JMIR Publications

ABSTRACT

Background:

Wearable technology interventions combined with digital behaviour change resources provide opportunities to increase adolescents’ physical activity. Implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) Study was a 12-week cluster randomised controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aims were to increase moderate- to vigorous-intensity physical activity (MVPA) using: (i) a wrist-worn Fitbit® Flex and app; (ii) weekly challenges; (iii) digital behaviour change resources; and (iv) email and/or text message alerts.

Objective:

This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, and adolescent engagement and adherence, and potential for future scale-up.

Methods:

A mixed method evaluation assessed: acceptability, engagement, feasibility, adherence, and perceived impact. Nine intervention schools and n=144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed online surveys at baseline, and surveys and focus groups post-intervention. Teachers participated in interviews post-intervention. Facebook data tracked engagement with the online resources. Descriptive statistics were reported by sex. Qualitative data were analysed thematically.

Results:

Survey data were collected from 142 adolescents (99%) at baseline (mean age 13.70.4 years, 51% males) and 132 (98%) post-intervention. Fifteen focus groups (n=124) and nine interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content was easy to understand (83%) and the Fitbit easy to use (93%). Half perceived the text messages to be useful (51%), and liked the weekly challenges (48%) and Facebook videos (38%). Facebook engagement declined over time, only 19% self-reported wearing the Fitbit daily at post-intervention. Adolescents perceived the Fitbit increased their physical activity motivation (71%) and awareness (78%). Online delivery facilitated implementation, although school-level policies restricting phone use were perceived as a potential inhibiter to program roll-out.

Conclusions:

RAW-PA showed good acceptability among adolescents and teachers. Implementation feasibility was enhanced by low levels of teacher burden for delivery. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions, and ways of maximising system-level embeddedness of interventions in practice, would greatly advance the field. Clinical Trial: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000899448. Date of registration: July 7, 2016