Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial

Abstract

Background A high proportion of vocational education students smoke tobacco, have inadequate nutrition (ie, low fruit and vegetable intake), drink alcohol at risky levels, or are physically inactive. The extent to which vocational education students will sign up for proactively offered online and telephone support services for multiple health risk behaviors is unknown. Objective The aim of this study is to examine the uptake of proactively offered online and telephone support services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors, individually and in combination, among vocational education students in the Technical and Further Education (TAFE) setting. The characteristics associated with the uptake of online or telephone services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors were also examined. Methods Vocational education students enrolled in a TAFE class in New South Wales, Australia, which ran for 6 months or more, were recruited to participate in a cluster randomized controlled trial from May 2018 to May 2019. In the intervention arm, participants who did not meet the Australian health guidelines for each of the smoking, nutrition, alcohol consumption, and physical activity risk behaviors were provided electronic feedback and proactively offered online and telephone support services. Uptake of support was measured by whether participants signed up for the online and telephone services they were offered. Results Vocational education students (N=551; mean age 25.7 years, SD 11.1; 310/551, 56.3% male) were recruited into the intervention arm. Uptake of the proactive offer of either online or telephone services was 14.5% (59/406) for fruit and vegetables, 12.7% (29/228) for physical activity, 6.8% (13/191) for smoking, and 5.5% (18/327) for alcohol use. Uptake of any online or telephone service for at least two health behaviors was 5.8% (22/377). Participants who were employed (odds ratio [OR] 0.10, 95% CI 0.01-0.72) and reported not being anxious (OR 0.11, 95% CI 0.02-0.71) had smaller odds of signing up for online or telephone services for smoking, whereas participants who reported not being depressed had greater odds (OR 10.25, 95% CI 1.30-80.67). Participants who intended to change their physical activity in the next 30 days had greater odds (OR 4.01, 95% CI 1.33-12.07) of signing up for online or telephone services for physical activity. Employed participants had smaller odds (OR 0.18, 95% CI 0.06-0.56) of signing up for support services for at least two behaviors. Conclusions Although the uptake of proactively offered online and telephone support services is low, these rates appear to be higher than the self-initiated use of some of these services in the general population. Scaling up the proactive offer of online and telephone services may produce beneficial health outcomes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001.

Barriers and Facilitators to the Uptake of Online and Telephone Services Targeting Health Risk Behaviours among Vocational Education Students: A Qualitative Study

“…This study found that vocational education students' uptake of proactively offered online support services ranged from 5.5-14.3% across SNAP risk behaviours while uptake of proactively offered telephone services was between 0.9-7.0% across these risk behaviours [29]. Uptake of support services targeting nutrition and physical activity (12.7-14.5%) appeared higher than that of services for smoking and alcohol (5.5-6.8%) [29]. In relation to modifying multiple SNAP risk behaviours, only 5.8% of vocational education students signed up for online or telephone support to modify two or more health risk behaviours [29].…”

“…For ADIS, participants provided their contact details and were e-mailed or sent a text with the ADIS phone number to contact. This study found that vocational education students' uptake of proactively offered online support services ranged from 5.5-14.3% across SNAP risk behaviours while uptake of proactively offered telephone services was between 0.9-7.0% across these risk behaviours [29]. Uptake of support services targeting nutrition and physical activity (12.7-14.5%) appeared higher than that of services for smoking and alcohol (5.5-6.8%) [29].…”

“…Uptake of support services targeting nutrition and physical activity (12.7-14.5%) appeared higher than that of services for smoking and alcohol (5.5-6.8%) [29]. In relation to modifying multiple SNAP risk behaviours, only 5.8% of vocational education students signed up for online or telephone support to modify two or more health risk behaviours [29].…”

“…Despite the potential of proactive recruitment to engage more users, a previous study that examined the uptake of proactively offered online and telephone support services targeting SNAP risk behaviours reported low uptake of these services among vocational education students [29]. In this study, participants who did not meet the Australian health guidelines for smoking tobacco, fruit intake, vegetable intake, alcohol consumption, and physical activity were proactively offered onscreen via a computer tablet online and telephone support services they could use to modify their health risk behaviours [29]. The online and telephone services were QuitCoach and Quitline for smoking, Healthy Eating Quiz and Get Healthy Information and Coaching Service (GHICS), for fruit and vegetable consumption, Tertiary Health Research Intervention Via Email (THRIVE) and Alcohol Drug Information Service (ADIS) for alcohol, and 10,000 steps and Get Healthy Information and Coaching Service for physical activity.…”

“…Vocational education students study courses such as carpentry, floristry, plumbing, automotive engineering, hairdressing, and commercial cooking at vocational education institutions such as trade schools, technical schools, community colleges, and colleges of further education [28]. Despite the potential of proactive recruitment to engage more users, a previous study that examined the uptake of proactively offered online and telephone support services targeting SNAP risk behaviours reported low uptake of these services among vocational education students [29]. In this study, participants who did not meet the Australian health guidelines for smoking tobacco, fruit intake, vegetable intake, alcohol consumption, and physical activity were proactively offered onscreen via a computer tablet online and telephone support services they could use to modify their health risk behaviours [29].…”