Rationale and study protocol for ‘Switch-off 4 Healthy Minds’ (S4HM): A cluster randomized controlled trial to reduce recreational screen time in adolescents

Abstract

The S4HM study will involve the evaluation of an innovative, theory-driven, multi-component intervention that targets students and their parents and is designed to reduce recreational screen time in adolescents. The intervention has been designed for scalability and dissemination across Australian secondary schools.

The Role of Recreational Online Activities in School-Based Screen Time Sedentary Behaviour Interventions for Adolescents: A Systematic and Critical Literature Review

“…The search resulted in 2583 items (see flow diagram in Fig. 1), and identified 30 published papers analysing 15 intervention studies (12 registered RCTs, three pre-post designs) that met the criteria for inclusion in the review (Aittasalo et al 2019;Andrade et al 2014Andrade et al , 2015Babic et al 2016;Babic et al 2015;Bagherniya et al 2018;Barbosa Filho et al 2019;Barbosa Filho et al 2016;Barbosa Filho et al 2015;Cui et al 2012;Foley et al 2017;Hamulka et al 2018;Hankonen et al 2016Hankonen et al , 2017Jussila et al 2015;Leme et al 2016;Leme and Philippi 2015;Lubans et al 2016a;Lubans et al 2016b;Majumdar et al 2013;Singh et al 2006Singh et al , 2009Singh et al , 2007Smith et al 2017;Smith et al 2014aSmith et al , 2014bTarro et al 2017, Tarro et al 2019Vik et al 2015;Wadolowska et al 2019). Out of the 15 studies, eight were analysed in more than one paper, presenting a separate rationale/study protocol or protocol and baseline results and additional effectiveness of RCT papers ( Table 1).…”

“…Few studies conducted review synthesis and explored the stakeholder perspective (i.e. with students and parents) prior to the development of the intervention (Andrade et al 2014;Hankonen et al 2016Hankonen et al , 2017Singh et al 2009;Vik et al 2015) or were based on prior pilot studies or interventions (Babic et al 2015;Foley et al 2017;Hankonen et al 2016;Leme et al 2016;Smith et al 2014aSmith et al , 2014bVik et al 2015). The age of the samples ranged from 10 to 19 years, and sample sizes varied from n = 172 (Bagherniya et al 2018) to n = 3147 (Vik et al 2015).…”

“…Outcome data were reported per assessment period and as overall intervention effects (in Table 2). However, the samples were not representative in terms of gender, socio-economic status and general education: for gender (Bagherniya et al 2018;Leme et al 2016;Smith et al 2014aSmith et al , 2014b; low socio-economic family status (Andrade et al 2015;Babic et al 2015;Leme and Philippi 2015;Singh et al 2009;Smith et al 2014aSmith et al , 2014b, use of a vocational school, not representing general secondary education (Hankonen et al 2016(Hankonen et al , 2017Singh et al 2009); use of Catholic schools only (Babic et al 2015), and potential biased parental involvement due to their children's participation status and lower socio-economic status that has been found to be a predictor of heavier recreational ST use (Babic et al 2015), posing a threat to ecological validity, with the exception of Vik et al' (2015) international study with a large cohort. There was no reference to attribution of intervention components to outcomes or of identification of the most effective behaviour change mechanisms, with the exception of Hankonen et al (2016) study that identified behaviour change techniques with higher uptake than others.…”

“…PA was measured with accelerometers across all studies in activities (except from water sports in the main), and during sleep time for seven consecutive days. These have been found to provide a reliable estimate of PA with potential higher compliance (Babic et al 2015). Additionally, weight, height, BMI measures, and BMI-z scores were calculated in studies in order to assess differences post-intervention.…”

“…It has been argued that adolescents are potentially the most appropriate target groups for interventions due to (i) their vulnerability to addictive and excessive behaviours (Chambers et al 2003;Kuss et al 2013), (ii) a decrease in the engagement with PA compared to previous activity levels (Hankonen et al 2017;Hynynen et al 2016;Todd et al 2015), (iii) a significant increase in their media engagement and autonomy over recreational time (highest media and videogame use in late childhood and early adolescence) (Babic et al 2015;Garcia et al 2017;Rideout et al 2010) and (iv) an identified need for more research in this age group for the reduction of SBs (Biddle et al 2014). Additionally, there is an increasing scientific focus on the developmental aetiology or precursors of problems (Catalano et al 2004), highlighting the importance of targeting this age group.…”