The Triple E Project: Assessing Strategies for Enhancing Engagement with eHealth Approaches Targeting Lifestyle Behaviours in Adolescents

INTERVENTION: All participants will be provided with access to the Health4Life app for 3 months. The Health4Life app is a multiple health behaviour change, self‐monitoring mobile app for adolescents. See more information about the Health4Life app under the 'control treatment' section. Participants will also receive access to a combination of the following four adherence strategies over the same 3‐month period when they have access to the Health4Life app. Gamification in the Health4Life app: Gamification is the use of game design elements in non‐game contexts. In the Health4Life app, users assigned to the gamification intervention condition can view how many medals they have earnt for meeting health behaviour guidelines. Those randomised to receive the gamification component will receive additional access to a ‘Medal Tally Leader board’. On first use, users will be assigned to a team. The combined medal tallies of team members will be displayed in a leader board, similar to an Olympic medal tally, to be updated daily. Teammates will be able to communicate with other teammates by sending ‘high fives’ or ‘thumbs up’ messages of support. Access to a health coach: Participants in the health coach condition will be asked to attend an initial phone call with the health coach for approximately 15 minutes within one week following completion of the study baseline assessment (i.e., within one week into the 3‐month study period). On this initial call the health coach will explain how the health coach intervention works and answer any questions participants may have about the intervention or the research study. During this call the health coach will also conduct an initial brief assessment of the participants’ health behaviour goals and their engagement with the Hea CONDITION: Cardiovascular ‐ Coronary heart disease Poor diet;Low levels of physical activity;Poor sleep;Excessive recreational screen time;Alcohol use;Tobacco use; ; Poor diet ; Low levels of physical activity ; Poor sleep ; Excessive recreational screen time ; Alcohol use ; Tobacco use INCLUSION CRITERIA: (i) Adolescent aged 13‐17 years of age (inclusive) with a parent/guardian willing to be a part of the study (ii) Adolescent and parent/guardian reside in Australia (ii) Adolescent has access to a smartphone with Apple or Android operating systems that can receive text messages and phone calls (iii) Parent/guardian and adolescent have sufficient knowledge of English to read and interact with an app pitched at a reading level for 7th grade (iv) Parent/guardian and adolescent provide informed e‐consent PRIMARY OUTCOME: Engagement with the Health4Life app, as measured by an Engagement Index modelled on Taki et al.’s (2017; doi:10.2196/mhealth.7236) App engagement index. ; ; The Engagement Index will include 5 subindices. ; ; Sub index 1: click depth (number of pages of the app visited)[Data for this sub index will be collected continuously via the Health4Life app over the three month intervention period. ] Engagement with the Health4Life app, as measured by an Engagement Index modelled on Taki et al.’s (2017; doi:10.2196/mhealth.7236) App engagement index. ; ; The Engagement Index will include 5 subindices. ; ; Sub index 2: loyalty (how frequently a user accessed the app)[Data for this sub index will be collected continuously via the Health4Life app over the three month intervention period.; ] Engagement with the Health4Life app, as measured by an Engagement Index modelled on Taki et al.’s (2017; doi:10.2196/mhealth.7236) App engagement index. ; ; The Engagement Index will include 5 subindices. ; ; Sub index 3: volume of contributions (number of times users self‐report a health behaviour or set a goal within the app).[Data for this sub index will be collected continuously via the Health4Life app over the three month intervention period.] SECONDARY OUTCOME: Acceptability of the Health4Life app between experimental conditions, as measured by the Mobile App Rating Scale‐User Version (Stoyanov et al. 2016; doi:10.2196/mhealth.5849).[3‐month post‐commencement of intervention follow‐up assessment.] Alcohol consumption (Teesson et al. 2020, doi: 10.1136/bmjopen‐2019‐035662)[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Body height (in centimeters) measured with tape measure[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Body weight (in kilograms) measured with bathroom scales[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Intention to use the Health4Life app in the future, as assessed by an item adapted from Vankatesh et al. (2003; doi: 10.2307/30036540).[3‐month post‐commencement of intervention follow‐up assessment.] Level of recreational screen time assessed with questions from Prince et al. (2017, doi: 10.7717/peerj.4130)[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Level of recreational screen time assessed with questions from Teesson et al. (2020, doi: 10.1136/bmjopen‐2019‐035662)[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Levels of physical activity assessed with questions from The 2016 Active Healthy Kids Australia Report Card on Physical Activity for Children and Young People (Active Healthy Kids Australia 2016).[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Levels of physical activity assessed with questions from The Active Australia Survey (Australian Institute of Health and Welfare 2003). [Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Quality of diet (NSW Schools Physical Activity and Nutrition Survey [SPANS] 2015, Hardy et al. 2016)[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Quality of sleep assessed with questions from Drake et al. (2003, doi: 10.1093/sleep/26.4.455)[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Quality of sleep assessed with questions from Short et al. (2013, doi: 10.2147/NSS.S38369)[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] This is an additional primary outcome. ; ; Engagement with the Health4Life app, as measured by an Engagement Inde Xmodelled on Taki et al.’s (2017; doi:10.2196/mhealth.7236) App engagement index. ; ; The Engagement Inde Xwill include 5 subindices. ; ; Sub inde X4: recency (average time difference between each session a user accessed the app)[Data for this sub inde Xwill be collected continuously via the Health4Life app over the three month intervention period.] This is an additional primary outcome. ; ; Engagement with the Health4Life app, as measured by an Engagement Inde Xmodelled on Taki et al.’s (2017; doi:10.2196/mhealth.7236) App engagement index. ; ; The Engagement Inde Xwill include 5 subindices. ; ; Sub inde X5: subjective feedback on the app as assessed by the total score on the Mobile App Rating Scale – User Version (Stoyanov et al. 2016; doi:10.2196/mhealth.5849)[3‐month post‐commencement of intervention follow‐up assessment.] Tobacco consumption (Youth risk behavior survey, Centers for Disease Control and Prevention 2019). [Baseline and 3‐month post‐commencement of intervention follow‐up assessment.] Usability of the Health4Life app between experimental conditions, as measured by the System Usability Scale (SUS; Brooke 2013).[3‐month post‐commencement of intervention follow‐up assessment.] User‐rated quality of the Health4Life app between experimental conditions, as measured by the Mobile App Rating Scale‐User Version (Stoyanov et al. 2016; doi:10.2196/mhealth.5849).[3‐month post‐commencement of intervention follow‐up assessment.] Waist circumference (in centimeters) measured with tape measure[Baseline and 3‐month post‐commencement of intervention follow‐up assessment.]