Engaging adolescents in changing behaviour (EACh-B): a programme of research to improve the diets and physical activity levels of teenagers

Aim: To develop and test a complex intervention designed to engage, motivate and support 13 to 14 year old students to improve their diets and physical activity levels. By the end of the programme we will have i) developed and evaluated a new three-component intervention and ii) determined the most efficient and cost-effective methods of integrating this intervention into school curricula. PPI: This proposal has been developed with input from three PPI groups, two of which solely comprise adolescents. We will work closely with our PPI representatives throughout this programme, involving them in our Steering Committee, intervention planning and the interpretation of our findings and the factors influencing the acceptability, feasibility and effectiveness of the intervention. Public health relevance: Poor diet costs the NHS £6 billion annually; physical inactivity £1 billion. Meeting current dietary recommendations would reduce years-of-life-lost to coronary heart disease by 2 million, stroke by 400,000, and type-2 diabetes by 19,000 over 20 years. Small increases in activity reduce non-communicable disease (NCD) risk. UK adolescents have poorer diets than other age groups, and fewer than 20% meet physical activity guidelines. Health behaviours track into adulthood; sub-optimal diet and activity in adolescence affects immediate health but also increases risks of obesity and NCDs later, and in the next generation. Adolescents have unique physiological and psychological characteristics, and unrecognised and unmet needs. Building a cheap, sustainable way of engaging them in making healthier choices will benefit their health and that of their future children. Motivated and engaged adolescents can improve their health behaviours. Unfortunately, little is known about how to motivate them to change or how to sustain changes long-term. Background: Evidence suggests school-based interventions may be effective, with those offering combinations of peer-modelling, social support and choice improving diet and increasing activity. More work is needed to understand how these influences can be harnessed to be optimally acceptable and persuasive to adolescents, who vary in their response to interventions. Digital platforms offer potential for engaging adolescents in health behaviour change but have suffered from low usage and high attrition. More focus is needed on incorporating effective behavioural techniques and better methods of engagement. Our PPI groups said social support and competition are important in helping them maintain healthy lifestyle behaviours. Adults engagement with digital interventions has benefitted from addition of face-to-face support. Incorporating game features is a strategy that holds promise for adolescents. We plan to develop a complex, three-component intervention, LifeLabPlus, involving: 1) motivating adolescents to improve their diets and increase physical activity through a school-based education programme (LifeLab); plus 2) face-to-face support from specially trained teachers, and 3) a personalised digital intervention with game and peer-support features. LifeLab is a three-week science module linked to the National Curriculum which helps 13-14 year old students think about the science underlying their health. Cost-effectiveness analysis, stakeholder engagement and PPI will maximise the likelihood of rapid/inexpensive roll-out into routine practice in schools. Research plan: We propose three closely-linked, parallel research streams. RS1 includes systematic review and evidence synthesis of the literature to identify key intervention features associated with effectiveness, cost-effectiveness, engagement, acceptability and feasibility to inform intervention development (WP1.1), economic modelling to estimate cost-effectiveness of the intervention tested in RS3 and the wider health benefits and costs of diet and physical activity interventions for adolescents (WP1.2), and understanding implementatio