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- Bendtsen, Marcus, 1982-, et al.
(författare)
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mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth) : Protocol for a randomised controlled trial
- 2021
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Ingår i: Public Health Nursing. - : BMC. - 0737-1209 .- 1525-1446 .- 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundNational surveys in Sweden demonstrate that the majority of young people do not engage in health promoting behaviours at levels recommended by the Public Health Agency of Sweden. The objective of this study is to estimate the effectiveness of a novel mHealth intervention named LIFE4YOUth, which targets multiple lifestyle behaviours (alcohol, diet, physical activity, and smoking) among high school students in Sweden.MethodsA 2-arm parallel groups single blind randomised controlled trial (1:1) will be employed to estimate the effectiveness of the novel mHealth intervention. Students will be recruited at high schools throughout Sweden, and will be included if they fulfil one of six criteria relating to unhealthy behaviours with respect to alcohol, diet, physical activity and smoking. Eligible participants will be randomised to either receive the novel intervention immediately, or to be placed on a waiting list for 4 months. The intervention consists of a combination of recurring screening, text messages, and an interactive platform which is adaptable to individual preferences. Outcome measures with respect to alcohol, diet, physical activity and smoking will be assessed through questionnaires at 2 and 4 months post randomisation.DiscussionThe findings of this trial could be generalised to a diverse high-school student population as our recruitment encompass a large proportion of schools throughout Sweden with various educational profiles. Furthermore, if effective, the mHealth intervention has good potential to be able to be scaled up and disseminated at high schools nationally.Trial registrationRegistered prospectively on 2020-05-20 in ISRCTN (ISRCTN34468623).
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| 2. |
- Seiterö, Anna, et al.
(författare)
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Exploring the Black Box of an mHealth Intervention (LIFE4YOUth) : A Qualitative Process and Outcome Evaluation of End-User Engagement
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:21
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Tidskriftsartikel (refereegranskat)abstract
- The effectiveness of mHealth interventions rely on whether the content successfully activate mechanisms necessary for behavior change. These mechanisms may be affected by end-users experience of the intervention content. The aim of this study was to explore how the content of a novel mHealth intervention (LIFE4YOUth) was understood, interpreted, and applied by high school students, and the consequences of engaging with the content. Qualitative content analysis was used inductively and deductively to analyze interview data (n = 16) based on think-aloud techniques with Swedish high school students aged 16-19 years. Theoretical constructs from social cognitive theory framed the deductive analysis. The analysis resulted in four categories which describe central activities of intervention engagement among end-users: defining, considering, centralizing, and personalizing. End-users engaged in these activities to different degrees as illustrated by four typologies: Literal, Vague, Rigid, and Creative engagement. Most informants knew about the risks and benefits of health behaviors, but engagement with intervention content generally increased informants awareness. In conclusion, this study provides in-depth knowledge on the cognitive process when engaging with mHealth content and suggests that deliberate and flexible engagement most likely deepens end-users understanding of why and how health behavior change can be managed.
