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A mobile healthy lifestyle intervention to promote mental health in adolescence : a mixed-methods evaluation

Carmen Peuters (UGent) , Laura Maenhout (UGent) , Greet Cardon (UGent) , Annick De Paepe (UGent) , Ann DeSmet, Emelien Lauwerier (UGent) , Kenji Leta (UGent) and Geert Crombez (UGent)
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Abstract
Background A healthy lifestyle may improve mental health. It is yet not known whether and how a mobile intervention can be of help in achieving this in adolescents. This study investigated the effectiveness and perceived underlying mechanisms of the mobile health (mHealth) intervention #LIFEGOALS to promote healthy lifestyles and mental health. #LIFEGOALS is an evidence-based app with activity tracker, including self-regulation techniques, gamification elements, a support chatbot, and health narrative videos. Methods A quasi-randomized controlled trial (N = 279) with 12-week intervention period and process evaluation interviews (n = 13) took place during the COVID-19 pandemic. Adolescents (12-15y) from the general population were allocated at school-level to the intervention (n = 184) or to a no-intervention group (n = 95). Health-related quality of life (HRQoL), psychological well-being, mood, self-perception, peer support, resilience, depressed feelings, sleep quality and breakfast frequency were assessed via a web-based survey; physical activity, sedentary time, and sleep routine via Axivity accelerometers. Multilevel generalized linear models were fitted to investigate intervention effects and moderation by pandemic-related measures. Interviews were coded using thematic analysis. Results Non-usage attrition was high: 18% of the participants in the intervention group never used the app. An additional 30% stopped usage by the second week. Beneficial intervention effects were found for physical activity (χ21 = 4.36, P = .04), sedentary behavior (χ21 = 6.44, P = .01), sleep quality (χ21 = 6.11, P = .01), and mood (χ21 = 2.30, P = .02). However, effects on activity-related behavior were only present for adolescents having normal sports access, and effects on mood only for adolescents with full in-school education. HRQoL (χ22 = 14.72, P < .001), mood (χ21 = 6.03, P = .01), and peer support (χ21 = 13.69, P < .001) worsened in adolescents with pandemic-induced remote-education. Interviewees reported that the reward system, self-regulation guidance, and increased health awareness had contributed to their behavior change. They also pointed to the importance of social factors, quality of technology and autonomy for mHealth effectiveness. Conclusions #LIFEGOALS showed mixed results on health behaviors and mental health. The findings highlight the role of contextual factors for mHealth promotion in adolescence, and provide suggestions to optimize support by a chatbot and narrative episodes. Trial registration ClinicalTrials.gov [NCT04719858], registered on 22/01/2021.
Keywords
Public Health, Environmental and Occupational Health, Universal prevention, Self-regulation techniques, Conversational agents, Narrative persuasion, Participatory development, Digital behavior change interventions, Healthy lifestyles, Mental health promotion, Adolescents, Mobile health applications

