A cluster-randomised controlled trial of the LifeLab education intervention to improve health literacy in adolescents

Feasibility Testing of a Health Literacy Intervention With Adolescents and Young Adults in South Africa: The LifeLab Soweto Programme

INTRODUCTION

Low health literacy levels during adolescence and young adulthood (AYA) may impact acute healthcare access and longer-term health outcomes. Previous research in South African AYA suggests that health literacy levels are typically suboptimal but few interventions exist. This study aimed to test the acceptability and feasibility of a co-created, interactive health literacy intervention (LifeLab-Soweto) with AYA in Soweto, South Africa.

METHODS

Participants (18-24 years, n = 107) were recruited (September-October 2022) from a youth development centre database by telephone and through snowball sampling. AYA involved in the co-creation process were excluded. Pre-intervention data on participant age, gender identity and ability to correctly identify a normal blood pressure (BP) reading were captured via survey. Post-intervention, participants repeated the BP question and completed a satisfaction survey. Additionally, n = 31 AYA agreed to an in-depth interview about their LifeLab-Soweto experience. Interview transcripts were analysed using inductive thematic analysis.

RESULTS

Participants (mean age 21 ± 2.4 years; 59% female, 39% male, 2% nonbinary) generally viewed LifeLab-Soweto as well-designed, relevant, simple to follow, fun, useful, and interesting, with most reporting an increased understanding of health and that they would use this new knowledge. Comparing pre- and post-intervention BP question accuracy, males showed the greatest improvement in scores. Interviews showed that, while LifeLab-Soweto was not what AYA were expecting, gains in health knowledge led AYA to consider changes in health behaviours including accessing health services.

CONCLUSION

Life-Soweto presents an acceptable, feasible and relevant health literacy intervention for South African youth with potential to improve health literacy and health behaviours.

PATIENT AND PUBLIC INVOLVEMENT

To ensure the health literacy intervention was contextually relevant, age appropriate, and gender inclusive, a group of 40 adolescents (aged 18-24 years, male, female and non-binary) were recruited from Soweto to firstly identify the health topics that were most pressing in their daily lives. This youth advisory group identified stress as a major challenge impacting physical and mental health, health behaviour and daily functioning. Together with the youth group, researchers from South Africa and the UK worked to co-develop the health literacy intervention that delivers self-directed exploration and learning of how stress impacts health, behaviour and well-being. This manuscript describes how this cocreated intervention was received by a broader range of South African youth who were not involved in the cocreation process.

Understanding DOHaD Concepts Among New Zealand Adolescents: A Qualitative Exploration of Knowledge, Intervention Windows, and Information Accessibility

The Developmental Origins of Health and Disease (DOHaD) framework has highlighted the role of maternal and paternal health on disease risk in offspring and across generations. Although adolescence is increasingly recognised as a key DOHaD window where interventions may have the greatest impact in breaking the cycle of non-communicable diseases, data around the recognition of this concept in adolescents remain limited. Previous work by our group found that the understanding of DOHaD-related concepts among adolescents in New Zealand was low, including some adolescents showing disagreement with key DOHaD concepts. This qualitative study aimed to explore DOHaD perspectives and understandings among a group of adolescents who responded to the survey using semi-structured focus groups and interviews (n = 12). Four core themes were identified: 1. knowledge of DOHaD and DOHaD-related terminology; 2. understanding different life course windows for DOHaD interventions; 3. recognising that DOHaD-related information needs to be accessible for adolescents; and 4. the importance of developing context-specific resources for adolescents. Adolescents in this study indicated that they had not heard of DOHaD or related terminology. Although the majority recognised that there were many important life stages for potential interventions, there was a strong emphasis on adolescence as a key window of opportunity. Adolescents suggested that more could be done in schools to help promote awareness and understanding of DOHaD-related concepts during the later years of schooling. The development of future resources needs to be contextually specific for adolescents to ensure increased uptake of information during this important developmental window.

