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Schools are ideal settings to promote adolescent physical activity (PA), yet school-based interventions have shown limited long-term impact. This position paper presents key issues surrounding school-based PA interventions. Collaborative conceptual thinking drawing on multi-author expertise and available evidence advanced our understanding and opinion. Key arguments: 1) the adoption of a systems approach, which maximizes partnership action and leverages policy, is crucial for understanding the complexities of implementing whole-school programs; 2) a reorientation to an assets perspective optimizes existing strengths and resources allowing greater emphasis on the full range of physical, cognitive, emotional and social benefits that PA provides, and 3) a move beyond traditional positivist research designs to advance our knowledge of what works better, for whom and in what context is needed for greater progress We provide suggestions, specifically advocating for systems approaches, as a realistic way to improve how we support PA in schools in the future. [ABSTRACT FROM AUTHOR]

Background: Adapting co-creation research processes and/or public health interventions improves the fit between the intervention and population of interest, potentially resulting in more relevant and effective interventions. Mode 2 research approaches (e.g., co-creation, co-production, co-design, community-based participatory research, and participatory action research) can ensure that adaptations fit the socio-cultural and economic contexts. However, an overview of existing practices and how to co-adapt is lacking. This study aimed to provide an overview of the use of co-adaptation in co-creation processes and/or public health interventions., Methods: We conducted a rapid review search on the Health CASCADE co-creation database. Relevant peer-reviewed studies reporting on co-adaptation of public health interventions were identified. A call for case studies via social media and co-authors' snowballing was issued to perform interviews with co-creation researchers gaining insights into how co-adaptation was applied from unpublished studies and practice. Interviews were analysed using template analysis., Results: Fourteen studies addressed various public health issues by co-adapting co-creation processes, intervention activities, communication platforms, monitoring strategies, training components, and materials' language and tone. Most studies lacked detailed reporting on the co-adaptation process, though some provided information on group composition and number, duration, and methods applied. Two out of 14 studies used a framework (i.e., Intervention Mapping Adapt), seven described their adaptation procedure without naming a specific framework, and five did not report any procedures or frameworks. Five of seven case studies used adaptation frameworks (e.g., ADAPT guidance). Interviews provided insights into the co-adaptation process emphasising the importance of contextual fit, integrating prior knowledge, and logging adaptations., Conclusions: This study is the first introducing the concept of and exploring co-adaptation of co-creation processes and/or public health interventions. It provides details regarding adaptations made, whether and which frameworks were used, and procedures applied to adapt. The findings highlight the need for tailored frameworks for co-adaptation and better reporting of co-adaptation processes., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was granted with code 2122003 by the Ethics Committee of the faculty of Psychology, Education and Sport Sciences at Blanquerna – Ramon Llull University. Written informed consent was obtained from all interview participants who were not co-authors. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: Co-adaptation is a collaborative process to adapt existing interventions to new contexts and offers a promising way to scale (co-created) public health interventions. However, there is limited understanding of how co-adaptation processes are experienced. This study examined whether a robust co-creation process can be maintained when adapting a previously co-created intervention to promote adolescents' healthy sleep. Adolescents' experiences during this co-adaptation process were explored, using five key dimensions of co-creation (1) multistakeholder collaborative action, 2) co-learning towards innovation, 3) contextual knowledge production, 4) generating meaning, 5) open, trustful, and inclusive dialogue) as the guiding framework., Study Design: Qualitative observational study., Methods: Qualitative data were collected from a co-adaptation process with an action group of adolescents (n = 8) and researchers (n = 2). Over eleven sessions (50 min) following Intervention Mapping, a needs assessment was conducted, and the original intervention's goals and materials were adapted. Data sources included session transcripts, facilitator reflections, adolescent evaluations (n = 5), and focus group transcripts (n = 3), elaborating on adolescents' experiences during sessions, and were analysed using Qualitative Content Analysis (QCA)., Results: All five dimensions of co-creation were reflected in adolescents' experiences of co-adapting the healthy sleep intervention. They enjoyed collaborating, committed to the project, reported ongoing possibilities for learning, and produced contextual knowledge from their lived experiences. The process felt meaningful, with a respectful atmosphere. However, challenges like the exclusion of students outside the group and time constraints were also encountered., Conclusions: The presence of the five dimensions of co-creation in this study demonstrates that robust co-creation research can be maintained also when co-adapting a previously co-created intervention to a new context with a new group of stakeholders., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Sleep deprivation and reduced sleep quality are common in adolescents and negatively impact their physical and mental wellbeing. This study evaluates the effect of a participatory-developed school-based healthy sleep intervention for adolescents., Method: A 16-week long intervention, cocreated with adolescents, was conducted with two schools with four schools serving as measurement-only controls. Intervention elements included a kickoff event, posters, Instagram posts, an application, and class activities. Data on sleep parameters, sleep hygiene, and psychosocial factors were collected before, immediately after, and 6 months after implementation ( N = 1,176; 15.2 ± 0.7 years; 37.9% girls). Sleep duration was objectively measured with activity trackers in a subsample ( n = 133). Generalized linear mixed models were applied to analyze the intervention effect in RStudio., Results: Participants in the intervention group demonstrated significant increases in sleep knowledge and larger decreases in supportive peer and parental factors compared to the control group. At 6 months, the intervention group displayed increased self-reported weekend sleep duration and objectively measured week sleep duration. There was a significantly smaller increase in the use of screens in bed and barriers toward screen use in bed in the intervention group compared to the control group. Finally, a significant decrease in peer modeling and mental support of parents was observed in the intervention group (versus significant increase and no significant change in the control group, respectively)., Conclusion: Researchers developing healthy sleep interventions should consider combining a participatory approach with a theory-based protocol including the use of active parental components. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The transition from secondary school to college or university is a well-known and well-studied risk period for weight and/or fat gain and not meeting the dietary recommendations. Higher education acts as a promising setting to implement nutrition interventions. An important condition for intervention success is that interventions are implemented as intended by the protocol and integrated in the institutional policy. Unfortunately, to date, there is only little understanding of the factors influencing adoption and implementation of nutrition interventions in higher education settings. This study aimed to provide insight into stakeholders' perspectives on facilitators and barriers to adoption and implementation of nutrition interventions promoting healthy and sustainable diets among higher education students in Flanders. Eight online group interviews and three online individual interviews were conducted involving a total of 37 stakeholders (e.g., staff of student services and student restaurants) from ten Flemish higher education institutions with varying food policy quality scores, and one external catering company which provides catering in higher education institutions. A semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR-framework) was used to facilitate the interviews. Afterwards, the data were analyzed using a combined inductive and deductive thematic approach led by the CFIR-framework. Most of the institutions' food policies focused on the provision and promotion of healthy and sustainable nutrition. Therefore, the reported factors in the present study consequently relate primarily to these two strategies. Stakeholders preferred to adopt low cost and institution-tailored interventions supported by experts and evidence, considering them easier and less resourceful to implement in the specific context of the institution. They stressed the importance of considering both students' and institution stakeholders' needs and perspectives in the development of nutrition interventions and implementation plans. Furthermore, interventions should be focused on a combination of different ecological levels and various strategies. Future interventions should be developed participatively and should be focused on a combination of both individual and environmental levels. Higher education institutions are encouraged to use opportunities such as creating win-win situations within the institution, working together with research groups and engaging students through student associations. The findings of this research add to the literature on implementation science and inform future development and implementation of nutrition interventions in higher education settings., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval: The present study was approved by the Ethics Committee of Ghent University Hospital, Gent, Belgium (Ref. nr. ONZ-2023-0077). Consent to participate: All participants signed an informed consent prior to participation. Consent for publication: All participants signed an informed consent prior to participation. The manuscript does not contain any individual person’s data in any form (including any individual details, images or videos)., (© 2024. The Author(s).)

