Lisa Marriott, Assistant Professor, OHSU/PSU School of Public Health This presentation was given at the 2017 Serious Play Conference, hosted by the George Mason University - Virginia Serious Play Institute. Games for improving health and education: approaches for integrating data collection and persuasive system design on an academic budget

1. Lisa Marriott, PhD
Assistant Professor
marriott@ohsu.edu
Working with
Local Schools on
Nutrition
Education
Game-based approaches for improving health
and education on an academic budget

2. About Us
2007 2009 2011 2014 2015 2017
Program launched as 2 week exhibit at science museum (no dedicated staff)
Funded to go to schools & communities (1 local programmer, 1 coordinator)
First game about skin cancer (2012 Serious Play Award), 2 prgmrs + 1 coord
Second “game” about epigenetics (2014 Serious Play Award);
CTSA-housed team of programmers
Technology Award, Soc. Public Health Education;
Worksite wellness program in Thailand
Integration with EMR for worksite wellness;
Migration of platform to online
By the Numbers
33,000+ participants
25+ schools, 1 tribal school
4 school districts, longitudinally
1200 volunteers trained
6 teacher professional development sessions

3. Cancer Risk
Skin cancer, lung
cancer, and breast
cancer risk assessment
Blood Pressure
Systolic and diastolic blood
pressure measurements
Diet
Computerized assessment
with tailored feedback. Bitter
taste sensitivity
Sleep
Computerized assessment of
sleep quality, morningness /
eveningness, and daytime
sleepiness with tailored feedback
Body Composition
Height, weight, waist
circumference, body mass
index, body fat percentage
CommunitiesSchools
Data linked anonymously
to each participant by
scanning their random
wristband barcode
Automatically added to
database at OHSU
Researchers
What is “Let’s Get Healthy!” ?
Cognitive Function
Computerized
assessments of short-term
visuospatial memory and
attention
Epigenetics Education
- Automated content
- Tailored feedback

4. www.letsgethealthy.org
How can we get schools to use their health data?
Elements applied:
• Exploration, discovery, & learning in a time-pressure environment
• Branching choices for participation leading to measurement
• Success/failure feedback based on their results
• Anonymity for participation
• Competition (in # stations completed, comparisons with peers)
• Debrief with their teacher (peers, family)

6. Using Data for Play and Learning
• Support students’ interest in
science (particularly MS)
• Increase understanding of the
importance of research and its
personal relevance
• Increase students’ data literacy
through inquiry and data play
• Support schools in their ability to
get grants to improve local health

7. Theory-based Design
Component Key Theory Applied
Getting students initially
interested in their health
data via the health fair
Health Belief Model -- seeing their own results expected to increase awareness of
perceived susceptibility of themselves and others. (Pulls in knowledge, efficacy,
benefits)
Getting teacher buy in to
using the data in the
classroom – and why health
data are relevant for
students
Social Cognitive Theory - human behavior is an interaction of personal factors,
behavior, and the environment. E.g. A class can explore through inquiry “Does our
school have higher sugar consumption than other schools and what school factors
might influence that?” (Pulls in observational learning, outcome expectations,
reciprocal determinism). Or classes can examine together how the student fits into
their world via ecological perspective to examine health behaviors in
family/school/community contexts
Students’ ability and
intention to use the health
data
Theory of Planned Behavior – Attitudes toward use of data in research;
norms/motivation for using the data within the classroom, behavioral control to
interact with the data; intention to use it; Actual usage.
Supporting interest and skills
in students’ science
development
Self-Determination Theory – Goal of satisfying 1) competence (science self-efficacy);
2) relatedness (building students’ STEM identity and interest); and 3) supporting
autonomy (ability to have control over decisions)

8. Addressing factors that influence the behavior
Target Components for Intervention When considering what we want to
change, what are the….
When designing an
intervention, what
programmatic characteristics
would specifically target this
identified factor?
Predisposing factors
Intellectual and emotional “givens” that tend to make individuals more
or less likely to adopt healthful or risky behaviors or lifestyles or to
approve of or accept particular environmental conditions.
• Knowledge, Attitudes, Beliefs/Norms (mistaken or legit), Values,
Confidence/Efficacy
Enabling factors
Internal and external conditions directly related to the issue that help
people adopt and maintain healthy or unhealthy behaviors and
lifestyles, or to embrace or reject particular environmental conditions.
Among them are:
 Availability of resources, Accessibility of services
 Community and/or government laws, policies, priority, and
commitment to the issue.
 Issue-related skills. (e.g., job placement programs).
Reinforcing factors
People and community attitudes that support or make difficult adopting
healthy behaviors or fostering healthy environmental conditions. These
are largely the attitudes of influential people: family, peers, teachers,
employers, health or human service providers, the media, community
leaders, and politicians and other decision makers. An intervention
might aim at these people to most effectively reach the real target
group.
Other. Any policies, regulatory issues, and/or
organizational/participant culture to consider?
• Students may not know
how to use raw data
• Students may find data
boring
• Supply interactive,
pre-analyzed data
• Make the data
about themselves
• Teachers may not have
the time to devote to
new resources.
• Teachers may not
know how to teach it
• Make it easy for
teachers; integrate
with existing
coursework
• Provide lesson
plans
• Peers are a big deal --
who is like me?
• Families
• Principals -approving
at a school level
• Show comparisons
for students
• Provide summaries
• Pulling in the whole
school, anonymously
• Research! IRB! • Transparency
Based on Precede-Proceed model

