A technology-based program to promote healthy lifestyles among secondary school students
The Health4Life Initiative: Evaluation of an eHealth school-based program targeting multiple chronic disease risk factors among young Australians
The University of Sydney
7,200 participants
Apr 1, 2019
Interventional
Conditions
Summary
The Health4Life intervention uses web- and app-based technology to improve the physical and mental health of Australian teenagers. Unhealthy behaviours, such as eating poorly, smoking, risky alcohol use and physical inactivity, are known risk factors for serious chronic disease, the leading cause of death worldwide. Previous research has shown that these risk behaviours are well established by late adolescence and commonly co-occur as clusters. It has also been shown that these ‘risk clusters’ are associated with more immediate harms among young Australians, including anxiety, depression and psychological distress. To address these problems, we developed the Health4Life intervention. The Health4Life study utilises online technology and interactive cartoons to encourage young people to adopt six key health behaviours (“the Big 6”): healthy eating, healthy sleep, physical activity, limiting sedentary recreational screen time and being alcohol and smoke-free. By increasing knowledge and improving skills, this program aims to prevent or improve these behaviours before they become entrenched. The Health4Life program will recruit 7200 Year 7 students from 72 schools across Australia in 2019. It is anticipated that this intervention will improve both physical and mental health during adolescence, whilst also halting a potential trajectory towards chronic disease later in life. In addition, the Health4Life Biomarker Checkpoint will re-recruit a subsample of Health4Life participants (approx. 200) when they are in year 10, to assess any differences in anthropometric measurements, in depth dietary intake, C-reactive protein, and other heart-health biomarkers between intervention groups as part of a related sub-study for a PhD project.
Eligibility
Inclusion Criteria4
- o Year 7 students attending participating schools in 2019
- o Fluent in English
- o Parental consent received
- o Active student consent provided
Exclusion Criteria2
- o Schools with less than 30 Year 7 students enrolled in 2019
- o Schools based outside NSW, WA and QLD
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Interventions
Intervention name: Health4Life Health4Life is an eHealth program that aims to empower adolescents to improve their health and wellbeing and reduce the risk of chronic disease later in life by simultaneously targeting six key lifestyles risk factors: physical inactivity, poor diet, sedentary recreational screen time, poor sleep, alcohol use, and tobacco use. Participating secondary schools will be randomly allocated to one of two groups. One group will serve as the control group and receive their usual Year 7 health education and the other group with receive the Health4Life intervention. The Health4Life intervention consists of 3 parts: A) Online classroom lessons (Health4Life school-based program). Part 1 consists of 6 x 20-minute online lessons delivered via interactive cartoon storylines (completed individually by students). Teachers also have the choice of whether to deliver optional activities (e.g. online worksheets, discussion topics, role plays) to their class following the online lesson. These range from 5 to 20 minutes in duration, depending on which, and how many activities, the teacher selects. The program will be delivered during Year 7 health education classes at school (once per week over six weeks). Using principles of social influence and self-determination theories, the intervention aims to provide students with evidence-based information about the Big 6 (e.g. short- and long-term harms, benefits of maintaining good health), improve resistance skills (e.g. to resist peer pressure to smoke or drink), modify existing norms and increase autonomous motivation. Short online quizzes are embedded at the end of each cartoon lesson to test knowledge and reinforce the content. The school-based Health4Life program will be accessed online via the Health4Life study website, and teachers will be provided with links to the syllabus, lesson summaries and curriculum-consistent assessment tasks, and implementation guidelines. No teacher training is required to deliver the Health4Life intervention. However, researchers are available for a one-off meeting with teachers at each school (in group format, approximately 30 minutes) to assist them with navigation of the study website and integrating the program into their lesson plans. B) Companion smartphone app (Health4Life App). To reinforce the school-based program content and encourage uptake of healthy behaviours, a smartphone app will be implemented in conjunction with the online lessons. Students will be invited to download the Health4Life app onto their smartphones, and to use the monitoring app outside of the classroom to encourage adoption of healthy lifestyle goals. The app will allow students to track their physical activity (e.g. steps per day), sedentary recreational screen time, dietary intake (e.g. servings of fruit/vegetables, sugar-sweetened beverages), abstinence from using alcohol and tobacco, sleep duration and mood. The app includes goal-setting opportunities and provides automated feedback. Student’s will be able to choose how often to use the app. It is anticipated that logging health behaviours should take no more than 10 minutes per day. Students will have access to the app for a 12-month period. C) Early intervention app for at-risk young people (Health4Life booster). Students who complete the 12- and 24-month follow-up surveys (when they are in Years 8 and 9 respectively), and who indicate engagement in two or more Big 6 risk behaviours at that assessment, will be invited to access additional booster content via the Health4Life smartphone app to encourage behaviour change to reduce their risk. Although the student surveys will be completed in class, the booster app will be used outside of the classroom setting. The app delivers tailored education about the Big 6 risk factors for chronic disease (reinforcing the education provided in the online intervention) and uses cognitive behavioural therapy and motivational interviewing to assist the person to build motivation to change and teach coping strategies to facilitate adoption of health behaviours within their current environment. The app consists of seven 25-minute modules (one for each of the Big 6 risk factors and one module addressing mood). Students will have ongoing access to the booster content over 12 months, with the recommendation that they access it at least once per week until they have completed each module once. Program Fidelity: Teachers will be asked to complete logbooks to document their implementation of the Health4Life program (i.e. timing, activities delivered, technical problems, other implementation details). Use within the smartphone app will be electronically tracked to assess use of, and engagement with, the application.
Locations(1)
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ACTRN12619000431123