Developing and Evaluating 'Zest for Life!': a New HENRY Behaviour Change Programme for Young People

Abstract

Physical activity (PA) and healthy eating (HE) behaviours during adolescence confer health benefits, yet many adolescents (hereafter referred to as young people) fail to meet national recommendations for both behaviours, justifying the need to intervene. Such interventions can come from third sector organisations such as HENRY who currently provide behaviour change programmes to parents of younger children. In seeking to develop an evidence-informed programme for young people themselves, HENRY partnered with the University of Hertfordshire which founded the brief for this research. The aims of this research were therefore to (1) review existing literature on PA and HE behaviour change interventions to identify promising behaviour change techniques, while simultaneously reviewing the literature on best practice in training deliverers of such interventions, (2) discern influences on young people’s PA and HE behaviours and identify recommended elements of a new behaviour change programme, and (3) develop and evaluate a new behaviour change programme to support young people’s PA and HE behaviours and wellbeing. The pragmatic approach adopted by this research started by reviewing potential intervention design and evaluation frameworks, selecting the Behaviour Change Wheel and APEASE criteria as the best method for developing and evaluating the new behaviour change programme. The systematic review then considered the effectiveness of PA and/or HE interventions at post-intervention and longer-term maintenance. From this, promise ratios identified promising behaviour change techniques associated with each behaviour, i.e., practical social support and information about health consequences for PA, and problem solving, action planning, self-monitoring of behaviour, unspecified social support, instruction on how to perform the behaviour, information about health consequences, and behavioural practice/rehearsal for HE. The review also aimed to consider best practice in training deliverers of behaviour change interventions though scant literature meant no conclusions could be drawn. A series of qualitative studies conducted with key participant groups discovered influences on young people’s PA and HE behaviours through reflexive thematic analysis. Results from young people (n = 23, mean age 14 years), practitioners (n = 10, mean age 30 years), and commissioners (n = 7, mean age 40 years) identified a range of influences encompassing personal e.g., knowledge, social e.g., role of parents and peers, and environmental e.g., availability, factors. Each study additionally identified elements of behaviour change programmes considered important and beneficial by participants such as the need for fun, practical, and interactive activities delivered from a solution-focused approach by skilled practitioners. Data from these studies were triangulated to form a behavioural diagnosis during programme development. This diagnosis revealed the necessity of including parents and being holistic in nature through inclusion of wellbeing topics, and thus the brief was amended to reflect these findings. The Behaviour Change Wheel was used to develop the new programme. All eight steps were followed which identified target behaviours for PA and HE, and ascertained determinants of behaviour to be targeted through a behavioural diagnosis using the COM-B model of behaviour and the Theoretical Domains Framework. Appropriate intervention types i.e., Education, Training, Enablement, Modelling, Environmental restructuring (for HE behaviour only), and Persuasion, were selected using APEASE criteria to determine appropriateness for the new programme. One policy option, Service provision, was selected using APEASE criteria. Possible behaviour change techniques, including those identified in the systematic review, were considered against APEASE resulting in the inclusion of 17 for PA and 23 for HE from the groups Goals and planning, Feedback and monitoring, Social support, Natural consequences, Comparison of behaviour, Repetition and substitution, Comparison of outcomes, Reward and threat, Regulation, Antecedents, and Covert learning. Following identification of components using the Behaviour Change Wheel, they were incorporated into the new programme guided by principles from the qualitative interviews and HENRY. Specifically, two versions of the programme were developed for different age groups, namely 11-13-year-olds and 14-16-year-olds, while parental sessions were created to be delivered in the evening. Sessions were designed to be interactive and practical to both impart knowledge and foster skill development. The HENRY approach e.g., use of inclusive language, was built into sessions as were other HENRY elements e.g., use of physical objects to divide young people into groups within sessions. Ultimately, Zest for Life! was created as an eight-session programme for both young people and parents. Sessions were 1.5 hours for all participants, delivered in person to young people and online to parents. The newly created Zest for Life! programme was delivered by HENRY and evaluated through the concluding part of this research. The pragmatic APEASE formative evaluation of 23 participants (18 young people, 5 parents) found the programme to be acceptable, practicable, and equitable to young people and their parents. Participants reported benefits of the programme on their PA and HE behaviours such as increased fruit and vegetable intake, food swaps, and increased PA, in addition to wellbeing such as improved sleep and a more positive mindset, while negative spill-over effects were minimal. The evaluation synthesised feedback which can be used to further enhance the programme for future participants. Additionally, recommendations for further evaluation were made, such as obtaining feedback from facilitators who deliver the programme, assessing fidelity, and use of alternative measures capable of capturing the range of behavioural changes made by participants. Overall, the evaluation has provided initial evidence for the feasibility of the Zest for Life! programme.