Enhancing Child Digital Dietary Self-Monitoring via Positive Reinforcement: Proof-of-Concept Trial

Background/Objectives: Dietary self-monitoring (DSM) is an essential behavior change strategy in pediatric nutrition interventions, but engagement is poor. Positive reinforcement (PR) techniques are used to improve behaviors in children. This proof-of-concept trial examined the ability to implement two types of PR, caregiver praise and gamification, using a digital DSM log. Methods: Families were recruited between February and October 2024. Children aged 8-12 years (n = 19) and an adult caregiver were randomly assigned to DSM conditions with or without caregiver praise and/or gamification (2 × 2 factorial design). Children tracked intake of fruits, vegetables, sweet/salty snack foods, and sugar-sweetened beverages for 4 weeks in a digital log. Feasibility focused on examining the amount of PR delivered. DSM behaviors (frequency and timing), child intrinsic motivation, and log usability and acceptability were also examined. Results: Gamification was implemented significantly more than caregiver praise. Caregiver praise was delivered on 12.2 ± 5.8 of 28 days, whereas gamification was delivered on 20.8 ± 12.3 of 28 days. There were no differences in DSM behaviors between PR conditions. Overall, children tracked on 23.6 ± 4.6 of 28 days, recorded 69.3% ± 45.1% of items on day of intake, and completed 23.1 ± 8.2 logging sessions. Additionally, there were no differences in child intrinsic motivation between PR conditions, and children and caregivers generally found the log usable and acceptable. Conclusions: The automation of gamification, which provides immediate, consistent, and convenient PR, may provide unique advantages for reinforcing child behaviors compared to praise, which relies on caregiver implementation.