A mobile healthy lifestyle intervention to promote mental health in adolescence: a mixed-methods evaluation

BACKGROUND

A healthy lifestyle may improve mental health. It is yet not known whether and how a mobile intervention can be of help in achieving this in adolescents. This study investigated the effectiveness and perceived underlying mechanisms of the mobile health (mHealth) intervention #LIFEGOALS to promote healthy lifestyles and mental health. #LIFEGOALS is an evidence-based app with activity tracker, including self-regulation techniques, gamification elements, a support chatbot, and health narrative videos.

METHODS

A quasi-randomized controlled trial (N = 279) with 12-week intervention period and process evaluation interviews (n = 13) took place during the COVID-19 pandemic. Adolescents (12-15y) from the general population were allocated at school-level to the intervention (n = 184) or to a no-intervention group (n = 95). Health-related quality of life (HRQoL), psychological well-being, mood, self-perception, peer support, resilience, depressed feelings, sleep quality and breakfast frequency were assessed via a web-based survey; physical activity, sedentary time, and sleep routine via Axivity accelerometers. Multilevel generalized linear models were fitted to investigate intervention effects and moderation by pandemic-related measures. Interviews were coded using thematic analysis.

RESULTS

Non-usage attrition was high: 18% of the participants in the intervention group never used the app. An additional 30% stopped usage by the second week. Beneficial intervention effects were found for physical activity (χ21 = 4.36, P = .04), sedentary behavior (χ21 = 6.44, P = .01), sleep quality (χ21 = 6.11, P = .01), and mood (χ21 = 2.30, P = .02). However, effects on activity-related behavior were only present for adolescents having normal sports access, and effects on mood only for adolescents with full in-school education. HRQoL (χ22 = 14.72, P < .001), mood (χ21 = 6.03, P = .01), and peer support (χ21 = 13.69, P < .001) worsened in adolescents with pandemic-induced remote-education. Interviewees reported that the reward system, self-regulation guidance, and increased health awareness had contributed to their behavior change. They also pointed to the importance of social factors, quality of technology and autonomy for mHealth effectiveness.

CONCLUSIONS

#LIFEGOALS showed mixed results on health behaviors and mental health. The findings highlight the role of contextual factors for mHealth promotion in adolescence, and provide suggestions to optimize support by a chatbot and narrative episodes.

TRIAL REGISTRATION

ClinicalTrials.gov [NCT04719858], registered on 22/01/2021.

Do Storytelling and Processing Motivation Matter? Comparing Narratives and Exemplars in Promoting Hepatitis C Screening among College Students

Encouraging hepatitis C screening, particularly among young adults who are at increased risk of infection, is essential for eliminating viral hepatitis. A 3 (narrative vs. exemplar vs. informational message) × 2 (processing motivation: low vs. high) between-subjects experiment was conducted among college students to compare the effectiveness of different message strategies and examine the moderating role of processing motivation. Findings revealed that the narrative was perceived more favorably than the exemplar message, and both messages led to a greater screen intention than the informational message. The narrative persuaded by increasing transportation and identification and, then, enhancing message perceptions. However, these mediation paths did not explain the effects of the simple exemplar. Moreover, the effects of the narrative and the exemplar did not differ significantly depending on levels of processing motivation. The study advances a theoretical understanding of the differences between narratives and exemplars. It also offers practical suggestions for campaign message design.

Reducing COVID-19 vaccine hesitancy among African Americans: the effects of narratives, character's self-persuasion, and trust in science

This research examines the efficacy of self-persuasion narratives (i.e., narratives that describe how a character has changed their mind about the COVID-19 vaccines) in encouraging vaccine uptake among unvaccinated African Americans. A five-condition experiment (N = 394) was conducted in June 2021. Participants viewed one of the three pro-vaccine messages (a self-persuasion narrative, a narrative without self-persuasion, or a non-narrative message) or an irrelevant message or completed a self-persuasion task. Findings supported the persuasive benefits of the self-persuasion narrative compared to the narrative without self-persuasion, actual self-persuasion, and the irrelevant message. Its advantage over the narrative without self-persuasion was mediated by increased self-referencing, affective empathy, and perceived similarity with the character. Moreover, its psychological effects were moderated by participants’ trust in science. Unexpectedly, the non-narrative showed persuasive benefits compared to other intervention strategies. The theoretical implications for narrative persuasion and practical implications for vaccine promotion were discussed.

