Can Internet-Based Tools Engage Adolescents on Health Lifestyle Factors? Why Tapping Psychosocial and Developmentally Relevant Issues Is Key
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Abstract
Background
Engaging adolescents in health promotion is not an easy task. While many initiatives focus on obesity prevention with efforts to increase fruit/vegetable intake and exercise, today’s adolescents have more immediate concerns than potentially poor health outcomes in adulthood. Can addressing developmentally relevant psychosocial issues be a hook to engage teens around engaging in healthy lifestyle behaviors? Moreover, can technology-based tools be one way to reach this demographic? Considering that epidemiological estimates suggest that up to 44% of today’s adolescents will be overweight adults in 2020, prevention efforts are critical. However, motivating adolescents to adopt and maintain positive health habits during a phase of relative good health is challenging.
Objective
To develop and test a web-based platform, BodiMojo, to appeal to teenagers and address healthy lifestyle, body image, and other developmentally relevant concerns (e.g., dating /relationships). A secondary aim was to examine gender differences in outcomes. BodiMojo utilizes personalized health assessments that deliver targeted, evidence-based feedback via “BodiMojo Snapshots†based on gender, grade in school, BMI, and participation in organized sports. Content is tagged to the teen user based on assessment scores. Teenagers set health goals and receive reminders about those goals. The site content is balanced with stories by teens and articles by health experts.
Methods
User experiences design methods, such as teen “personas†and usability testing, and a randomized-controlled comparison study in high schools, were employed. Efficacy of the web program was examined in a brief classroom intervention with 178 high school students (Girls = 113; Boys = 65; mean age 15.2) in 3 urban and suburban Boston schools. Randomized by classrooms, intervention groups used the BodiMojo program for 4 weekly class periods, while controls participated in their usual health curriculum.
Lifestyle measures included Fruit & Vegetable Screener, Seven-Day Physical Activity Recall and Decisional Balance for Eating Fruits and Vegetables. Body image measures included the Eating Disorder Inventory Body Dissatisfaction subscale, the Body Esteem Scale (Weight, Appearance and Attribution subscales), and the Physical Appearance Comparison Scale.
Results
No baseline differences between the intervention and control groups were found on any measure or BMI. No intervention effects were found for nutrition or activity outcomes. Among girls, post-intervention assessments indicated that body dissatisfaction (p < .05) and physical appearance comparison (p<.05) decreased, and appearance satisfaction increased (p < .05), relative to the control group. No intervention effects were found for boys. Satisfaction ratings were high.
Conclusions
Among high school aged teenagers, web-based interventions may not engage adolescents beyond the nutrition and physical activity activities already taught in health classes. However, technology programs may be effective in targeting teen concerns around perception of weight, physical appearance, and body image issues. It is likely that such sensitive topics are not discussed in co-ed health classrooms and as such, the privacy and anonymity of web-based programming may appeal to this age group. This may be especially so with adolescent girls, who as a group have high rates of body dissatisfaction, and who are also highly engaged in digital media and social networks.
Engaging adolescents in health promotion is not an easy task. While many initiatives focus on obesity prevention with efforts to increase fruit/vegetable intake and exercise, today’s adolescents have more immediate concerns than potentially poor health outcomes in adulthood. Can addressing developmentally relevant psychosocial issues be a hook to engage teens around engaging in healthy lifestyle behaviors? Moreover, can technology-based tools be one way to reach this demographic? Considering that epidemiological estimates suggest that up to 44% of today’s adolescents will be overweight adults in 2020, prevention efforts are critical. However, motivating adolescents to adopt and maintain positive health habits during a phase of relative good health is challenging.
Objective
To develop and test a web-based platform, BodiMojo, to appeal to teenagers and address healthy lifestyle, body image, and other developmentally relevant concerns (e.g., dating /relationships). A secondary aim was to examine gender differences in outcomes. BodiMojo utilizes personalized health assessments that deliver targeted, evidence-based feedback via “BodiMojo Snapshots†based on gender, grade in school, BMI, and participation in organized sports. Content is tagged to the teen user based on assessment scores. Teenagers set health goals and receive reminders about those goals. The site content is balanced with stories by teens and articles by health experts.
Methods
User experiences design methods, such as teen “personas†and usability testing, and a randomized-controlled comparison study in high schools, were employed. Efficacy of the web program was examined in a brief classroom intervention with 178 high school students (Girls = 113; Boys = 65; mean age 15.2) in 3 urban and suburban Boston schools. Randomized by classrooms, intervention groups used the BodiMojo program for 4 weekly class periods, while controls participated in their usual health curriculum.
Lifestyle measures included Fruit & Vegetable Screener, Seven-Day Physical Activity Recall and Decisional Balance for Eating Fruits and Vegetables. Body image measures included the Eating Disorder Inventory Body Dissatisfaction subscale, the Body Esteem Scale (Weight, Appearance and Attribution subscales), and the Physical Appearance Comparison Scale.
Results
No baseline differences between the intervention and control groups were found on any measure or BMI. No intervention effects were found for nutrition or activity outcomes. Among girls, post-intervention assessments indicated that body dissatisfaction (p < .05) and physical appearance comparison (p<.05) decreased, and appearance satisfaction increased (p < .05), relative to the control group. No intervention effects were found for boys. Satisfaction ratings were high.
Conclusions
Among high school aged teenagers, web-based interventions may not engage adolescents beyond the nutrition and physical activity activities already taught in health classes. However, technology programs may be effective in targeting teen concerns around perception of weight, physical appearance, and body image issues. It is likely that such sensitive topics are not discussed in co-ed health classrooms and as such, the privacy and anonymity of web-based programming may appeal to this age group. This may be especially so with adolescent girls, who as a group have high rates of body dissatisfaction, and who are also highly engaged in digital media and social networks.
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