique 2010). The EQ-IMNEP was filled out by students, parents, and

researchers, consisting of 18 (evaluating all educational videos, educational game and PC Dance

Mat), 16 (evaluating on educational videos only), and 48 (evaluating on all educational videos

both students and parents, educational game and PC Dance Mat) questions, respectively

(multiple choice answers and different responses from video evaluation, game, and PC Dance

Mat separately). It evaluated the quality and clarity of wording, contents, audio, graphics, and

colours of the CD-ROM and games. In general, feasibility assessment contained one question,

applicability consisted of seven questions, and practicality consisted of three questions. Other

than that, it also gathered suggestions and critical comments on the implementation of IMNEP.

Ethical Approval and Data Collection Procedure

The ethical approval was endorsed by USM Human Research Ethics Committee

(USM/JEPeM/14110478), Ministry of Education (MoE) via Educational Research Application

System, and Kelantan Education Department. Permission to conduct the study was also obtained

from the Headmasters or Representatives of the participated schools once a brief meeting

regarding the whole study process had been conducted. All participants were informed verbally

and via the Information Sheet about the purpose of this study. They were then requested to

complete the EQ-IMNEP.

Statistical Analysis

Results of the questionnaires were analysed using the licensed IBM Statistical Package for Social

Sciences Version 20.0 for Windows (SPSS Inc., Chicago IL, USA) through the utilisation of

descriptive statistics for all responses to check the feasibility, acceptability, and practicality.

Findings were presented as frequencies and percentages.


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Results

There were a total of 68 respondents; 73.6% (n=50) were primary school children, 14.7% (n=10)

were researchers, and 11.7% (n=8) were parents. Almost all of the respondents provided positive

responses and feedbacks. They felt that IMNEP was interesting and engaging in terms of various

topics namely graphics, contents, and animations.

Feasibility

From a total number of 50 students, 96.0% of them were found to possess either laptop or

computer at home with internet access. They had prior experiences in playing computer or

mobile games. Regarding the educational video game assessment, they liked playing this kind of

newly developed healthy food flash game. They also informed us that they would love to play

the game frequently (Table 2).

Table 2: Evaluation of education game for students

Item Students Researchers

(%) Male (%) Female (%) All (%)

Frequency of playing games

Everyday

Sometimes

Never

11 (47.8)

11 (47.8)

1 (4.3)

11 (40.7)

15 (55.5)

1 (3.7)

22 (44)

26 (52)

2 (4)

-

-

-

Comprehension

Very good

Good

Poor

Very poor

19 (82.6)

4 (17.4)

-

-

22 (81.5)

4 (14.8)

1 (3.7)

-

41 (82.0)

8 (16.0)

1 (2.0)

-

9 (90.0)

1 (10.0)

-

-

Quality of the text

Very good

Good

Poor

Very poor

13 (56.5)

10 (43.5)

-

-

21 (77.8)

6 (22.2)

-

-

34 (68.0)

16 (32.0)

-

-

3 (30.0)

6 (60.0)

1 (10.0)

-

Quality of the sound effects

Very good

Good

Poor

Very poor

19 (82.6)

4 (17.4)

-

-

18 (66.7)

8 (29.6)

1 (3.7)

-

37 (74.0)

12 (24.0)

1 (2.0)

-

-

4 (40.0)

6 (60.0)

-

Quality of the colors

Very good

Good

16 (69.6)

7 (30.4)

18 (66.7)

9 (33.3)

34 (68.0)

16 (32.0)

3 (30.0)

7 (70.0)


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Item Students Researchers

(%) Male (%) Female (%) All (%)

Poor

Very poor

-

-

-

-

-

-

-

-

Perceived usage

Once

Repeated

Not use

2 (8.7)

21 (91.3)

-

4 (14.8)

23 (85.3)

-

6 (12.0)

44 (88.0)

-

-

-

-

Enough information

Yes

No

Not sure

Provide new knowledge

Yes

No

Not sure

18 (78.3)

1 (4.3)

4 (17.4)

22 (95.7)

1 (4.3)

0

22 (81.5)

