@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}},
  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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