Effects of narrative persuasion in promoting influenza vaccination in Hong Kong: A randomized controlled trial

OBJECTIVES

The study examined the effectiveness of narrative persuasion in promoting influenza vaccination in Hong Kong.

METHODS

The study conducted a randomized controlled trial with a sample of 440 Hong Kong adults who were either at high risk or had a high-risk family member. The participants were randomly assigned to watch a narrative video, an informational video, or no message, and were assessed for perceived threats, perceived efficacy, and vaccination intent, and were followed up three months later for actual vaccination.

RESULTS

Experimental conditions produced significant differences on perceived threats of influenza but not on perceived efficacy, vaccination intent, and actual vaccination. When compared to informational messages delivered containing equivalent amount of information, narrative messages were more persuasive in promoting perceptions about influenza, equally effective in enhancing vaccination intention and actual behaviors, and equally ineffective in changing efficacy beliefs. The persuasiveness of narratives in promoting threat perceptions was found to work better for individuals with lower literacy levels.

CONCLUSIONS

Incorporating authentic sociocultural beliefs and experiences in message design can effectively enhance threats perceptions related to influenza.

PRACTICE IMPLICATIONS

Narratives presented in short-video stories could be an effective tool for promoting health threats especially among high-risk individuals with limited health literacy.

A meta-analysis of the impact of point of view on narrative processing and persuasion in health messaging

OBJECTIVE

To synthesize experimental research on the impact of narrative point of view (POV) on message processing and persuasion outcomes in health promotion. Moderators examined included characteristics of study design, participants, and experimental stimuli.

DESIGN AND MAIN OUTCOME MEASURES

Random effects model meta-analysis of 16 health promotion experiments, using the metafor package in R. Studies included compared the effects of first- and third-person POV on risk perceptions, attitudes, behavioral intention, identification and transportation.

RESULTS

There was no evidence of publication bias. Narratives told in the first-person POV led to higher levels of perceived susceptibility (d = 0.10, 95% CI [0.01, 0.20]) and identification feelings (d = 0.10, 95% CI [0.10, 0.21]) than third-person narratives. The effects of first-person POV narratives were significantly stronger for stories that were written in the past-tense and that depicted the protagonist as being similar to message recipients.

CONCLUSION

Findings support a theoretical model of POV impact in which a first-person perspective increases identification with the character, thereby leading to higher levels of perceived susceptibility to the health threat. The practical implication is that the effectiveness of narrative persuasion is enhanced by using the first-person point of view, emphasizing target audience-protagonist similarities, and telling stories in the past tense.

Narrative persuasion and stigma: Using news accounts to denormalize texting while driving

Despite nearly universal texting while driving bans in U.S. states, distracted driving still poses a major risk for American motorists and pedestrians on a daily basis. We argue texting while driving behavior, due to its cultural, social, and psychological motivations, may be addressed by cultivating a stigma to denormalize TWD much in the same way public health campaigns and bans did with tobacco use. While extant strategies may similarly stigmatize this risky behavior, we contend the stigmatizing effect of news narratives offers an untapped and unexamined resource. In this paper we draw on emergent findings in narrative persuasion work to present an exploratory analysis and evidence indicates news narratives, through narrative engagement, can both stigmatize TWD behavior and diminish attitudes toward distracted driving. These initial findings are then validated against an independent sample. If applied widely, this method may be applied to increase social pressure against distracted driving, leading to fewer people engaging in TWD behavior, and making roads safer.

When the physical coldness in the viewer's environment leads to identification with a suffering protagonist

Based on theories of narrative engagement and embodied cognition, we hypothesised that a fit between the psychological state of a protagonist and the physical sensation of the viewer would enhance the subsequent identification with the protagonist, but not para-social relationship with him (seeing the protagonist as a friend). We also hypothesised that identification and a para-social relationship would lead to distinct effects on attitudes related to the narrative. Participants (N = 60) were randomly assigned to either a warmed or cooled room where they watched a movie clip alone in which a suffering protagonist wanted to undergo euthanasia while his close others wanted him to stay alive. Then, the participants answered a questionnaire measuring their identification and para-social relationship with the protagonist and their attitudes toward euthanasia. In accordance with the hypotheses, the results demonstrated that feeling cold enhanced identification with the suffering protagonist. However, the environmental temperature did not affect the development of para-social relationships. Moreover, identification with the suffering protagonist contributed to acceptance of his attitudes, reflected in more positive views of euthanasia. In contrast, having a para-social relationship with the protagonist resulted in negative attitudes toward euthanasia.