Health Ninjas: A Personalized Biofeedback Game to Teach Children Deep Breathing and Nutrition Knowledge

Abstract

Children’s wellbeing has been regarded as one of the primary focus of public health. Among all of the factors which have huge impacts on children’s wellbeing, stress has been given a primary priority and is the one which has lifelong effects. Deep breathing is an established and evidence-based strategy for reducing stress and it has been integrated with biofeedback techniques to help adults regulate their stress. While all these biofeedback games are effective to teach adults self-regulation skills while emerged in a stressful environment, however, they are not likely to be applicable to children. Thus more could be gained if a biofeedback game typically designed for children could take consideration of child’s characteristics and capability, and meanwhile provide necessary guidance and instructions.

We developed a personalized biofeedback game – Health Ninjas as a game-like intervention to teach children deep breathing and nutrition knowledge in an effective and fun way. To the best of knowledge, Health Ninjas is the first game that integrates self-regulation training with nutrition education. Health Ninjas incorporates calibration function which calculates “personalized” target breathing rate within the child’s capability, and more importantly, provides intuitive visualization of desired breathing patterns for the child to follow. Additionally, Health Ninjas incorporates nutrition education to help children better discriminate between healthy and junk food.

Health Ninjas includes three game scenarios: Direct Biofeedback mode, Indirect Biofeedback mode and Control mode. We conducted two comparative studies: one study aims at testing whether children are able to follow subtle biofeedback cues or need a more explicit feedback; the other study aims to test whether playing our nutrition education game changes children’s perception of healthy vs. junk foods. Our results indicated that children need a more explicit and intuitive biofeedback strategy to better perform the desired behaviors.