Aims: A significant number of children and adolescents are insufficiently physically active and have a sedentary lifestyle, which is associated with adverse health outcomes, necessitating effective interventions. Using a participatory approach, which engages youth in intervention development, may enhance intervention effectiveness, as such interventions are believed to be more tailored to the needs of the target group. This scoping review aimed to provide an overview of the results of process and effect evaluations of studies that developed school-based physical activity and/or sedentary behaviour interventions using a participatory approach among children and adolescents., Methods: Six databases (MEDLINE, Embase, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus and SPORTDiscus) were searched. Studies were included when they evaluated the participatory process, intervention implementation or health-related intervention effects. A quality assessment was completed using two QualSyst checklists. Extracted data included characteristics of studies, interventions, and participatory processes; characteristics of participants from whom data were collected; outcomes measured and measurement methods used; and key findings., Results: Twenty-five papers, covering 18 original studies, were included. Studies suggested that participatory processes were generally perceived positively, resulting in pupils feeling empowered, experiencing ownership and gaining certain skills. Participatory developed interventions also seemed to be generally well received, although the intervention dose delivered and intervention reach seemed to vary between studies. Finally, studies generally tended to report no effects on health., Conclusions: Although a participatory approach could be promising in empowering pupils and promoting intervention acceptance, apparent differences in intervention implementation and limited effectiveness highlight the need to enhance participatory processes and intervention effectiveness., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Mutual learning and shared decision-making are key elements of Participatory Action Research (PAR), highlighting the important role of the facilitator to support this. This study aims to illustrate how a facilitator can contribute to successful PAR sessions based on the reflection of three PAR projects., Methods: Participatory sessions took place with adolescents for 3-4 school years. After each session (n = 252 sessions across three projects), facilitators filled in a reflection form that assessed the group process and their facilitating role. Facilitators independently coded a selection of 135 reflection forms partly deductive and partly inductive based on core PAR principles derived from a pragmatic literature search., Results: A well-prepared session - for example, including active and creative participatory methods and a clearly stated goal - contributed to efficiency and the necessary flexibility. Making agreements, making sure everyone is heard and taking 'fun-time' appeared important for creating and maintaining a safe, functional and positive atmosphere. Finally, facilitators needed to encourage co-researchers to take the lead and adapt to the group dynamics, to ensure ownership and shared decision-making., Conclusion: In-depth qualitative analyses of a standardized reflection form used in three different PAR projects resulted in various lessons to support facilitators in collaborating with co-researchers in PAR projects., (© 2024. The Author(s).)