Enhancing nutritional knowledge and self-regulation among adolescents: efficacy of a multifaceted food literacy intervention

This health literacy intervention study, conducted on adolescent students, aimed to evaluate the impact of a comprehensive educational program on promoting healthy eating habits. The intervention sought to enhance adolescents' knowledge about nutrition, foster self-regulation skills, and ultimately improve their overall health, including their body mass index (BMI). Through a multi-component approach that combined theoretical learning with practical activities and the integration of digital tools such as the MyFitnessPal app, the study targeted improvements in food literacy, which encompasses nutrition knowledge, food label interpretation skills, and cooking abilities. These elements are critical in influencing adolescents' food choices and eating behaviors, with a focus on increasing the consumption of fruits and vegetables while reducing the intake of fast food and processed snacks. The intervention was structured around a series of educational workshops and interactive sessions, facilitated by professionals experienced in nutrition. These sessions covered topics such as food composition, the importance of a balanced diet, and strategies for avoiding excessive consumption of processed and high-energy-density foods. A distinctive feature of the program was its use of digital tools to enhance engagement and allow for the practical application of learned concepts through food tracking and activity monitoring. Preliminary results indicate positive outcomes in terms of increased food knowledge and improved dietary habits among participants. Notably, there was a significant improvement in adolescents' BMI, highlighting the potential of food literacy interventions to contribute to better physical health outcomes. The study underscores the importance of adopting multidisciplinary and technology-enhanced approaches in educational programs aimed at promoting healthy eating among adolescents. The study's findings suggest that well-structured food education programs, tailored to address the specific needs of adolescents, can facilitate positive changes in eating behavior. This highlights the critical role of food literacy in adolescents' health and wellbeing and points to the need for continued investment in research and development to optimize intervention strategies. The integration of digital technologies and a focus on self-regulation strategies are identified as promising avenues for future research and educational practice, reinforcing the call for innovative investments in food education and health promotion among the youth.

Effect of a context-specific health education intervention on knowledge of health risk behaviors among adolescents in Nigerian public and private secondary schools: a comparative study

OBJECTIVES

Health education programmes that utilizes multicomponent classroom teaching strategies have the potential to enhance knowledge, attitudes, and actions of adolescents concerning health risk behaviors (HRBs). This study assessed the effect of a school-based context-specific health education intervention (CsHEI) on knowledge of HRBs among in-school adolescents in public- and private-owned secondary schools in Nigeria.

METHODS

In-school adolescents were recruited into this quasi-experimental study using stratified random sampling from secondary schools in Ile-Ife, Osun-State, Nigeria. Knowledge of HRBs was assessed pre- and post-implementation of a CsHEI. The intervention was a four-week instructor-led health education class on HRBs, delivered over a 2-h class activity per week. Data was summarized using descriptive statistics as well as Inferential statistics.

RESULTS

With a mean age of 14.9 ± 1.56 years, a total of 145 females (54.3 %) and 122 males (45.7 %) participated in this study. Over 70 % of the participants had good knowledge of HRBs prior to the intervention with the pre-test mean general knowledge of HRB (t=-3.13, p=0.002) and knowledge of personal safety (t=-2.99, p=0.003) being significantly lower between students in public-schools compared to their private-school counterparts. Post-intervention, a significant improvement in participants' knowledge was observed in all HRB domains with over 90 % of participants having a good knowledge of HRBs.

CONCLUSIONS

The CsHEI improved knowledge of in-school adolescents in public- and private-owned secondary schools in Osun state, Nigeria in all domains of HRBs. Integrating the CsHEI with other health behavioral change strategies can mitigate prevalence of HRBs among adolescents, thereby improving health-outcomes and well-being of adolescents.

What Does 'Preconception Health' Mean to People? A Public Consultation on Awareness and Use of Language

INTRODUCTION

There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health.

METHODS

A public consultation was undertaken with people of any gender aged 18-50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers.

RESULTS

Fifty-four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18-30 years, 30% 31-40 years, 15% 41-50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender-sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well-being during the childbearing years', 'health and well-being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School-based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness.

CONCLUSION

This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co-development of public awareness campaigns and guidance for healthcare professionals.

PATIENT OR PUBLIC CONTRIBUTION

This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co-authors of the paper.

Projected health and economic effects of the increase in childhood obesity during the COVID-19 pandemic in England: The potential cost of inaction

BACKGROUND

The prevalence of overweight and obesity in young children rose sharply during the COVID-19 pandemic. Here we estimate the potential future health and economic effects of these trends in England.

METHODS

Using publicly available annual Body Mass Index (BMI) data from 2006-2022, we calculated the increase in overweight/obesity prevalence (BMI ≥85th reference percentile) during the COVID-19 pandemic among children aged 4-5 and 10-11, and variation by deprivation and ethnicity. We projected the impact of child BMI trends on adult health measures to estimate added lifelong medical and social costs.

