Abstract
BackgroundSix key behavioural risk factors (risky alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and unhealthy sleep patterns) have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers. School-based interventions targeting these multiple health risk behaviours among adolescents have the potential to halt the trajectory towards later disease, whilst online and mobile technology interventions offer advantages in terms of student engagement, reach and scalability. Despite this, the efficacy of eHealth school-based interventions targeting these six health risk behaviours among adolescents has not been evaluated. The proposed systematic review aims to address this by determining the nature and efficacy of existing eHealth school-based interventions targeting multiple health risk behaviours among adolescents.MethodsA systematic search of the MEDLINE, Embase, PsycINFO and Cochrane Library databases will be conducted to identify eligible published papers. Eligible studies will be randomised controlled trials, including cluster randomised controlled trials, of interventions targeting two or more of the following lifestyle risk behaviours: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and sleep. Eligible studies will be those evaluating interventions delivered in a secondary school setting among participants 11–18 years of age, via an eHealth platform (Internet, computers of mobile technology). Two reviewers will independently screen studies for eligibility, extract data and assess the risk of bias. Study outcomes will be summarised in a narrative synthesis, and meta-analyses will be conducted where it is appropriate to combine studies.DiscussionIt is anticipated that the results from this review will serve to inform the development of future eHealth multiple health behaviour interventions for adolescents by identifying common characteristics of effective programs and highlighting knowledge gaps in the evidence base.Systematic review registrationPROSPERO CRD42017072163
Highlights
Six key behavioural risk factors have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers
It is well established that the major chronic diseases share four common behavioural risks: poor diet, physical inactivity, smoking and alcohol use [2, 3]
Findings from this review suggest that too few studies of school-based multiple health behaviour interventions have been conducted to be able to determine whether targeting behaviours simultaneously has a synergistic effect
Summary
This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42017072163) and was written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines [47] as provided in Additional file 1. Interventions addressing other risk behaviours in addition to two or more of the six behaviours of interest, for example, illicit drug use, risky sexual behaviour, sun protection habits and aggressive behaviour, will be eligible for inclusion Whilst data for these additional outcomes will not be meta-analysed, studies and results may be discussed within the paper qualitatively. Data will be extracted by two reviewers and will include: Publication details (study authors, year published) Study characteristics (design, country, sample size, attrition) Participant characteristics (e.g. age, gender, ethnicity, socio-economic status) Intervention characteristics (delivery method, program duration, frequency of delivery, theoretical basis, content and components, number and type of specific lifestyle risk behaviours targeted) Primary and secondary outcomes of interest across all time points Measurement tools employed (e.g. validated scales, objective measures) Details of the comparison group. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess the quality of the body of evidence [52]
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