Background: Co-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation., Methods: We searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components., Results: 54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%).38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%).13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation., Conclusion: The broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: Adolescents living in vulnerable socioeconomic conditions are confronted with tobacco-related health disparities. As school-based interventions appear to be less effective among these youngsters, other approaches are necessary. One promising avenue is youth social work settings that offer sport and recreational activities (SR-settings). SR-settings have been examined as a levering context for health promotion, but evidence regarding smoking prevention is currently lacking., Methods: This study describes the protocol of a non-randomised cluster controlled trial evaluating a smoking prevention intervention for adolescents. At least 24 SR-settings are needed for the intervention and control group. A mixed-method design will be used. Quantitative measures will be used to assess effectiveness, involving validated questionnaires on smoking initiation behaviour and influencing factors (i.e. attitude, self-efficacy, social influence and risk perception). In addition, feasibility will be assessed with regard to intervention fidelity, dose and reach. Data will be collected at baseline, three and nine months following the intervention. To gain deeper understanding on the impact and underlying processes of the intervention, we will conduct qualitative interviews with users (adolescents) and implementers (youth workers within the SR-settings) of the intervention., Conclusions: Conducting this trial will offer novel insights into the effectiveness of a smoking prevention intervention designed for adolescents living in vulnerable socioeconomic conditions. A mixed-method design will enable to measure impact, implementation and underlying processes of the intervention. Overall, this design will enhance our understanding on the suitability of SR-settings as contexts for smoking prevention initiatives targeting hard-to-reach youth. This trial is registered on Clinicaltrials.gov: NCT05920772., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

Background: While there is increasing evidence for negative physical health consequences of high volumes of sedentary time and prolonged sedentary time in adolescents, the association with cognition is less clear. This study investigated the association of volumes of habitual sedentary time and prolonged sedentary time with executive functions and short-term memory in adolescents., Methods: This study has a cross-sectional observational study design. Volumes of sedentary time and prolonged sedentary time (accumulated sedentary time spent in bouts of  ≥ 30 min) were measured using the Axivity AX3 accelerometer. Six cognitive functions (spatial and verbal short-term memory; and working memory, visuospatial working memory, response inhibition and planning as executive functions) were measured using six validated cognitive assessments. Data were analysed using generalised linear models., Results: Data of 119 adolescents were analysed (49% boys, 13.4 ± 0.6 year). No evidence for an association of volumes of sedentary time and prolonged sedentary time with spatial and verbal short-term memory, working memory, and visuospatial working memory was found. Volumes of sedentary time and prolonged sedentary time were significantly related to planning. One hour more sedentary time or prolonged sedentary time per day was associated with respectively on average 17.7% (95% C.I.: 3.5-29.7%) and 12.1% (95% C.I.: 3.9-19.6%) lower scores on the planning task., Conclusions: No evidence was found for an association of volumes of habitual sedentary time and prolonged sedentary time with short-term memory and executive functions, except for planning. Furthermore, the context of sedentary activities could be an important confounder in the association of sedentary time and prolonged sedentary time with cognition among adolescents. Future research should therefore collect data on the context of sedentary activities., Trial Registration: This study was registered at ClinicalTrials.gov in January 2020 (NCT04327414; released on March 11, 2020)., (© 2024. The Author(s).)

