Mediated effects of LIFE4YOUth—a mobile health intervention for multiple lifestyle behavior change among high school students in Sweden: findings from a randomized controlled trial
Abstract Background Digital interventions have been shown to improve adolescents’ health behaviors. However, little is known about the mechanisms of change related to multiple risk behaviors in this population. This study aimed to estimate the natural direct and indirect effects of a digital interve...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-03-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-025-22097-5 |
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| Summary: | Abstract Background Digital interventions have been shown to improve adolescents’ health behaviors. However, little is known about the mechanisms of change related to multiple risk behaviors in this population. This study aimed to estimate the natural direct and indirect effects of a digital intervention for multiple health behavior change in high school students. Methods This was a secondary analysis of mediated effects of a digital intervention based on data from a randomized controlled trial among high school students in Sweden. Participants were classified as being at risk with respect to having at least one health behavior among lack of physical activity, unhealthy diet, alcohol consumption, or smoking. The digital intervention comprised of weekly monitoring and feedback of health behaviors together with content on strategies for behavior change. The comparator was referral to a national website where health information was available. Primary outcomes were self-reported physical activity, diet, alcohol consumption, and smoking at 4 months post-randomization. Based on a counterfactual framework, three potential mediating factors were assessed: importance, knowledge of how to change (know-how), and confidence. Results Between September 2020 and June 2023, 756 high school students were recruited. The estimated indirect effect on moderate-to-vigorous physical activity via the mediating factors was 5.2 min (95% CoI = -8.6; 19.9) while the estimated direct effect was 76.3 min (95% CoI = 19.4; 134.2). For fruit and vegetable consumption, the estimated indirect effect was 0.04 daily portions (95% CoI = -0.01; 0.1), and the estimated direct effect was 0.19 daily portions (95% CoI = -0.08; 0.45). No marked mediated effects were observed concerning alcohol- or sugary-drinks-intake, and smoking. Conclusions The observed intervention effects of increased physical activity and fruit and vegetable intake could only to a small extent be explained by increased confidence and know-how. To further understand the mechanisms of health behavior change, future studies should explore other potential mediators and evaluate different strategies for how to best assess and incorporate psychosocial mediators in multiple lifestyle behavior interventions for adolescents. Trial registration Prospective registration in the ISRCTN database 20 May 2020 (ISRCTN34468623). |
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| ISSN: | 1471-2458 |