Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians

Abstract

IntroductionLifestyle risk behaviours, including alcohol use, smoking, poor diet, physical inactivity, poor sleep (duration and/or quality) and sedentary recreational screen time (‘the Big 6’), are strong determinants of chronic disease. These behaviours often emerge during adolescence and co-occur. School-based interventions have the potential to address risk factors prior to the onset of disease, yet few eHealth school-based interventions target multiple behaviours concurrently. This paper describes the protocol of the Health4Life Initiative, an eHealth school-based intervention that concurrently addresses the Big 6 risk behaviours among secondary school students.Methods and analysisA multisite cluster randomised controlled trial will be conducted among year 7 students (11–13 years old) from 72 Australian schools. Stratified block randomisation will be used to assign schools to either the Health4Life intervention or an active control (health education as usual). Health4Life consists of (1) six web-based cartoon modules and accompanying activities delivered during health education (once per week for 6 weeks), and a smartphone application (universal prevention), and (2) additional app content, for students engaging in two or more risk behaviours when they are in years 8 and 9 (selective prevention). Students will complete online self-report questionnaires at baseline, post intervention, and 12, 24 and 36 months after baseline. Primary outcomes are consumption of sugar-sweetened beverages, moderate-to-vigorous physical activity, sleep duration, sedentary recreational screen time and uptake of alcohol and tobacco use.Ethics and disseminationThis study has been approved by the University of Sydney (2018/882), NSW Department of Education (SERAP no. 2019006), University of Queensland (2019000037), Curtin University (HRE2019-0083) and relevant Catholic school committees. Results will be presented to schools and findings disseminated via peer-reviewed journals and scientific conferences. This will be the first evaluation of an eHealth intervention, spanning both universal and selective prevention, to simultaneously target six key lifestyle risk factors among adolescents.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000431123), 18 March 2019.

A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program

“…In addition, a selective intervention based on cognitive behavioral and motivational enhancement principles provides youth who remain at risk of chronic disease when they are in grades 8 and 9, with additional web and app content to assist them in developing coping strategies and skills to facilitate healthy behavior change. Detailed information about these additional components has been published elsewhere [ 54 ]. Together, these 3 components span both universal and selective prevention, maximizing outcomes for students throughout their secondary school years.…”

“…Together, these 3 components span both universal and selective prevention, maximizing outcomes for students throughout their secondary school years. Finally, as the Health4Life program is delivered to students via web-based technology with interactive components and no teacher training is required for implementation, student engagement and program fidelity is likely to be increased [ 21 ] (assessment of these outcomes is reported on elsewhere [ 54 ]). Importantly, web-based interventions also typically lead to improved scalability and sustainability, which enhances the dissemination potential and reach of the Health4Life program.…”

“…The next important step is to evaluate the effectiveness of the Health4Life intervention. A large cluster randomized controlled trial is currently underway in 71 Australian schools (>6600 students) to evaluate whether Health4Life is more effective than health education as usual in delaying the uptake of alcohol and tobacco use, reducing sedentary recreational screen time, reducing the decline in MVPA, reducing consumption of sugar-sweetened beverages, and improving sleep [ 54 ].…”

A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App

“…The development process consisted of three key stages: stage 1, scoping of the literature; stage 2, end user consultations; and stage 3, app development and beta testing. Following this development work, the Health4Life app was included as an intervention component in the Health4Life trial (a large cluster randomized trial currently underway [43]), and we collected and analyzed information regarding the app's usability and acceptability among 232 initial users.…”

“…After logging on to the app, students were sent daily reminder messages each evening, prompting them to record their health behaviors in the app. The Health4Life trial is a cluster randomized controlled trial currently being conducted among 6640 students from 71 schools across New South Wales, Western Australia, and Queensland, Australia (trial commenced in 2019; full trial details are given in the study by Teesson and Champion [43]).…”