To date, it remains unknown which psychosocial determinants identified by several leading behavior change theories are associated with different sleep parameters among adolescents. Therefore, this study investigates whether changes in knowledge about healthy sleep, attitude toward healthy sleep and going to bed on time, self-efficacy to engage in healthy sleep behavior, perceived parental and peer norms, perceived barriers (e.g., worrying, fear of missing out), and perceived support (e.g., bedtime rules, encouragement) related to healthy sleep are associated with changes in adolescents' sleep duration on school days and free days and sleep quality over a period of 1 year. Two-wave data of 1648 Flemish adolescents (mean age = 15.01, SD = 0.65, 46.3% female) were analyzed using linear models. Increased levels of parental social support, positive attitude towards and perceived advantages of healthy sleep, norm-knowledge, and perceived peer behavior were associated with sleep duration, with parental social support having the strongest association. Increased levels of perceived barriers were associated with decreased levels of sleep quality parameters, and increased levels of self-efficacy, positive attitude, and parental modeling were associated with improved sleep quality parameters, with perceived barriers having the strongest association. The current results indicate that behavior change theories are useful in the context of adolescent sleep behavior and suggest that perceived parental support (i.e., bedtime rules) and perceived barriers are most strongly associated with adolescents' sleep duration and/or quality., (© 2023. The Author(s).)

Background: Adolescents' sleep deteriorated over the last decades, urging the need to develop effective interventions. Using participatory action research (PAR) is a promising and unique approach to target adolescents' sleep. This study aims to describe the process and results of combining PAR and intervention mapping (IM) to guide future researchers on developing and planning of the implementation and evaluation of interventions promoting healthy sleep in adolescents., Methods: In each of three intervention schools (two with general and technical education and one with technical and vocational education), an action team including adolescents (age 13- 15 years, n=max. 12) and a researcher was composed to develop and plan the intervention. During weekly sessions (n=ranging from 23 to 34 per school), the action team went through the six steps of IM. A short PAR was performed with parents (n=7) to develop parental intervention components., Results: Combining PAR and IM resulted in interventions focusing on the importance of healthy sleep, regular sleep patterns and associated behaviors: screen behaviors, physical activity, dietary behavior and relaxation. Several differences in the participatory process (i.e. more guidance needed during brainstorms in the vocational/technical school) and developed intervention (i.e. less intrusive intervention components in the vocational/technical school) were observed between schools., Conclusion: Combining PAR with IM resulted in more extensive interventions than other existing school-based sleep interventions. Future studies should investigate whether a participatory developed sleep intervention could be transferred to another setting using a shorter participatory process., Competing Interests: The authors declare that they have no conflict of interests., (© 2023 The Author(s).)

Background: Previous research on the association between sports participation and body composition has shown mixed findings. The family home is considered one of the most influential environments on childhood obesity. Thus, the association between sports participation and body composition in children may be influenced by an obesogenic home environment., Objectives: To investigate if an obesogenic family environment moderates the association between sports participation and body composition in children., Methods: A total of 3999 children (54% girls; 11.6 ± 0.7 years) and their parent(s) were included from the ENERGY project. A composite obesogenic family environment risk score was created from 10 questionnaire items. Height, weight (to calculate body mass index), and waist circumference were obtained by trained researchers and used as indicators of body composition., Results: The composite risk score significantly moderated the association between sports participation and both waist circumference and body mass index. In children from families with moderate and high obesogenic risk, organized sports participation was significantly associated with smaller waist circumference (moderate risk: -0.29, 95% CI -0.45 to -0.14; high risk: -0.46, 95% CI -0.66 to -0.25) and lower body mass index (moderate risk: -0.10, 95% CI -0.16 to -0.04; high risk: -0.14, 95% CI -0.22 to -0.06), but not in children with a low obesogenic family risk score., Conclusions: Enrolling children in sports activities from an early age can be important for healthy weight maintenance, especially among children from obesogenic family environments., (© 2023 World Obesity Federation.)

