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

• Published in: BMC public health Vol. 24; no. 1; p. 44
• Main Authors: Peuters, Carmen, Maenhout, Laura, Cardon, Greet, De Paepe, Annick, DeSmet, Ann, Lauwerier, Emelien, Leta, Kenji, Crombez, Geert
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.01.2024; BioMed Central; BMC
• Subjects: Accelerometers; Adolescence; Adolescent; Adolescents; Analysis; Belgium; Chatbots; COVID-19; Digital behavior change interventions; Education; Effectiveness; Epidemics; Evaluation; Exercise; Health behavior; Health promotion; Healthy Lifestyle; Healthy lifestyles; Humans; Intervention; Laws, regulations and rules; Medical law; Mental Health; Mental health promotion; Methods; Mobile Applications; Mobile health applications; Mood; Narratives; Pandemics; Pandemics - prevention & control; Participatory development; Physical activity; Psychological aspects; Psychological factors; Quality of Life; Sleep; Social factors; Statistical models; Students; Teenagers; Telemedicine; Tracking devices; Well being; Belgium; Universal prevention; Participatory development; Conversational agents; Digital behavior change interventions; Mobile health applications; Narrative persuasion; Adolescents; Healthy lifestyles; Self-regulation techniques; Mental health promotion
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-023-17260-9

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. 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. 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 (χ  = 4.36, P = .04), sedentary behavior (χ  = 6.44, P = .01), sleep quality (χ  = 6.11, P = .01), and mood (χ  = 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 (χ  = 14.72, P < .001), mood (χ  = 6.03, P = .01), and peer support (χ  = 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. #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. ClinicalTrials.gov [NCT04719858], registered on 22/01/2021.