0

5 (18.5)

25 (92.6)

0

2 (7.4)

40 (80.0)

1 (2.0)

9 (18.0)

47 (94.0)

1 (2.0)

2 (4.0)

Acceptability

Most of the school children ranked the education videos shown from ‘good’ to ‘very good’ with

regards to the comprehension (98.0%), text (98.0%), sound (96.0%), voice (94.0%), and colours

(94.0%). However, sixteen (16) of them requested for more graphics and figures to be included

(32.0%), nine (9) preferred short sentences (18.0%), and the other six (6) were hoping for

developer to reduce the use of scientific sentences (12.0%). Only a small number of them

expressed their lack of understanding regarding the terms ‘sedentary’ (2.0%) and ‘obesity’

(8.0%), while most of them felt that this education video provides enough information with new

knowledge.

In terms of education video for parents, all eight (8) respondents rated the video as

comprehensive (good to very good) along with the text, sound, voice, and colours used, as stated

in Table 3. They also received sufficient information in this video and almost all believed this

video was helpful for them in reducing their children’s weight. There were some negative

feedbacks relating to the sound of the education video – being described as annoying hence

modification should be done. Other than that, as displayed in Table 4, other comments include;

(1) inappropriate terms, (2) too wordy with long sentences, and (3) the speed of the slides and

other contents should be revised and modified. In addition, ten researchers with nutrition

background were invited to evaluate the IMNEP in terms of content suitability.


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Table 3: Evaluation of education video for students and parents using EQ-IMNEP

Item Education video for students Education video for

parents

Healthy food flash game for

students

Students

n (%)

Researchers

n (%)

Parents

n (%)

Researchers

n (%)

Students

n (%)

Researchers

n (%)

Comprehension

Very good

Good

Poor

Very poor

40 (80.0)

9 (18.0)

1 (2.0)

-

3 (30.0)

7 (70.0)

-

-

5 (62.5)

3 (37.5)

-

-

2 (20.0)

8 (80.0)

-

-

41 (82.0)

8 (16.0)

1 (2.0)

-

9 (90.0)

1 (10.0)

-

-

Quality of the text

Very good

Good

Poor

Very poor

30 (60.0)

19 (38.0)

-

1 (2.0)

2 (20.0)

7 (70.0)

1 (10.0)

-

4 (50.0)

4 (50.0)

-

-

3 (30.0)

7 (70.0)

-

-

34 (68.0)

16 (32.0)

-

-

3 (30.0)

6 (60.0)

1 (10.0)

-

Quality of the

sound effects

Very good

Good

Poor

Very poor

30 (60.0)

18 (36.0)

1 (2.0)

1 (2.0)

2 (20.0)

6 (20.0)

2 (20.0)

-

3 (37.5)

5 (62.5)

-

-

7 (70.0)

3 (30.0)

-

-

37 (74.0)

12 (24.0)

1 (2.0)

-

-

4 (40.0)

6 (60.0)

-

Quality of the voice

Very good

Good

Poor

Very poor

22 (44.0)

25 (50.0)

2 (4.0)

1 (2.0)

3 (30.0)

4 (40.0)

3 (30.0)

-

2 (25.0)

6 (75.0)

-

-

3 (30.0)

3 (30.0)

4 (40.0)

-

-

-

-

-

-

-

-

-

Quality of the

colors

Very good

Good

Poor

Very poor

37 (74.0)

12 (24.0)

1 (2.0)

-

4 (40.0)

6 (60.0)

-

-

5 (62.5)

3 (37.5)

-

-

4 (40.0)

6 (60.0)

-

-

34 (68.0)

16 (32.0)

-

-

3 (30.0)

7 (70.0)

-

-

Perceived usage

Once

Repeated

Not use

8 (16.0)

42 (84.0)

-

-

-

-

-

8 (100.0)

-

-

-

-

6 (12.0)

44 (88.0)

-

-

-

-

Table 4: Suggestion for improvement of the IMNEP

Item Students (%) Researchers (%) Parents (%)

Video education for parents

Provide the healthy menus - - 1 (12.5)

