The Triple E Project: Assessing Strategies for Enhancing Engagement with eHealth Approaches Targeting Lifestyle Behaviours in Adolescents

All participants will be provided with access to the Health4Life app for 3 months. The Health4Life app is a multiple health behaviour change, self-monitoring mobile app for adolescents. See more information about the Health4Life app under the 'control treatment' section. Participants will also receive access to a combination of the following four adherence strategies over the same 3-month period when they have access to the Health4Life app. Gamification in the Health4Life app: Gamification is the use of game design elements in non-game contexts. In the Health4Life app, users assigned to the gamification intervention condition can view how many medals they have earnt for meeting health behaviour guidelines. Those randomised to receive the gamification component will receive additional access to a ‘Medal Tally Leader board’. On first use, users will be assigned to a team. The combined medal tallies of team members will be displayed in a leader board, similar to an Olympic medal tally, to be updated daily. Teammates will be able to communicate with other teammates by sending ‘high fives’ or ‘thumbs up’ messages of support. Access to a health coach: Participants in the health coach condition will be asked to attend an initial phone call with the health coach for approximately 15 minutes within one week following completion of the study baseline assessment (i.e., within one week into the 3-month study period). On this initial call the health coach will explain how the health coach intervention works and answer any questions participants may have about the intervention or the research study. During this call the health coach will also conduct an initial brief assessment of the participants’ health behaviour goals and their engagement with the Health4Life app, provide support to any participants experiencing difficulties with their health behaviour goals or the Health4Life app, and also set expectations for any future ‘check-ins’ with participants. Participants will then be sent a message once a fortnight via their preferred method of communication (SMS or email) informing them about the availability of a health coach to ask questions of or request additional information or support. If a participant indicates interest in receiving text messages, email, or telephone support from the health coach, the health coach will respond using the method indicated. These ‘check-ins’ will include personalised messages regarding engagement with the Health4Life app, checking-in on how participants feel they are going with their health behaviours, answering any questions they have, and encouraging engagement with the app. These interactions will be guided by a semi-structured health coach manual that has been specifically designed for this study and draws on the guiding principles of Mohr et al.’s (2011; doi: 10.2196/jmir.1602) Supportive Accountability Model. It will be up to the adolescent to decide and manage their level of engagement with the health coach. The 'check-ins' will be offered for three months. The health coaches will be allied health professionals, such as psychologists, or Research Assistants with adequate training and experience in supportive counselling, mental health first aid and responding to child safety and wellbeing risks. Parent factsheets Nominated parents/guardians of participants will be provided with parent resources regarding the Big 6 health behaviours (healthy eating, physical activity, sleep, recreational screen time, alcohol consumption, tobacco consumption) and how to help their adolescent improve their health behaviours, plus tips and conversation starters regarding the Health4Life app. These resources have been designed specifically for this study. Parents will be provided with access to a website from where they can download 6 evidence based-fact sheets and emailed one of these fact sheets per-fortnight over the 3 month study period. Text message prompts Participants randomised to this condition will receive a text message every three days to prompt them to use the Health4Life app. To ensure messages are acceptable and likely to engage adolescents, messages have been co-created by adolescents. With assistance from a senior researcher, two Young Person Research Assistants (aged 17 and 20) employed for 6 months developed and conducted an online consultation via Zoom with twenty five Adolescent Expert Advisors. They then used the advisors’ feedback to generate text messages designed to engage adolescents with the Health4Life app. Participants will be allocated to one of the following conditions: 1. Health4Life app + Gamification + Health Coach + Parent Resources + Text Messages 2. Health4Life app + Gamification + Health Coach + Parent Resources 3. Health4Life app + Gamification + Health Coach + Text Messages 4. Health4Life app + Gamification + Health Coach 5. Health4Life app + Gamification + Parent Resources + Text Messages 6. Health4Life app + Gamification + Parent Resources 7. Health4Life app + Gamification + Text Messages 8. Health4Life app + Gamification 9. Health4Life app + Health Coach + Parent Resources + Text Messages 10. Health4Life app + Health Coach + Parent Resources 11. Health4Life app + Health Coach + Text Messages 12. Health4Life app + Health Coach 13. Health4Life app + Parent Resources + Text Messages 14. Health4Life app + Parent Resources 15. Health4Life app + Text Messages 16. Health4Life app Adolescent participants’ engagement with the Health4Life app and gamification adherence strategy will be assessed using app analytics data (e.g., app logins, clicks, logging information in the app). Participants’ engagement with the health coach adherence strategy will be assessed by the number of fortnightly health coach ‘check-ins’ each participant opts into. Adolescent participants’ perceptions of each of the adherence strategies they are allocated to will be assessed at the 3-month post-commencement of intervention follow-up assessment. Specifically, participants will be asked to report, on 5-point Likert scales, the degree to which each of the adherence strategies (gamification, health coach, parent resources, text messages) helped them to engage with the Health4Life app and improve their health behaviours. Participants will also be given the opportunity to provide open-ended feedback on what it was about each strategy that they found helpful or unhelpful, as well as suggestions for how each strategy might be improved. Parent/guardian engagement with the parent resources adherence strategy will be assessed using email marketing analytics data (e.g., email opens, link clicks, attachment downloads) and website analytics (e.g., clicks, document downloads). Parents/guardians allocated to the parent resources condition will also be asked during the 3-month post-commencement of intervention follow-up assessment to report how many parent resources they read during the study.