A Mobile Healthy Lifestyle Intervention Including Behavior Change Techniques, a Chatbot and Narrative Videos to Promote Mental Health in Adolescence: a Mixed-Methods Study Using a Quasi-Randomized Controlled Trial Design (Preprint)
Authors: Peuters Carmen , Maenhout Laura , Cardon Greet , De Paepe Annick , DeSmet Ann , Lauwerier Emelien , Leta Kenji , Crombez Geert 
Published: January 2023

BACKGROUND

Improving healthy lifestyles may promote mental health in adolescents, and mobile health (mHealth) may be a valuable way to reach that objective. So far, no mobile healthy lifestyle intervention existed for promoting mental health in the general adolescent population. The mHealth intervention #LIFEGOALS was developed using a participatory approach, and combining behavior change techniques with a support chatbot and narrative videos as engagement-enhancing features.

OBJECTIVE

To evaluate the effectiveness of the mHealth intervention #LIFEGOALS for promoting mental health and health behaviors, and to identify its potential working mechanisms.

METHODS

A quasi-RCT with 12-week intervention period was followed by process evaluation interviews and took place in 2020-21 during the COVID-19 pandemic. Adolescents (12-15y) were allocated at school-level to the intervention group (receiving #LIFEGOALS app with activity tracker for self-monitoring) or control group (receiving no intervention). Health-related quality of life (HRQoL, KIDSCREEN-10) was measured via a web-based survey at baseline, after 6 weeks, and post-intervention. At baseline and post-measurement, psychological well-being, moods & emotions, self-perception, social support & peers, resilience, depressive symptoms, sleep quality and breakfast frequency were assessed via a web-based survey; and physical activity, sedentary time, and week-weekend sleep time difference via Axivity accelerometers. Multilevel generalized linear models were fitted to investigate intervention effects and moderation by pandemic-related measures. Individual interviews were conducted in a subsample (with above average app usage) of the intervention group. Themes aiding in the understanding of how the intervention led to change were identified using thematic analysis.

RESULTS

Out of 184 participants in the intervention group, 150 had used the app and were included in the analyses (total N=279, age=13.63±0.96 years, 55% girls). The mHealth intervention showed positive effects on moods & emotions for adolescents with full in-school education (χ2(1)=2.30, P=.02), but negative effects on HRQoL (χ2(2)=14.72, P<.001), moods & emotions (χ2(1)=6.03, P=.01), and social support & peers (χ2(1)=13.69, P<.001) for adolescents with pandemic-induced partially remote-education. Regarding health behavior, the intervention showed beneficial effects on physical activity (χ2(1)=4.36, P=.04), sedentary behavior (χ2(1)=6.44, P=.01), and sleep quality (χ2(1)=6.11, P=.01); of which the activity-related effects were only present for adolescents having normal sports access. Non-usage attrition was high (90/184, 49% by the second week). Interviewed users (n=13) experienced that mainly the reward system and self-regulation guidance had contributed to their behavior change, but also pointed to social factors, quality of technology and autonomy as important elements within mHealth, and to the role of gaining awareness as motivator to change behavior.

CONCLUSIONS

#LIFEGOALS showed mixed results on healthy lifestyle and mental health outcomes. The findings highlight the role of contextual factors for mHealth promotion in adolescence, and provide suggestions to optimize a support chatbot and narrative episodes within mHealth for improving adoption and effectiveness.

CLINICALTRIAL

ClinicalTrials.gov [NCT04719858]