Abstract

BackgroundChronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently.ObjectiveThis study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6).MethodsThe development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience.ResultsThe co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues.ConclusionsThe Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood.

Highlights

  • BackgroundChronic diseases such as cardiovascular disease, type 2 diabetes, and mental disorders are the leading causes of death globally [1]

  • Adolescence is a critical period to intervene, as it coincides with the emergence of many health risk factors and is a time when young people acquire greater autonomy over their lifestyle choices [7]

  • Watching television is associated with high-fat snacking [9], and young people who engage in risky alcohol and other drug use are more likely to eat poorly and be sedentary [7]

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Summary

Introduction

BackgroundChronic diseases such as cardiovascular disease, type 2 diabetes, and mental disorders are the leading causes of death globally [1]. Emerging evidence has linked these established chronic disease risk factors with 2 additional risk behaviors: sedentary behavior (ie, sitting and recreational screen time) [3,4] and poor sleep (ie, long or short duration and/or poor quality) [5] Together, these 6 risk factors (the Big 6) are important targets for prevention and early intervention programs to reduce chronic disease. Watching television is associated with high-fat snacking [9], and young people who engage in risky alcohol and other drug use are more likely to eat poorly and be sedentary [7] In recognition of this clustering, multiple health behavior change interventions [10] have been developed to address risk factors together, rather than in isolation.

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