Fight for Your Right To Fruit©: Development and Testing of a Manga Comic Promoting Fruit Intake in Middle-School Youth

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  • March 22, 2019
Creator
  • Leung, May May
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
Abstract
  • Innovative interventions addressing childhood obesity are needed to capture the attention of youth living in a multi-media environment. The purpose of this study was to develop a Manga comic (Japanese comic art) promoting fruit intake and evaluate its impact on related psycho-social variables in middle-school youth. This dissertation followed three aims. Aim 1 consisted of a content analysis of nutrition and physical activity (PA)-related behaviors in four Shonen (Boys) and four Shojo (Girls) Manga comics. Most common positive health behaviors represented were fruit/vegetable consumption, family meals and moderate/vigorous PA, while large portion sizes, intake of high energy-dense foods and television/other screen time usage were the most frequent negative health behaviors depicted. In Aim 2, seven focus groups and two interviews (N=28) were conducted with youth to better understand such topics as enjoyable components of Manga comics and important health concepts. Most frequently mentioned themes related to enjoyable Manga comic components were detailed graphics and artistic style of text used to convey sound effects. Majority of the participants said eating fruits/vegetables was the most important nutrition behavior for proper health. Aim 3 consisted of a three-group, randomized single-session study with middle-school students. Participants (n=263) were randomly assigned to receive a Manga comic about fruit (Comic group), a newsletter about fruit (Newsletter group), or a newsletter about ancient Greece (Control group). Psycho-social variables related to fruit consumption were measured at baseline and immediately after reading. Post-intervention focus groups were conducted to evaluate acceptability and comprehension of the comic. Outcome expectations tended to be different in the Comic group compared to the Control group (p=0.03), while the Comic group reported greater transportation (p<0.01), enjoyment (p<0.05) and engagement (p=0.00) than the Newsletter and Control groups. Focus group data show the majority of Comic group participants enjoyed the graphics and storyline, understood the main message and felt like eating more fruit. Results are promising and suggest that Manga comics may create an entertaining and informative learning environment that has potential to help promote behavior change in youth. Further research should be conducted to explore its impact on health behaviors.
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Nutrition.
Advisor
  • Ammerman, Alice
Degree granting institution
  • University of North Carolina at Chapel Hill
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