Modeling Psychosocial Pathways of Adolescent Fruit and Vegetable Intake Through Nutrition Literacy and Digital Gamification in School Settings: A Theory-Based Quasi-Experimental Study

Irma Handayani; Ilham Syahputra Siregar; Sri Wahyuni

doi:10.70716/mohr.v4i3.636

Authors

Irma Handayani Diploma of Nursing, Sekolah Tinggi Ilmu Kesehatan Sehat Medan, Indonesia
Ilham Syahputra Siregar Diploma of Nursing, Sekolah Tinggi Ilmu Kesehatan Sehat Medan, Indonesia
Sri Wahyuni Diploma of Nursing, Sekolah Tinggi Ilmu Kesehatan Sehat Medan, Indonesia

DOI:

https://doi.org/10.70716/mohr.v4i3.636

Keywords:

adolescents, digital gamification, fruit and vegetable intake, nutrition literacy, psychosocial pathways

Abstract

Adolescent fruit and vegetable (FV) intake remains below recommended levels. In Indonesia, only 2.3% of adolescents aged 10–14 years met recommended intake in the 2023 Indonesian Health Survey. Low nutrition literacy and limited psychosocial support contribute to this problem, while school interventions rarely integrate digital gamification with behaviour-change theories. This study develops a conceptual model linking digital gamification, nutrition literacy, and psychosocial pathways to adolescent FV intake and provides empirical evidence through a school-based intervention. Grounded in the ANIMOE health-promotion model and integrating the Transtheoretical Model, PRECEDE-PROCEED framework, and Social Cognitive Theory, this mixed-method quasi-experimental pretest-posttest control-group study involved 103 junior high school students in Jambi City, Indonesia (intervention n=52; control n=51). FV intake was assessed using a Food Frequency Questionnaire. Within-group changes were analysed using the Wilcoxon signed-rank test (p<0.05). The intervention significantly increased nutrition knowledge (13.62 to 18.88), attitude (89.03 to 110.42), and FV intake (3.00 to 4.91 servings/day; all p<0.05), while controls showed no significant changes. Behavioural intention progressed across TTM stages, with the modal stage shifting from contemplation to action. Parental support and teacher reinforcement also improved. The theory-based gamified intervention improved cognitive, motivational, and behavioural determinants of adolescent FV intake. The proposed model provides a framework for structural validation, while schools represent settings for nutrition promotion.

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