Abstract
Adolescence offers a window of opportunity during which improvements in health behaviours could benefit long-term health, and enable preparation for parenthood-albeit a long way off, passing on good health prospects to future children. This study was carried out to evaluate whether an educational intervention, which engages adolescents in science, can improve their health literacy and behaviours. A cluster-randomised controlled trial of 38 secondary schools in England, UK was conducted. The intervention (LifeLab) drew on principles of education, psychology and public health to engage students with science for health literacy, focused on the message "Me, my health and my children's health". The programme comprised: • Professional development for teachers. • A 2-3 week module of work for 13-14-year-olds. • A "hands-on" practical health science day visit to a dedicated facility in a university teaching hospital. Data were collected from 2929 adolescents (aged 13-14 years) at baseline and 2487 (84.9%) at 12-month follow-up. The primary outcome was change in theoretical health literacy from pre- to 12 months post- intervention. This study is registered (ISRCTN71951436) and the trial status is complete. Participation in the LifeLab educational intervention was associated with an increase in the students' standardised total theoretical health literacy score (adjusted difference between groups = 0.27 SDs (95%CI = 0.12, 0.42)) at 12-month follow-up. There was an indication that intervention participants subsequently judged their own lifestyles more critically than controls, with fewer reporting their behaviours as healthy (53.4% vs. 59.5%; adjusted PRR = 0.94 [0.87, 1.01]). We conclude that experiencing LifeLab led to improved health literacy in adolescents and that they demonstrated a move towards a more critical judgement of health behaviour 12 months after the intervention. Further work is needed to examine whether this leads to sustained behaviour change, and whether other activities are needed to support this change.
Highlights
Adolescence is a critical developmental stage during which lifelong health behaviours can be established
Following the approach devised by Guttersrud et al [22], but guided by our previous pilot studies and PPI input from young people themselves, we identified a series of health literacy questions, based on those used in the pilot randomised controlled trial (RCT) [23], which assessed adolescents’ knowledge of the way lifestyle choices can impact on health throughout the life course, and on the health of future generations
Due to the paucity of data of adolescent health literacy and lack of validated measures for adolescent health literacy, we followed the approach devised by Guttersrud et al [22], but considering issues that were more appropriate for adolescents, we identified a series of health literacy questions, used previously in feasibility and pilot studies [18, 23]
Summary
Adolescence is a critical developmental stage during which lifelong health behaviours can be established. At this time, targeted interventions may reduce the emergence or establishment of risk factors for health problems in adulthood, especially non-communicable diseases (NCDs) [1, 2]. Appreciating that adolescents are future parents provides a powerful argument for tailoring interventions to this age-group, but raises questions about the most appropriate forms of intervention to adopt for a population that can be hard to engage [6]. Schools have long been seen as ideal settings for targeting public health interventions as they have the potential to reach a large population of children and young people across the socio-economic spectrum, and to provide a consistent and constant setting in which to engage them with peers and adults. Other than the family, offers such a consistent, prolonged opportunity for engagement with children and young people [10,11,12,13] and the opportunity to use education as a means to increase health literacy [14, 15]
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