RESULTS

During 2020-2021 there were steep increases in overweight and obesity prevalence in children. By 2022, overweight and obesity prevalence in children aged 4-5 returned to expected levels based on pre-pandemic trends. However, overweight and obesity prevalence in children aged 10-11 persisted and was 4 percentage points (p<0.001) higher than expected, representing almost 56,000 additional children. The increase was twice as high in the most compared with the least deprived areas. The additional lifelong healthcare cost in this cohort will amount to £800 million with a cost to society of £8.7 billion. We did not find an increase in maternal obesity associated with the COVID-19 pandemic, however, prevalence grew faster in the post pandemic period.

DISCUSSION

The return of overweight and obesity prevalence to pre-pandemic trends in children aged 4-5 provides a clear policy target for effective intervention to tackle this growing and serious population health concern.

A systematic review exploring evidence for adolescent understanding of concepts related to the developmental origins of health and disease

The developmental origins of health and disease (DOHaD) framework has highlighted the importance of the early life period on disease risk in later life with impacts that can span generations. A primary focus to date has been around maternal health and the 'First Thousand Days' as a key developmental window whereby an adverse environment can have lasting impacts on both mother and offspring. More recently, the impact of paternal health has gathered increasing traction as a key window for early life developmental programming. However, to date, adolescents, the next generation of parents, have attracted less attention as a key DOHaD window although many behavioural traits become entrained during adolescence and track into adulthood. This systematic review examined literature focused on identifying adolescent understanding of DOHaD concepts. Consistent across the eligible articles was that overall understanding of DOHaD-related concepts in adolescents was low. Three key themes emerged: 1. Individual-level awareness of DOHaD concepts (cognitive engagement and action of the adolescents themselves); 2. Interpersonal communication and social awareness of DOHaD concepts (cognitive engagement and communication of the DOHaD concepts to family and wider community); and 3. Health literacy and the promotion of adolescence as a key DOHaD life stage. These findings highlight the need to develop strategic approaches to increase DOHaD awareness that are not only appealing to adolescents but can also support sustained changes in health behaviour. Investment in today's adolescents has the potential to act as a NCD 'circuit breaker' and thus will yield significant dividends for future generations.

Teaching Australian high school students to think critically about health claims: a cluster randomized trial

Making informed health decisions requires knowledge and skills in appraising health claims, and teaching adolescents these skills may prepare them for future decision-making. This cluster randomized trial evaluated the effectiveness of an educational intervention on students' ability to identify and appraise health claims. Nine Australian high schools (4 control and 5 intervention) were recruited, comprising 974 students (382 control and 592 intervention) in Grades 7-10. Intervention impact was evaluated through baseline and follow-up evaluation. Follow-up mean scores on questions (maximum score of 25) from the Claim Evaluation Tools database (primary outcome) showed minimal between-group difference (intervention versus control: 14.4 versus 13.6; difference 0.8, 95% confidence interval [CI] -1.6 to 3.1; P = 0.52). Change scores were only slightly higher in the intervention group (difference 1.2 [95% CI -0.7 to 3.1; P = 0.21]). Between-group differences for secondary outcomes were also minimal. Most intervention group students 'trusted' and 'liked' the programme and found the content 'easy' and 'helpful'. Most teacher feedback was positive, some noting challenges of covering content in allocated time and maintaining student engagement. It is unlikely that the assessed educational intervention had a large effect. Future research priorities are suggested.

Obesity, Pregnancy and the Social Contract with Today's Adolescents

Adolescent health and well-being are of great concern worldwide, and adolescents encounter particular challenges, vulnerabilities and constraints. The dual challenges of adolescent parenthood and obesity are of public health relevance because of the life-altering health and socioeconomic effects on both the parents and the offspring. Prevention and treatment strategies at the individual and population levels have not been successful in the long term, suggesting that adolescent pregnancy and obesity cannot be managed by more of the same. Here, we view adolescent obese pregnancy through the lens of the social contract with youth. The disruption of this contract is faced by today's adolescents, with work, social and economic dilemmas which perpetuate socioeconomic and health inequities across generations. The lack of employment, education and social opportunities, together with obesogenic settings, increase vulnerability and exposure to lifelong health risks, affecting their offspring's life chances too. To break such vicious circles of disadvantage and achieve sustainable solutions in real-world settings, strong efforts on the part of policymakers, healthcare providers and the community must be oriented towards guaranteeing equity and healthy nutrition and environments for today's adolescents. The involvement of adolescents themselves in developing such programs is paramount, not only so that they feel a sense of agency but also to better meet their real life needs.

Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme

Objective

To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents.

Design

A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted.

Participants

A hypothetical cohort of 100 adolescents with a mean age of 13 years.

Interventions

An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling.

Outcome measure

Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained.

Results

The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane.

Conclusions

The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting.

Trail registration number

ISRCTN74109264.

What Is the Impact of Nutrition Literacy Interventions on Children's Food Habits and Nutrition Security? A Scoping Review of the Literature

INTRODUCTION

Nutrition literacy is a relatively new concept that seems to have a relevant role on the quality of people's diets; however, we do not know the role of nutrition literacy interventions on children's food habits and nutrition security.

METHODS

We conducted a literature review on four databases (PubMed, Embase, Web of Science, and Cochrane) and we considered studies describing the impact of interventions aimed at improving the quality of children's diet.

RESULTS

A total of six articles were finally included. The total number of participants included in the studies was 4016, and the median study size was equal to 224 participants. Studies included in the review reflected a broad heterogeneity of interventions.

CONCLUSIONS

The results were contrasting and revealed that the most effective type of nutrition literacy interventions included the following characteristics: technological components, involvement with multiple modalities, duration of more than 4 weeks, and face to face sessions.

Evaluating and Engaging: Using Participatory Video With Kenyan Secondary School Students to Explore Engagement With Health Research

Background

The growing ethical requirement to engage communities with health research has yielded diversification in approaches and targeted audiences. Conventional approaches like community “town-hall meetings,” laboratory open-days and focus group discussions, have evolved into new methods and audiences such as community drama and school engagement with health research (SEHR) involving learning interactions between researchers and school students. While engagement practices are diversifying, evaluations of these initiatives are rare in Low- and Middle-Income Countries (LMIC). This article focuses on the use of Participatory Video (PV) to explore the influence of the KEMRI-Wellcome Trust Research Programme's (KWTRP) School Engagement Programme (SEP) on the views and understandings of science and research among Kenyan state secondary school students.

Methods

Twelve male and twelve female students from four coeducational schools were provided with film-making kits (1 per school), and a one-day PV training workshop. They prepared 22 short films over 8 weeks depicting their experiences and views of research and engagement and conveying their career aspirations. Schools were selected based on prior SEP participation; two schools having experienced different engagement approaches, and the others with no prior school engagement. Study data comprised footage and participant observation notes.

Results

PV provided an opportunity to simultaneously engage and evaluate to inform practice. Through student-led filmmaking, PV stimulated conversations with students about research and engagement, enabling them to share their views in a way they felt was appropriate. These interactions offered an understanding of student gains from engagement, the depth of interaction required to address perceptions held about research and the potential unintended consequences of engagement. PV also provided insights into the context and complexity of life in which engagement is situated. Understanding this context is important because of its potential influence on participation in engagement activities. We draw on these insights to make two recommendations for school engagement practice. First is that PV can provide an enjoyable and insightful means of combining engagement with evaluation. Second, given that time for SEHR is competed for against other important curricular and extracurricular activities, SEHR practitioners must ensure that activities are as beneficial and enjoyable as possible to students.

Nutrition Literacy Tailored Interventions May Improve Diet Behaviors in Outpatient Nutrition Clinics

OBJECTIVES

Nutrition literacy examines the intersection of nutrition knowledge and skills; however, no evidence shows interventions tailored to nutrition literacy deficits affect diet behaviors. This study examined the effects of nutrition interventions tailored to individual nutrition literacy deficits on improving diet-related behaviors.

METHODS

Five outpatient clinics were randomized to 2 arms. The nutrition literacy and diet behaviors of patients were assessed before intervention with a dietitian and again 1 month later. Intervention-arm dietitians received patient nutrition literacy levels and tailored interventions toward nutrition literacy weaknesses. Differences in diet behaviors between arms were analyzed using Mann-Whitney U-tests and within-arms using Wilcoxon signed-rank tests.

RESULTS

Intervention-arm patients improved 10 of 25 measured diet behaviors; control-arm patients improved 6 behaviors. Similarly, intervention-arm patients reported increased green vegetable consumption from baseline to follow-up (z = 2.00; P = 0.04).

CONCLUSIONS AND IMPLICATIONS

Nutrition interventions tailored toward nutrition literacy deficits may play an important role in improving patient diet behaviors.