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| 3. |
- Seiterö, Anna, 1982-
(författare)
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mHealth Targeting Physical Activity, Diet, Alcohol, and Smoking among Swedish High School Students : Processes and Outcomes of a Multiple Health Behavior Change Intervention (LIFE4YOUth)
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Effective health promotion and disease prevention strategies are required to achieve societies where preventable diseases are effectively prevented. Physical activity, diet, alcohol consumption, and tobacco use are all determinants for high-prevalent diseases such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. The cumulative risk of multiple health risk behaviors exceeds the combined risk of each individual behavior. Because health behaviors are formed during childhood and adolescence and occur in clusters that overall affect health, interventions targeting multiple health behaviors in these populations may have a lasting impact on public health. Schools are important for health promotion and disease prevention in children and adolescents. Nevertheless, the literature indicates that school-based interventions that involve school staff to address health-risk behaviors tend to be short-term projects due to barriers that impede long-term implementation. Mobile phones can provide resources for adolescents to promote their health, such as health applications and short text messages that do not rely on school personnel. However, more research is required to better understand whether stand-alone mobile phone-delivered interventions that target multiple health behaviors are a viable way to encourage health-promoting behaviors in adolescents.Aim: This thesis aims to gain knowledge about health behavior change among Swedish high school students, including the use and effects of an mHealth intervention (LIFE4YOUth) targeting four health behaviors (physical activity, diet, alcohol consumption, and cigarette smoking). The overall aim was addressed through four sub-studies, which specifically aimed to: identify and describe how high school students perceive health behavior change and how mobile phones are used in the process of change (Paper I), explore how high school students understand, interpret, and apply the content of LIFE4YOUth and describe consequences on psychological resources relevant to behavior change (Paper II), investigate explanations for engagement among high school students with access to LIFE4YOUth (Paper III), and estimate the two- and four-month effectiveness of LIFE4YOUth on individual health behaviors (physical activity, diet, alcohol consumption, and cigarette smoking) compared to a waiting list control condition (Paper IV).Intervention: The LIFE4YOUth intervention gave participants four-month access to weekly prompts for recording health behaviors and receiving feedback based on national guidelines, a four-module interactive dashboard with content structured around two main questions: why change and how to change health behaviors, and text message services for each targeted behavior.Methods: All studies were conducted between 2019 and 2023 and included approximately 800 students from high schools all over Sweden. Two studies had a qualitative approach, with data collected through focus groups (Paper I) and individual interviews with "think aloud" techniques (Paper II). Data were analyzed using thematic analysis (Paper I) and qualitative content analysis (Paper II). One study (paper III) had a mixed-methods design with data collected from participants in the intervention arm of the LIFE4YOUth trial. The analysis included statistical analyses, qualitative content analysis, and qualitative comparative analysis. Finally, a two-armed randomized controlled trial (1:1) with an intervention group and a waiting list control group was enrolled (Paper IV). Data was collected through web-based questionnaires at baseline and after two and four months. All primary outcomes were analyzed using regression models with inferences drawn from Bayesian analysis and null hypothesis testing.Results: The process of health behavior change was understood as a learning process facilitated by independence, an open approach, and self-acceptance while striving for social ideals such as togetherness with friends. Participants engaged with LIFE4YOUth to varied extent, which can be explained by varied interest in behavior change, experiences with the intervention, and circumstances in their social environment. Most participants responded to the weekly prompts in ≤ 2 out of 16 weeks, with 58% engaging with the intervention at least once. The dashboard content had the potential to provide participants with insights that facilitate health behavior change, but participants understood, interpreted, and applied the content in varied ways depending on whether they deliberately acknowledged their interpretation of concepts, took their prior knowledge into consideration to comprehend what was not explicitly outlined, and placed themselves in the center by accounting for their personal needs when interacting with the content.After two months, the intervention group participants had on average 50 minutes more of moderate to vigorous physical activity per week compared with the control group participants (95% CI = -0.19; 99.73, probability of effect = 97.4%, P=.05), and on average 0.32 more daily portions of fruits and vegetables (95% CI = 0.13; 0.53, probability of effect = 99.9%, P=.001). Furthermore, the probability of effect on weekly consumption of sugary drinks was 86% (IRR = 0.89, 95% CI = 0.73; 1.1, P=.29) and 94% on monthly frequency of heavy episodic drinking (IRR = 0.77, 95% CI = 0.55; 1.07, P=.14). The evidence for effect was weaker after four months. There was no marked evidence for an effect on weekly alcohol consumption or smoking cessation.Conclusion: The findings of this thesis indicate that the LIFE4YOUth intervention can raise Swedish high school students’ awareness of their health behaviors, encourage them to change their health-risk behaviors, and facilitate their process of adopting new behaviors. Nonetheless, the intervention’s potential may vary depending on high school students' interest in and cognitive processing of the intervention content. The strongest evidence for effect was on the weekly time spent in moderate to vigorous physical activity and the daily number of portions consumed of fruit and vegetables. These findings should encourage further research to gain more robust evidence on whether and how stand-alone mHealth multiple behavior change interventions are effective in promoting healthy behaviors among adolescents.
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