Tobacco smoking uptake is still a major public health concern, especially among youngsters living in vulnerable situations. Finding optimal ways to engage youngsters in smoking prevention is important. Compared to traditional settings such as schools, social work settings providing sports-based and recreational activities (SR-settings) tend to reach and engage youngsters more. This study aimed to gain insight into the reasons for smoking uptake among youngsters living in vulnerable situations and the conditions through which SR-settings are potentially beneficial for smoking prevention initiatives. Data were collected in two SR-settings in Flanders, Belgium, by means of five focus group discussions and six individual interviews with youngsters (n = 38, mean age = 12.9 ± 2.61 years, 69.7% boys) and eight individual interviews with youth workers (n = 8, mean age = 27.5 ± 7.95 years, 87.5% men). A thematic analysis (TA) approach was applied to analyse the data. Besides individual factors, such as attitudes towards smoking, the desire to be part of a group and conformity to group norms seem to be important drivers of smoking uptake among youngsters in vulnerable situations. The presence of powerful role models in SR-settings with whom youngsters identify may counteract group norms by encouraging healthy behaviour. SR-settings seem suitable for questioning perceptions of vulnerable youngsters, unlike other settings where they may struggle to be heard. The conditional characteristics of SR-settings, such as authentic group processes, having meaningful roles, and being heard, make these contexts promising venues for smoking prevention efforts among vulnerable youngsters. Youth workers who have established trusting relationships with youngsters seem well-suited to communicate smoking prevention messages. A participatory approach, in which youngsters are involved in developing smoking prevention programs, is desirable., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Adolescents around the world do not engage in sufficient physical activity and the Spanish context is no exception. Understanding the educational context as a complex system, school-based multi-level and multi-component interventions seem to be an effective strategy to reverse this trend. Moreover, a co-creational approach seems to facilitate the mobilization of community partnerships and the engagement of stakeholders in the intervention process. This study aims to describe the dissemination, implementation, and evaluation process of an effective school-based intervention program in another setting using the replicating effective programs framework and a co-participatory approach. This study will be conducted in two Spanish secondary schools located in the region of Aragon (experimental vs. control school) in a sample of adolescents in the second grade (13-14 years old). To evaluate the effectiveness, different health behaviors such as physical activity, sleep, sedentary time with screens, nutrition, and psychosocial variables will be quantitatively measured at baseline and after the implementation of the intervention. Qualitative methods will also be used to better understand the implementation process and the co-creation approach, as well as to provide insights into the sustainability of the intervention program. The current study has the potential to provide strong information about the dissemination, implementation, and evaluation process of school-based programs to promote healthy behaviors among adolescents.

Background: Co-creation is a method to develop acceptable, contextually appropriate and potentially more effective interventions. Adolescents with intellectual disabilities (ID) seldomly participate in research and program development due to the assumption that they lack the capacity to understand and discuss the related topics., Objective: This study describes reflections on a co-creation process with adolescents with ID from the point of view of the researchers in developing an intervention to increase physical activity. It was the aim to highlight elements that must be considered when implementing co-creation and consequently formulate important lessons learned., Methods: Twenty-three adolescents (14-22 y) with mild to moderate ID participated in six co-creation sessions at their school. The objectives and working methods in each session are described. Inductive thematic analysis was conducted on the researchers' reflection forms, which were completed after each session., Results: Seven main themes could be distinguished from the data: experiences related to assistance (i.e., teacher presence) during sessions, the importance of building rapport, co-decision making power, the impact of different group dynamics, the relevance of adapted questioning, the influence of co-creative working methods and required characteristics of a co-creation researcher., Conclusion: Seven lessons learned were formulated when preparing and conducting co-creation with adolescents with ID. Innovative, concrete (non-abstract) and creative working methods are highly needed. Describing the entire process transparently could be a first step to turn co-creative research into an evidence-based methodology., (© 2023. The Author(s).)

