Background Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

Western culture over the last two centuries has become significantly ecologically 'dis-embedded', with nature increasingly reduced to resources for human use. The consequence is global environmental degradation, including accelerating climate change. Much recent research supports associations between nature contact and human health and well-being, and between feelings of nature-connectedness and pro-environmental attitudes and behaviours. The oft-cited Ottawa Charter for Health Promotion (WHO, Ottawa Charter for Health Promotion, 1986) emphasises human-environment inextricability; however public health discourse and response has not fully engaged with this recognition. This qualitative study explored the attitudes, motivations, and experiences-including formative influences-of six individuals whose behaviour was congruent with recognition of human-nature interconnectedness; such individuals may be understood as ecologically embedded. Key aspects of participants' experience, identified through grounded theory thematic analysis, were (i) connecting with nature (especially in childhood); (ii) seeing the threat and taking it personally; (iii) the nature of reality; (iv) dedicated beyond the ego-oriented self; and (v) sustaining the eco-centric self. The findings highlight the necessity for cross-sectoral advocacy at all levels of government policy development focused on recognition of human-environment connectedness, especially bridging health, planning and education policies affecting children. Only thus will both population health and ecological health on which population health depends be possible.

BACKGROUND Wearable technology interventions combined with digital behaviour change resources provide opportunities to increase adolescents’ physical activity. Implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) Study was a 12-week cluster randomised controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aims were to increase moderate- to vigorous-intensity physical activity (MVPA) using: (i) a wrist-worn Fitbit® Flex and app; (ii) weekly challenges; (iii) digital behaviour change resources; and (iv) email and/or text message alerts. OBJECTIVE This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, and adolescent engagement and adherence, and potential for future scale-up. METHODS A mixed method evaluation assessed: acceptability, engagement, feasibility, adherence, and perceived impact. Nine intervention schools and n=144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed online surveys at baseline, and surveys and focus groups post-intervention. Teachers participated in interviews post-intervention. Facebook data tracked engagement with the online resources. Descriptive statistics were reported by sex. Qualitative data were analysed thematically. RESULTS Survey data were collected from 142 adolescents (99%) at baseline (mean age 13.70.4 years, 51% males) and 132 (98%) post-intervention. Fifteen focus groups (n=124) and nine interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content was easy to understand (83%) and the Fitbit easy to use (93%). Half perceived the text messages to be useful (51%), whilst 48% liked the weekly challenges and 38% liked the Facebook videos. Facebook engagement declined over time, only 19% self-reported wearing the Fitbit daily at post-intervention. Adolescents perceived the Fitbit increased their physical activity motivation (71%) and awareness (78%). Online delivery facilitated implementation, although school-level policies restricting phone use were perceived as a potential inhibiter to program roll-out. CONCLUSIONS RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. While adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement was low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions, and ways of maximising system-level embeddedness of interventions in practice, would greatly advance the field. CLINICALTRIAL Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000899448. Date of registration: July 7, 2016