9. • Working with schools?-- what is the
context of its use. What gaps exist?
– Need for lesson plans across subjects; integrate
with national/state educational standards.
– Teacher professional development sessions for
lesson and teacher guide creation
– Teachers lack time
• to plan fairs (used team of 5) + health department
stakeholder
• to analyze data (developed visualization website)
– Funding is tight; support teachers’
substitute time ($150/day in Oregon)
Defining Activities based on Factors

10. Defining Activities based on Factors
• Focus groups for developing data website – three steps
– Show examples of similar sites to pick specs that are liked
– Wireframe mock up of selected items
– Actual site, simplified, to make sure on track
www.letsgethealthy.org

11. Defining Activities based on Factors
• Health fairs highly sought after -- after
– New sites don’t know what to expect; Not all teachers
are on board
– Pre-fair workshop with the five teachers and principal;
bring food
– Demonstration by someone like them who’s gone
through it (call in; works amazingly well)
• After the fair
– Check in and debrief session, 6 weeks or so after. Time to
process, check in with colleagues, parents, students
– Lesson learned: data summaries are really important
here to provide taste of the data
• Follow-up to the fair
– Lesson learned: more time and support are needed
among teachers in using the data
– Available lessons provide a safety net for adaptation

12. Planning the evaluation
• Go back to what you want to accomplish
• What is incorporated into the game versus what is a pre/post?
• Who is your comparison group?
• Find short- and long-term goals for each – so in case long-term fails,
you can predict it and/or course correct before it’s too late
ADDED SUGAR INTAKE
17%
29%

13. Outcomes
Specifics:
• Experimental schools>Comparison schools; loads of repeat
fair requests and dissemination to new sites.
• Data used for two funded school-based grants, another site
runs an ongoing nutrition and physical activity projects.
• Primary lessons learned:
• Data use needs to be even easier, interactive, and visually appealing.
• Health departments and schools are really, really interested when
health data can be linked with learning outcomes.
General for other projects:
• People LOVE learning about themselves. Aim for 7th grade reading level.
• The “fun” aspects pull in more people (adult vs kid materials; new partner interest)
• Leave more time than expected for evaluation. Plus >10% budget
• Be open to unexpected findings - turned out to be my best parts
• What new procedures increase your goals? For us, partners offered new tracking
options

14. Worksite Wellness OHSU-BDMS
Occupational Health Centers of Excellence
• Integration with BDMS
employee check-up (EMR)
• 3 modules started in 2015
(Sleep, Cognitive, Diet (Thai))
• Migrated platform to a web-
based system
• Same individual feedback,
plus Corporate Report -- show
change over time

15. Development of Permanent Kiosk for
Great Lakes Science Center
• Leveraged online functionality
from Thailand to build museum
kiosk
• Subcontract from their SEPA award
funded migration of intranet-based
NCI/NHANES Diet Screener into
online platform for use with
museum visitors
• Crowd-sourced approach to
module development
2015; Launch early 2016
https://www.foodmaster.org www.letsgethealthy.org

16. Flexible
• Modules can be used as part of a health fair, kiosk, or completed online from home.
• Demo options exist where participants can complete modules without data being
collected, important for building trust with communities.
Personalized
• Content and recommendations automatically tailor to participants’ age and gender;
• Algorithms support immediate calculation of results to show participants as feedback.
Long-term
• Organizations given administrative access to create their own events; they define the
permissions and access levels (e.g. data privacy; administrator access)
• Built-in programming supports cohort development. Consent, enrollment, and
longitudinal tracking all built into program for simplicity;
• New! Change over time automatically calculated for individuals and shown in real
time.
Refinements based on the Project
2015 Technology Award, Society of Public Health Education

17. School interested in using the free online modules? Contact marriott@ohsu.edu
www.letsgethealthy.org