Background: Over the last decades, adolescents' sleep has deteriorated, suggesting the need for effective healthy sleep interventions. To develop such interventions, it is important to first gather insight into the possible factors related to sleep. Moreover, previous research has indicated that chances of intervention effectivity could be increased by actively involving adolescents when developing such interventions. This study examined psychosocial factors related to sleep in adolescents and investigated adolescents' willingness to participate in the development of a healthy sleep intervention., Methods: Nine focus group interviews were conducted with seventy-two adolescents (63.9% girls, 14.8 (± 1.0) years) using a standardized interview guide. Interviews were audio-recorded and thematic content analysis was performed using Nvivo 11., Results: Adolescents showed limited knowledge concerning sleep guidelines, sleep hygiene and the long-term consequences of sleep deficiency, but they demonstrated adequate knowledge of the short-term consequences. Positive attitudes towards sleep were outweighed by positive attitudes towards other behaviors such as screen time. In addition, adolescents reported leisure activities, the use of smartphones and television, high amounts of schoolwork, early school start time and excessive worrying as barriers for healthy sleep. Perceived behavioral control towards changing sleep was reported to be low and norms about sufficient sleep among peers were perceived as negative. Although some adolescents indicated that parental rules provoke feelings of frustration, others indicated these have a positive influence on their sleep. Finally, adolescents emphasized that it would be important to allow students to participate in the development process of healthy sleep interventions at school, although adult supervision would be necessary., Conclusion: Future interventions promoting healthy sleep in adolescents could focus on enhancing knowledge of sleep guidelines, sleep hygiene and the consequences of sleep deficiency, and on enhancing perceived behavioral control towards changing sleep. Interventions could also focus on prioritizing positive sleep attitudes over positive attitudes towards screen time, finding solutions for barriers towards healthy sleep and creating a positive perceived norm regarding healthy sleep. Involving adolescents in intervention development could lead to intervention components that match their specific needs and are more attractive for them., (© 2022. The Author(s).)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: The aim of this study was to investigate bidirectional associations between (prolonged) sitting time and sleep duration in 12- to 14-year-old adolescents using a between-subjects and within-subjects analyses approach., Methods: Observational data were used from 108 adolescents (53% girls; mean age 12.9 (SD 0.7) years) from six schools in Flanders, Belgium. The Axivity AX3 triaxial accelerometer, worn on the thigh, was used to assess daily total sitting time and daily time spent in sedentary bouts of ≥30 min (as a proxy for prolonged sitting time). The Fitbit Charge 3 was used to assess nightly sleep duration. Both monitors were worn on schooldays only (ranging from 4 to 5 days). Linear mixed models were conducted to analyse the associations, resulting in four models. In each model, the independent variable (sleep duration, sitting time or prolonged sitting time) was included as within- as well as between-subjects factor., Results: Within-subjects analyses showed that when the adolescents sat more and when the adolescents spent more time sitting in bouts of ≥30 min than they usually did on a given day, they slept less during the following night (p = 0.01 and p = 0.05 (borderline significant), respectively). These associations were not significant in the other direction. Between-subjects analyses showed that adolescents who slept more on average, spent less time sitting (p = 0.006) and less time sitting in bouts of ≥30 min (p = 0.004) compared with adolescents who slept less on average. Conversely, adolescents who spent more time sitting on average and adolescents who spent more time sitting in bouts of ≥30 min on average, slept less (p = 0.02 and p = 0.003, respectively)., Conclusions: Based on the between-subjects analyses, interventions focusing on reducing or regularly breaking up sitting time could improve adolescents' sleep duration on a population level, and vice versa. However, the within-subjects association was only found in one direction and suggests that to sleep sufficiently during the night, adolescents might limit and regularly break up their sitting time the preceding day., Trial Registration: Data have been used from our trial registered at ClinicalTrials.gov ( NCT04327414 ; registered on March 11, 2020)., (© 2021. The Author(s).)

Fathers play a unique and important role in shaping their children's physical activity (PA), independent from the mother. Lifestyle interventions focusing simultaneously on PA of fathers and their children ("co-PA") are therefore a novel and promising way to improve PA of both. A theory-based lifestyle intervention was co-created with fathers (i.e., the Run Daddy Run intervention), using the behavior change wheel as a theoretical framework. The aim of the present study is to describe the protocol of the Run Daddy Run intervention study, focusing on improving (co-)PA of fathers and children, and the prospected outcomes. The developed intervention consists of six (inter)active father-child sessions and an eHealth component, delivered over a 14-week intervention period. Baseline measurements will be conducted between November 2019-January 2020, post-test measurements in June 2020, and follow-up measurements in November 2020, with (co-)PA as the primary outcome variable. Outcomes will be measured using accelerometry and an online questionnaire. To evaluate the intervention, multilevel analyses will be conducted. This study will increase our understanding on whether a theory-based, co-created lifestyle intervention focusing exclusively on fathers and their children can improve their (co-)PA behavior and has important implications for future research and health policy, where targeting fathers might be a novel and effective approach to improve (co-)PA and associated health behaviors of both fathers and their children.