Improve the quality of voice - - 1 (12.5)

Reduce the speed of slides and voice - 1 (10.0) -

Reduce the wording - 1 (10.0) -

Inappropriate terms - 1 (10.0) -


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Item Students (%) Researchers (%) Parents (%)

Put more pictures - 1 (10.0) -

Video education for student

Improve the quality of voice - 1 (10.0) -

Revise the content of food serving size - 1 (10.0) -

Incorrect term - 3 (30.0) -

Healthy food flash game

Put more tricky questions 5 (10) - -

Type of fonts - 1 (10.0) -

Need to add the correct answer - 1 (10.0) -

Classification of the body mass index

need to be revised

- 1 (10.0) -

Should have button to skip meal - 1 (10.0) -

Should have button to cancel the food - 1 (10.0) -

Students were also asked about their opinions regarding healthy food flash game. Most of them

found it to be very good in terms of quality of the text (68.0%), sound effects (74.0%), colours

(68.0%) and 80.0% of them also agreed that the information contained in the educational game

was enough (Table 2). However, five (5) among them suggested to put more tricky questions in

the healthy food flash game to create more interesting activities (Table 4).

Applicability

IMNEP was also perceived as an advanced and effective medium in teaching the knowledge of

nutrition to the overweight and obese school children and parents. The education video was

helpful in reducing weight, especially for those under the category of overweight or obese.

Surprisingly, 84.0% of them believed that they would continue and repeatedly watch the video,

and none of them planned not to use the video. The researchers agreed that the information

contained in the IMNEP was enough to be delivered to the target group and assumed IMNEP

was helpful to increase their knowledge about healthy eating. Apart from that, a short video of a

commercially available PC Dance Mat was shown and the results indicated that this kind of


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activity was attractive to help students reduce their weight. The respondents would like to make

this PC Dance Mat as part of their physical activity routine.

Discussion

Generally, the present study focused on design and development of the IMNEP as well as

evaluating the feasibility, acceptability, and practicality of the IMNEP among the students,

parents and researchers. This study was conducted to provide unique data regarding the

suitability of IMNEP in promoting a healthy diet and physical activity hence controlling the

obesity problem among school children which now occurring in developing and developed

countries. As there are mounting concerns regarding childhood obesity and its associated risk of

chronic diseases, examining the intervention programs is crucial and it should begin from their

childhood (Dietz 1992; Sharma et al., 2015).

Overall results indicated that all respondents were greatly satisfied with IMNEP. The main

reason might be due to the novelty value of the variety tools used in delivering such education

through videos and game. This interaction design allows for human learning process to grow,

become easier, and more effective compared to traditional reading method. This non-

conventional, interactive method is regarded as effective and practical for the current generation

(Nazlena et al., 2013). A work by Cunha et al. (2013) demonstrated that by providing school-

based interventions with combinations of playing games, staging theatre sketches, watching

movies and puppet shows, as well as writing and drawing contests would present a positive

improvement towards healthy eating habit. However, these methods did not necessarily lead to

the reduction in BMI. This is inconsistent with other findings which combine health education,

physical activity and parental involvement that revealed a significant reduction in BMI and body

fat (Foster et al., 2008; Jiang et al., 2007; Savoye et al., 2007). These results suggest that the

combination of delivering nutrition information through video and game, parental involvement,

and physical activity enhancement might be an effective approach in reducing BMI especially

for overweight and obese children. These components are best compiled as a package instead of

individual components.


pp 24-48

42

In regard to the outcomes on acceptability as illustrated in Table 2 and 3, IMNEP was reported to

be highly acceptable with regards to information, contents, graphics, text and sound effect among

participants. They agreed that IMNEP has the potential to emerge as an effective education

programme with specific target population – overweight and obese children. Comments such as

“I like the variety of topics included”, “I like the sentence used”, “I like the graphics, content,

and animation added”, “I like the purpose of the IMNEP as a new medium for teaching nutrition

education”, and “this IMNEP would be helpful in reducing the children’s weight” were given by

the participants, suggesting further supportive evidence of IMNEP’s acceptability.

