JMIR Publications

ABSTRACT

Background:

Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving health outcomes and reducing chronic disease risk. Schools are ideal intervention settings and eHealth interventions afford several advantages, including increased student engagement, scalability and sustainability. Although lifestyle risk behaviours tend to co-occur, few school-based eHealth interventions have targeted multiple behaviours concurrently.

Objective:

This paper summarises the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent six 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”).

Methods:

Development of the Health4Life program was conducted over an 18-month period in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved: i) scoping of evidence and systematic literature review, ii) consultation with adolescents (n=815) via a cross-sectional online survey to identify knowledge gaps, attitudes, barriers and facilitators in relation to the Big 6; iii) content and web development; and iv) 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.

Results:

The 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 lessons, 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.

Conclusions:

The Health4Life school-based program is the first universal, web-based program to concurrently address six important chronic disease risk factors among secondary school students. By adopting a multiple health behaviour 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 health throughout adolescence and into adulthood. Clinical Trial: ANZCTR registration number ACTRN12619000431123 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376728