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Citation

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MLA
Peuters, Carmen, et al. “A Mobile Healthy Lifestyle Intervention to Promote Mental Health in Adolescence : A Mixed-Methods Evaluation.” BMC PUBLIC HEALTH, vol. 24, Springer Science and Business Media LLC, 2024, doi:10.1186/s12889-023-17260-9.
APA
Peuters, C., Maenhout, L., Cardon, G., De Paepe, A., DeSmet, A., Lauwerier, E., … Crombez, G. (2024). A mobile healthy lifestyle intervention to promote mental health in adolescence : a mixed-methods evaluation. BMC PUBLIC HEALTH, 24. https://doi.org/10.1186/s12889-023-17260-9
Chicago author-date
Peuters, Carmen, Laura Maenhout, Greet Cardon, Annick De Paepe, Ann DeSmet, Emelien Lauwerier, Kenji Leta, and Geert Crombez. 2024. “A Mobile Healthy Lifestyle Intervention to Promote Mental Health in Adolescence : A Mixed-Methods Evaluation.” BMC PUBLIC HEALTH 24. https://doi.org/10.1186/s12889-023-17260-9.
Chicago author-date (all authors)
Peuters, Carmen, Laura Maenhout, Greet Cardon, Annick De Paepe, Ann DeSmet, Emelien Lauwerier, Kenji Leta, and Geert Crombez. 2024. “A Mobile Healthy Lifestyle Intervention to Promote Mental Health in Adolescence : A Mixed-Methods Evaluation.” BMC PUBLIC HEALTH 24. doi:10.1186/s12889-023-17260-9.
Vancouver
1.
Peuters C, Maenhout L, Cardon G, De Paepe A, DeSmet A, Lauwerier E, et al. A mobile healthy lifestyle intervention to promote mental health in adolescence : a mixed-methods evaluation. BMC PUBLIC HEALTH. 2024;24.
IEEE
[1]
C. Peuters et al., “A mobile healthy lifestyle intervention to promote mental health in adolescence : a mixed-methods evaluation,” BMC PUBLIC HEALTH, vol. 24, 2024.
@article{01HK77X5BT0XW0VMV0KSB3042X,
  abstract     = {{Background
A healthy lifestyle may improve mental health. It is yet not known whether and how a mobile intervention can be of help in achieving this in adolescents. This study investigated the effectiveness and perceived underlying mechanisms of the mobile health (mHealth) intervention #LIFEGOALS to promote healthy lifestyles and mental health. #LIFEGOALS is an evidence-based app with activity tracker, including self-regulation techniques, gamification elements, a support chatbot, and health narrative videos.

Methods
A quasi-randomized controlled trial (N = 279) with 12-week intervention period and process evaluation interviews (n = 13) took place during the COVID-19 pandemic. Adolescents (12-15y) from the general population were allocated at school-level to the intervention (n = 184) or to a no-intervention group (n = 95). Health-related quality of life (HRQoL), psychological well-being, mood, self-perception, peer support, resilience, depressed feelings, sleep quality and breakfast frequency were assessed via a web-based survey; physical activity, sedentary time, and sleep routine via Axivity accelerometers. Multilevel generalized linear models were fitted to investigate intervention effects and moderation by pandemic-related measures. Interviews were coded using thematic analysis.

Results
Non-usage attrition was high: 18% of the participants in the intervention group never used the app. An additional 30% stopped usage by the second week. Beneficial intervention effects were found for physical activity (χ21 = 4.36, P = .04), sedentary behavior (χ21 = 6.44, P = .01), sleep quality (χ21 = 6.11, P = .01), and mood (χ21 = 2.30, P = .02). However, effects on activity-related behavior were only present for adolescents having normal sports access, and effects on mood only for adolescents with full in-school education. HRQoL (χ22 = 14.72, P < .001), mood (χ21 = 6.03, P = .01), and peer support (χ21 = 13.69, P < .001) worsened in adolescents with pandemic-induced remote-education. Interviewees reported that the reward system, self-regulation guidance, and increased health awareness had contributed to their behavior change. They also pointed to the importance of social factors, quality of technology and autonomy for mHealth effectiveness.

Conclusions
#LIFEGOALS showed mixed results on health behaviors and mental health. The findings highlight the role of contextual factors for mHealth promotion in adolescence, and provide suggestions to optimize support by a chatbot and narrative episodes.

Trial registration
ClinicalTrials.gov [NCT04719858], registered on 22/01/2021.}},
  articleno    = {{44}},
  author       = {{Peuters, Carmen and Maenhout, Laura and Cardon, Greet and De Paepe, Annick and DeSmet, Ann and Lauwerier, Emelien and Leta, Kenji and Crombez, Geert}},
  issn         = {{1471-2458}},
  journal      = {{BMC PUBLIC HEALTH}},
  keywords     = {{Public Health, Environmental and Occupational Health,Universal prevention,Self-regulation techniques,Conversational agents,Narrative persuasion,Participatory development,Digital behavior change interventions,Healthy lifestyles,Mental health promotion,Adolescents,Mobile health applications}},
  language     = {{eng}},
  pages        = {{19}},
  publisher    = {{Springer Science and Business Media LLC}},
  title        = {{A mobile healthy lifestyle intervention to promote mental health in adolescence : a mixed-methods evaluation}},
  url          = {{http://doi.org/10.1186/s12889-023-17260-9}},
  volume       = {{24}},
  year         = {{2024}},
}

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