Health4Life Parents & Teens: Evaluation of a digital student-and-parent program to promote healthy lifestyles among secondary school students experiencing socioeconomic disadvantage

Participating secondary schools will be randomly allocated to one of two groups: i) an active control group (usual health education) or ii) an intervention group (the Health4Life Parents & Teens intervention). Health4Life Parents and Teens is a combined student and parent digital prevention program that aims to improve adolescent health and wellbeing and reduce the risk of chronic disease, by targeting six key health risk behaviours (“the Big 6”): physical inactivity, poor diet, recreational screen time, poor sleep, alcohol use, and smoking/vaping. The intervention consists of two parts – one for parents and one for students. 1. Parents of adolescents will receive the Health4Life Parents and Teens program. This comprises six online learning modules (~20 minutes each in total), one module per risk factor: screen time and social media, smoking/vaping, alcohol, sleep, food and nutrition, and physical activity. To support engagement, parents will receive brief weekly reminder emails over the 6–8week period, with each reminder prompting completion of the next module. The self-directed modules aim to empower parents to support their adolescent child to adopt healthy behaviours by enhancing parental self-efficacy and improving knowledge. Each module comprises a podcast-style video (~12 minutes long) delivered with a health professional, followed by an interactive summary of expert-recommended parenting strategies, and a brief goal setting activity. Parents will complete one 20-minute online module each week for approximately 6 weeks, at a time and place of their choice, via the study website (www.parentsandteens.org.au). To maximise parent engagement and minimise attrition, parents will receive access to the parent intervention immediately after providing informed consent (for themselves and their child) and completing their baseline survey. As parent consent may be obtained on a rolling basis, commencement of the parent intervention will vary and may occur up to eight weeks prior to the delivery of the school-based student intervention. Parents will also receive automated tailored feedback about their parenting practices in relation to the six health 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 the health habits sub-scale from the PRADAS questionnaire (Cardamone-Breen, 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. Consistent with the Multiphase Optimisation Strategy (MOST) framework (Collins, 2018), the final intervention is based on the results from the analyses of our earlier factorial trial, which determined which components to include (see Champion et al., 2025). Results of this trial revealed online modules and tailored feedback as the most effective combination of intervention components for increasing parental encouragement of adolescent health behaviours, while being least burdensome for parents. 2. Students will complete the Health4Life school-based program during Year 7 Personal Development, Health and Physical Education (PDHPE) classes at school. The program will be accessed by students by logging in to the study website (www.parentsandteens.org.au). This program consists of 6x 20-minute web-based cartoon modules, designed to be delivered once per week over six weeks. Based on social influence, social cognitive and self-determination theories, the cartoons aim to modify the 'Big 6’ health risk behaviours by increasing knowledge, drug resistance skills, and autonomous motivation (Champion et al., 2020). Teachers also have the choice of whether to deliver optional activities (e.g. online worksheets, discussion topics, role plays) to their class following the online lesson. These range from 5 to 20 minutes in duration, depending on which, and how many activities, the teacher selects. Teachers will be given implementation guides; however, no training is required. Researchers are available to meet with teachers to demonstrate how to navigate the study website and answer any questions from teachers. Health4Life was previously trialled in a cluster RCT in 71 schools (Champion et al., 2023). Since then, the program has been refined to better reflect the experiences of students experiencing socio-economic disadvantage. Intervention Implementation: After the final lesson of the Health4Life school-based program, students and teachers in the intervention group will be asked to complete an online questionnaire to evaluate the program in terms of satisfaction, relevance, appropriateness and usefulness. Teachers in the intervention group will also complete a logbook to assess delivery fidelity and implementation barriers and facilitators, and to provide information related to frequency, duration, and content of ‘health education as usual’ related to the Big 6 behaviours delivered across the school year, in addition to the Health4Life program. Parents in the intervention will respond to items about their satisfaction with the online program, via questions asked in the 3-month follow-up survey. Website analytics will provide objective data on the dose and timing of intervention delivery.