Objective: Communication and education about health behaviours to the general population is essential in public health promotion. This paper describes the process and outcome of developing a new health education model (infographic) for physical activity (PA) and sedentary behaviour used in Flanders (Belgium)., Methods: The Flanders Institute for Healthy Living, expertise centre for public health, coordinated a process, including the evaluation of its previous education model among citizens; reviewing existing models from other countries; expert panel meetings (n = 3); and a formative evaluation (34 focus groups) among citizen with various profiles., Results: The previous model was difficult to understand and not motivating. Foreign models (n = 18) were mostly expert-based (72 %), but not evaluated among citizens. Based on expert meetings, the new model includes a daily and weekly variety of activities at different volumes and intensities, sitting (interruptions), and physical and mental health benefits of PA. Based on the focus groups, no quantitative PA recommendations were integrated, and specific symbols, colours, and heart icons were crucial to illustrate different PA behaviours, volumes and intensities., Practice Implications: Involving several key stakeholders, especially sedentary/inactive and vulnerable citizens, is suggested when developing a health model. Citizens preferred non-quantitative PA messages and quantitative messages around sitting interruptions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study aimed at (1) studying the effect of the standardized ToyBox intervention on European preschoolers' snacking behavior, and (2) studying whether a higher process evaluation score from teachers and parents/caregivers was associated with a more positive result for preschoolers' snack intake. A sample of 4970 preschoolers (51.4% boys, 4.74 ± 0.44 years) from six European countries provided information on snack intake with the use of a Food Frequency Questionnaire. To investigate the effect of the intervention, multilevel repeated measures analyses were executed for the total sample and the six country-specific samples. Furthermore, questionnaires to measure process evaluation were used to compute a total process evaluation score for teachers and parents/caregivers. No significant intervention effects on preschoolers' snack intake were found (all p > 0.003). In general, no different effects of the intervention on snack intake were found according to kindergarten teachers' and parents'/caregivers' process evaluation scores. The lack of effects could be due to limited intervention duration and dose. To induce larger effects on preschoolers' snack intake, a less standardized intervention which is more tailored to the local needs might be needed.

Background: E- and m-health interventions are promising to change health behaviour. Many of these interventions use a large variety of behaviour change techniques (BCTs), but it's not known which BCTs or which combination of BCTs contribute to their efficacy. Therefore, this experimental study investigated the efficacy of three BCTs (i.e. action planning, coping planning and self-monitoring) and their combinations on physical activity (PA) and sedentary behaviour (SB) against a background set of other BCTs., Methods: In a 2 (action planning: present vs absent) × 2 (coping planning: present vs absent) × 2 (self-monitoring: present vs absent) factorial trial, 473 adults from the general population used the self-regulation based e- and m-health intervention 'MyPlan2.0' for five weeks. All combinations of BCTs were considered, resulting in eight groups. Participants selected their preferred target behaviour, either PA (n = 335, age = 35.8, 28.1% men) or SB (n = 138, age = 37.8, 37.7% men), and were then randomly allocated to the experimental groups. Levels of PA (MVPA in minutes/week) or SB (total sedentary time in hours/day) were assessed at baseline and post-intervention using self-reported questionnaires. Linear mixed-effect models were fitted to assess the impact of the different combinations of the BCTs on PA and SB., Results: First, overall efficacy of each BCT was examined. The delivery of self-monitoring increased PA (t = 2.735, p = 0.007) and reduced SB (t = - 2.573, p = 0.012) compared with no delivery of self-monitoring. Also, the delivery of coping planning increased PA (t = 2.302, p = 0.022) compared with no delivery of coping planning. Second, we investigated to what extent adding BCTs increased efficacy. Using the combination of the three BCTs was most effective to increase PA (x 2  = 8849, p = 0.003) whereas the combination of action planning and self-monitoring was most effective to decrease SB (x 2  = 3.918, p = 0.048). To increase PA, action planning was always more effective in combination with coping planning (x 2  = 5.590, p = 0.014; x 2  = 17.722, p < 0.001; x 2  = 4.552, p = 0.033) compared with using action planning without coping planning. Of note, the use of action planning alone reduced PA compared with using coping planning alone (x 2  = 4.389, p = 0.031) and self-monitoring alone (x 2  = 8.858, p = 003), respectively., Conclusions: This study provides indications that different (combinations of) BCTs may be effective to promote PA and reduce SB. More experimental research to investigate the effectiveness of BCTs is needed, which can contribute to improved design and more effective e- and m-health interventions in the future., Trial Registration: This study was preregistered as a clinical trial (ID number: NCT03274271 ). Release date: 20 October 2017.