Next, regarding the feasibility assessment, data from the current study also indicated that IMNEP

was highly feasible to all respondents. The percentage of computer and internet ownership at

home (96.0%) among the respondents was unsurprisingly high. This finding could be due to the

increasing number of computer users in Malaysia from 56.0% in 2013 to 68.7% in 2015 (MCM,

2015). Researchers would also like to use IMNEP as an education tool in future. Nowadays, as

typically most children are the active users of various computer applications and the internet, this

tool is valuable for them to gain knowledge and at the same time effective for educators to

deliver the nutrition education.

The evidence of validity was further supported by the fact of highly acceptable results regarding

the appropriateness and proper language, sentences, fonts, and graphics used. The information

delivered through IMNEP was adequate and clearly understood. However, five students were

unclear with the term ‘obesity’ which had been clearly defined in the video. Besides, they had

been learning about ‘obesity’ since Year Three. Her and Lee (2003) found that the major

problems of dietary information for children include little interest, difficult content, and poor

information. However, by using graphics to explain, including explaining the term ‘obesity’, they

now understood better. Graphics usage became the major factor in affecting their understanding

level. The graphics used, for example pictures, charts, lists, or graphs had also been proven to

increase (1) user’s attention, (2) user’s comprehension, (3) user’s ability to recall what was

explained, and (4) user’s adherence to health recommendation (Houts et al., 2006). Therefore,

any information being delivered must be accurate, relevant to the target population, and should

be based on their backgrounds.


pp 24-48

43

Furthermore, the sentences and font size were also two of the elements that should be improved

to increase the attractiveness of IMNEP among children. Researchers found that majority of

respondents gave at least ‘good to very good’ for the game and videos in terms of the text used.

This could be because the IMNEP’s font size has a minimum of 36-point Akbar which helped

users to see clearly, read, and understand the contents. Besides that, there were a few respondents

in this study suggested on improving the quality of voice in the education videos to both parents

and students. The quality of voice and speech actually assists the speaker to transfer knowledge

and also helps students to build up their understanding level (Islam et al., 2015). Thus, the

quality of voice in the video would be modified before being applied in the intervention phase

later.

Other than that, it was also found that the respondents – students and researchers gave positive

feedbacks on the use of PC Dance Mat which was connected to PlayStation 2 or computer to

increase their level of physical activities. This commercially available product was easier to be

applied and considered as interesting game. Players should be following the virtual and musical

cues on the video screen to match their movement. This intervention strategy is supported with a

previous study that used almost similar product called ‘Just Dance’; indicating that children

would be using greater movement and burned more calories during this particular activity

(Quinn, 2013).

One of the limitations of this study is that it has a small sample size. Nevertheless, the feasibility

and acceptability aspects of IMNEP did receive positive feedbacks. It is crucial to conduct this

kind of preliminary study with process evaluation to provide feedbacks and for further

refinement of program components prior to efficacy testing. Recruitment of parents was quite

challenging and difficult due to less cooperation from them. Nevertheless, this was one of the

lessons learned in this pilot study, indicating the need for using more creative or effective parent

recruitment strategies.

Conclusion

The present study provides preliminary evidence that IMNEP is highly feasible, practical, and

acceptable among children and parents to educate healthy diets with physical activities for the


pp 24-48

44

purpose of controlling obesity issue. However, the effectiveness of IMNEP had not been

thoroughly measured due to its early implementation stage. Modifications are still opened and

welcome to be made. It is expected that IMNEP would give benefits especially for overweight

and obese school children who would become the target respondents in the intervention phase

later.

Acknowledgement

We are grateful and greatly acknowledge the contributions made by USM Human Research

Ethics Committee, Ministry of Education via Educational Research Application System, and

Kelantan Education Department for their approval in all matters throughout the progress of this

research. We express gratitude to all principals, teachers, and students from primary schools in

Kota Bharu for their participation in this project. The authors would also like to personally thank

Assoc. Prof Dr Nazlena Mohamad Ali from Universiti Kebangsaan Malaysia (UKM) for her

expert view, advice, and guidance in this pilot project.

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