The importance of relationships in adolescent risk behaviour prevention

Abstract

Abstract Health risk behaviours are a key contributing factor to adolescent morbidity and mortality. Furthermore, evidence shows that health behaviours begun in adolescence can impact on wellbeing across the lifespan. Current evidence suggests it is advantageous to target multiple health risk behaviours simultaneously, however efficacy testing remains the key focal point for research, with few studies exploring common underlying causal and contextual factors which may contribute to the success or failure of a programme. Methods This review used a customised realist approach, to explore how, why, for whom, and in what circumstances programmes are most successful in preventing multiple health risk behaviours in adolescents. The review synthesised evidence from published literature, along with qualitative data from stakeholders collected through focus groups with young people (n = 28) and school nurses (n = 22), and interviews with adolescent health and wellbeing practitioners (n = 8). Findings: Across all the realist programme theories developed, the role of relationships was the most commonly occurring theme. This theme goes beyond the expected impact of the relationship between programme deliverers and recipients, and familial and peer attachments, also taking in to consideration the relationships between programme and school leaders and staff, support networks and collaborative relationships between staff, and wider social connectedness within the community. These in turn were impacted upon by wider contextual factors, such as family, community, culture, socioeconomic status, intersectionality, and health inequalities. Conclusions These findings provide important insight in to understanding how, why, for whom, and in what circumstances multiple risk behaviour prevention programmes succeed or fail. Further to this they highlight key areas for consideration in the development of future adolescent public health interventions. Key messages Relationships built on trust and genuine care can improve adolescent risk behaviour prevention outcomes. Broader sociocultural context provide key explanations for variations in programme outcomes.