Health4Life Parents & Teens Optimisation Trial

Guided by the Multiphase Optimisation Strategy (MOST) framework, this study is an optimisation trial of the "Health4Life Parents & Teens" intervention. Delivered to parents, the intervention aims to support parents experiencing socio-economic disadvantage to improve modifiable lifestyle risk factors (e.g., physical inactivity, poor diet, smoking/vaping, alcohol use, screen time, and poor sleep) among their adolescent children. The intervention consists of five components delivered via a custom-built online platform (https//parentsandteens.org.au). Parents will be randomised to one of 16 conditions, receiving varying combinations of the following components: 1. ONLINE MODULES (Core component) All parents will receive access to six online modules available via the Health4Life Parents and Teens study website, one module per risk factor: screen time and social media, smoking and vaping, alcohol, sleep, food and nutrition, and physical activity. The modules are designed to empower parents to support their adolescent child to adopt healthy behaviours by enhancing parental self-efficacy and improving health literacy about lifestyle risk factors. Each module will comprise a 10-minute video podcast, an interactive summary of parenting strategies, and goal setting exercise. Content will focus on promoting role-modelling, rule-setting, parental monitoring, and high quality parent-child communication. The modules will take approximately 20 minutes to complete, and are designed to be completed once per week, over 6 weeks. 2) WEB-BASED TAILORED FEEDBACK Parents randomised to this component will receive tailored feedback about their parenting practices in relation to adolescent risk behaviours via the study website. Each week, parents will be prompted to answer one parenting-related question (aligning with the online module they are about to begin e.g. “screen time & social media”). The self-report questions were derived from our primary outcome measure (i.e. health habits sub-scale from the PRADAS questionnaire; Yap et al 2017). Responses are made on a four-point scale (never, rarely, sometimes, often). Based on their responses, parents will receive colour-coded, strengths-based feedback and motivational advice about their encouragement of their teen’s health habits. The feedback aims to help parents to identify behaviours to increase, decrease or maintain. Using this system, ‘green’ notifications will be provided to parents when they answer ‘often’ (‘Going Strong’), ‘orange’ notifications will be shown to parents when they respond ‘sometimes’ (‘Needs some work’) and ‘red’ notifications are shown when parents say they ‘never’ or ‘rarely’ do the parenting practice (‘Action encouraged’). Parents will then be prompted to complete the online module/podcast to learn more detailed parenting strategies. Parents will received feedback on one risk behaviour per week, over a total of 6 weeks. 3) STRESS MANAGEMENT TRAINING Parents randomised to this condition will have access to an additional online stress management module. Consistent with the core intervention, content will be delivered via a 10-minute video podcast, delivered via a registered psychologist. Parents will then complete brief interactive activities relating to parenting strategies to manage household stress and a goal setting activity. The key content will cover the physical, mental and social impacts of consistent stress, work-life balance planning, creating family routines, identifying and responding to stress triggers, managing financial stress, self-care strategies to reduce stress and skill building as a protective factor. The module will also contain links to resources to provide opportunities to practice stress alleviation and challenge negative beliefs. This component will take approximately 20-minutes to complete in total. It is designed as a one-off module, available to parents after the six "core" modules. 4) TEXT MESSAGES Text messages will be sent to parents to provide social support, supportive accountability and encourage intervention engagement. Based on our previous studies, a bank of text messages were developed in consultation with parents. Text messages will be semi-personalised (e.g. name) and delivered via our study website. Text messages will be triggered by interaction events with the website (e.g. starting a module, completing a module). Participants will receive 2-3 text messages per week, over the 6-week intervention period. 5) HEALTH COACHING Parents randomised to this component will receive weekly coaching calls with a trained health coach (minimum Bachelor degree in health promotion, psychology or related health field). Parents will choose to receive the coaching calls via phone or video call (e.g. Zoom) and will pick a suitable day and time for the calls to take place. The health coach will follow a semi-structured manual, with 10% of calls to be audio-taped to monitor fidelity. The manual will be guided by principles of supportive accountability from Mohr et al.’s (2011) Supportive Accountability Model, It will prompt the coach to check-in on participant progress with the intervention, troubleshoot any technical issues with the study website and/or barriers to intervention engagement, and check-in on progress against goals. The phone calls will take approximately 15-20 minutes each, and will be delivered once per week over the 6-week intervention period. Participants will be allocated to 1 of the following 16 experimental conditions: 1. Online Modules + Tailored Feedback + Stress Management + Text Messages + Health Coaching 2. Online Modules + Tailored Feedback + Stress Management + Text Messages 3. Online Modules + Tailored Feedback + Stress Management + Health Coaching 4. Online Modules + Tailored Feedback + Stress Management 5. Online Modules + Tailored Feedback + Text Messages + Health Coaching 6. Online Modules + Tailored Feedback + Text Messages 7. Online Modules + Tailored Feedback + Health Coaching 8. Online Modules + Tailored Feedback 9. Online Modules + Stress Management + Text Messages + Health Coaching 10. Online Modules + Stress Management + Text Messages 11. Online Modules + Stress Management + Health Coaching 12. Online Modules + Stress Management 13. Online Modules + Text Messages + Health Coaching 14. Online Modules + Text Messages 15. Online Modules + Health Coaching 16. Online Modules PROCESS OUTCOMES Following completion of each module, parents will be asked to provide a brief rating (out of 5 stars) via the study website. In addition, a brief self-report online questionnaire will be delivered to parents after the intervention period. To assess the acceptability of the intervention, parents will be asked to rate the acceptability of each component and the suitability of the length of each component. Parents will also be asked to report the effort it took to complete each component of the intervention that they were assigned to (ranging from ‘no effort at all’ to ‘huge effort’). This item was adapted from an existing Theoretical Framework of Acceptability questionnaire (Sekhon et al, 2022). Objective data will be collected via the study website to assess parent’s engagement with each intervention component, e.g. number of modules accessed, number completed, and the number of goals set. Health coaches will record the number of coaching sessions attended, the ode of communication (e.g., phone, Zoom) and duration of each contact.