Engaging adolescents in changing behaviour (EACH-B): a study protocol for a cluster randomised controlled trial to improve dietary quality and physical activity

Abstract

Background Poor diet and lack of physical activity are strongly linked to non-communicable disease risk, but modifying them is challenging. There is increasing recognition that adolescence is an important time to intervene; habits formed during this period tend to last, and physical and psychological changes during adolescence make it an important time to help individuals form healthier habits. Improving adolescents’ health behaviours is important not only for their own health now and in adulthood, but also for the health of any future children. Building on LifeLab—an existing, purpose-built educational facility at the University of Southampton—we have developed a multi-component intervention for secondary school students called Engaging Adolescents in Changing Behaviour (EACH-B) that aims to motivate and support adolescents to eat better and be more physically active. Methods A cluster randomised controlled trial is being conducted to evaluate the effectiveness of the EACH-B intervention. The primary outcomes of the intervention are self-reported dietary quality and objectively measured physical activity (PA) levels, both assessed at baseline and at 12-month follow-up. The EACH-B intervention consists of three linked elements: professional development for teachers including training in communication skills to support health behaviour change; the LifeLab educational module comprising in-school teaching of nine science lessons linked to the English National Curriculum and a practical day visit to the LifeLab facility; and a personalised digital intervention that involves social support and game features that promote eating better and being more active. Both the taught module and the LifeLab day are designed with a focus on the science behind the messages about positive health behaviours, such as diet and PA, for the adolescents now, in adulthood and their future offspring, with the aim of promoting personal plans for change. The EACH-B research trial aims to recruit approximately 2300 secondary school students aged 12–13 years from 50 schools (the clusters) from Hampshire and neighbouring counties. Participating schools will be randomised to either the control or intervention arm. The intervention will be run during two academic years, with continual recruitment of schools throughout the school year until the sample size is reached. The schools allocated to the control arm will receive normal schooling but will be offered the intervention after data collection for the trial is complete. An economic model will be developed to assess the cost-effectiveness of the EACH-B intervention compared with usual schooling. Discussion Adolescents’ health needs are often ignored and they can be difficult to engage in behaviour change. Building a cheap, sustainable way of engaging them in making healthier choices will benefit their long-term health and that of their future children. Trial registration ISRCTN 74109264. Registered on 30 August 2019. EACH-B is a cluster randomised controlled trial, funded by the National Institute for Health Research (RP-PG-0216-20004).

Treatment effect modifiers in a randomized trial of the good behavior game during middle childhood.

“…Furthermore, it is important to note that the use of CACE in school (as opposed to classroom, or individual) trials is a relatively new development. Though there are notable examples in the literature (Lord et al, 2018; López Turley et al, 2017; Panayiotou et al, 2020; Strömmer et al, 2020), school clustering in CACE is an area which has only recently begun to receive attention. Therefore, further work is needed in order to explore the methodological nuances related to school clustering, as noted above (e.g., three-level CACE, universal compliance).…”

Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme

“…Furthermore, there is an increasing use of digital platforms by adolescents. According to 2018 estimates, 83% of 12–15 years olds in the UK own smartphones, with 99% spending an average of 20 hours per week online 19 20. With an explosion in the use of such platforms to influence health behaviours in young people, they have potential as a complementary feature in complex interventions that aim to influence health behaviour in adolescents 20…”

Do dietary and physical activity interventions in adolescents provide a cost-effective use of healthcare resources? Model development and illustration based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme

“…According to 2018 estimates, 83% of 12-15 years olds own smartphones with 99% spending an average of 20 hours per week online. 19 20 With an explosion in the use of such platforms to influence health behaviours in young people, there are suggestions that they have potential as a complementary feature in complex interventions that aim to influence health behaviour in adolescents. 20…”

“…19 20 With an explosion in the use of such platforms to influence health behaviours in young people, there are suggestions that they have potential as a complementary feature in complex interventions that aim to influence health behaviour in adolescents. 20…”

“…Further details of the trial design are given elsewhere. 20 The research programme is funded by the National Institute for Health Research (RP-PG-0216-20004). The “LifeLab Plus” intervention developed as part of this programme is a complex three-part programme that comprises: i) an education module that teaches school students the science behind health messages through a 2-week module with a “hands-on” practical one-day visit to a teaching laboratory at University Hospital Southampton or in school while COVID-19 restrictions apply; ii) training for teachers in skills to support behaviour change; and iii) access to a specially-designed, interactive smartphone app with game features.…”