JMIR Publications

ABSTRACT

Background:

Vocational school students exhibit a high prevalence of addictive behaviors. Digital prevention programs targeting multiple addictive behaviors and promoting life skills are promising. Tailoring intervention content to participants’ preferences, such as allowing them to choose behavior modules, may increase engagement and efficacy. However, there is limited understanding of how personal characteristics relate to module choices.

Objective:

This paper examines the prevention needs of German vocational school students as well as their prevention preferences through self-determined module choice in the multi-behavior app-based addiction prevention program "ready4life".

Methods:

A two-arm cluster-randomized controlled trial recruited German vocational students aged 16+ years. Among 376 classes from 35 schools, "ready4life" was introduced during a school lesson. Students were invited to download the "ready4life" app, and completed an anonymous screening with individualized risk and competence feedback in form of a traffic light system. Informed consent was given by 2568 students. Intervention classes received individual app-based coaching, with weekly chat contacts with a virtual coach over four months. They could choose two out of six modules: alcohol, tobacco, cannabis, social media/gaming, stress and social competencies. Module choice was self-determined. Control group classes received a link to health behavior information and could access coaching after 12 months.

Results:

Prevention need was high. For 86% two or more risks were reported according to a yellow or red traffic light feedback. Within the intervention group, stress (818/1236, 66.2%) and social media/gaming (625/1236, 50.6%) were the most chosen topics, followed by alcohol (360/1236, 29.1%), social competencies (306/1236, 24.8%), tobacco (232/1236, 18.8%), and cannabis (131/1236, 10.6%). Module choices closely aligned with received traffic light feedback, particularly among those with one or two risks. Multilevel regression models showed females were significantly more likely to choose the stress module (P<.001; OR 2.38, 95% CI 1.69-3.33), while males preferred social media/gaming (P<.001; OR 0.52, 95% CI 0.40-0.69), alcohol (P<.001; OR 0.50, 95% CI 0.37-0.67) and cannabis (P<.001; OR 0.37, 95% CI 0.21-0.63), when holding age, education track and prevention need for the respective behavior constant. Younger students were significantly more likely to choose the cannabis module (P<.001; OR 0.81, 95% CI 0.74-0.90). Educational track also influenced module choice, e.g., those with lower education were more likely to choose alcohol and cannabis, suggesting a positive equity impact. Students’ prevention needs significantly influenced choice of the corresponding module, e.g., higher alcohol consumption increased the likelihood of choosing the alcohol module (P<.001; OR 1.31, 95% CI 1.20-1.43).

Conclusions:

Our study confirms vocational students' high prevention needs regarding addictive behaviors. A key finding was the high congruence between students' module choices and their demonstrated needs, with most students being interested in the stress module. Module choice also differed by age, gender, and educational track. Clinical Trial: German Clinical Trials Register (DRKS): DRKS00022328