Background : Sedentary behaviour guidelines recommend that individuals should regularly break up sitting time. Accurately monitoring such breaks is needed to inform guidelines concerning how regularly to break up sitting time and to evaluate intervention effects. We investigated the concurrent validity of three "UP4FUN child questionnaire" items assessing the number of breaks in sitting time among children and adolescents. Methods : Fifty-seven children and adolescents self-reported number of breaks from sitting taken at school, while watching TV, and during other screen time activities. Participants also wore an activPAL monitor (PAL Technologies, Glasgow, UK) to objectively assess the number of sitting time breaks (frequency/hour) during the school period and the school-free period (which was divided in the periods "after school" and "during the evening"). Concurrent validity was assessed using Spearman rank correlations. Results : Self-reported number of breaks/hour at school showed good concurrent validity (ρ = 0.676). Results were moderate to good for self-reported number of breaks/hour while watching TV (ρ range for different periods: 0.482 to 0.536) and moderate for self-reported number of breaks/hour in total screen time (ρ range for different periods: 0.377 to 0.468). Poor concurrent validity was found for self-reported number of breaks/hour during other screen time activities (ρ range for different periods: 0.157 to 0.274). Conclusions: Only the questionnaire items about number of breaks at school and while watching TV appear to be acceptable for further use in research focussing on breaks in prolonged sitting among children and adolescents.

Background: This study aimed to investigate the effect of integrating a video intervention "Movie Models" within the Feel4Diabetes-study on specific parenting practices and related parental self-efficacy regarding children's physical activity, screen-time and eating behaviour in vulnerable families (i.e. families living in low socioeconomic municipalities and at risk for developing type 2 diabetes). Additionally, there was examination of how the intervention was perceived by the parents., Methods: Within randomly selected low socioeconomic municipalities in Belgium, families were recruited through primary schools. Families at risk for developing type 2 diabetes were identified using the FINDRISC questionnaire (n = 457). Afterwards, the municipalities were randomly assigned to the intervention or control condition. At risk families assigned to the intervention group were invited to participate in six Feel4Diabetes counselling sessions in which families were encouraged to adopt a healthier lifestyle. The "Movie Models" videos were integrated within two sessions by using a face-to-face group discussion approach. Parenting-related factors were assessed before and after the integration of the videos, using a questionnaire. After integrating the videos, some extra evaluation questions were assessed. In total, 126 families were included in a per protocol evaluation and Repeated Measures ANOVAs were conducted to evaluate the potential intervention effects., Results: Some favourable intervention effects were found on parenting practices and related parental self-efficacy regarding children's eating behaviours, however almost no effects were found on parenting-related factors regarding children's physical activity and screen-time. In total, 60.0% of the participants indicated that they applied tips regarding parenting practices and 52.0% indicated that discussions with other participants regarding the videos were useful for them., Conclusion: The integration of "Movie Models" within the Feel4Diabetes-study was effective in improving some parenting-related factors regarding children's health behaviours, however most parenting-related factors could not be improved. The implementation of "Movie Models" as a face-to-face group discussion approach was relatively well received and may be a promising way to improve parenting-related factors in vulnerable families., Trial Registration: ClinicalTrials.gov NCT02278809., Competing Interests: The authors have declared that no competing interests exist.

Background: Adopting an active lifestyle plays a key role in the prevention and management of chronic diseases such as type 2 diabetes mellitus (T2DM). Web-based interventions are able to alter health behaviors and show stronger effects when they are informed by a behavior change theory. MyPlan 2.0 is a fully automated electronic health (eHealth) and mobile health (mHealth) intervention targeting physical activity (PA) and sedentary behavior (SB) based on the Health Action Process Approach (HAPA)., Objective: This study aimed to test the short-term effect of MyPlan 2.0 in altering levels of PA and SB and in changing personal determinants of behavior in adults with T2DM and in adults aged ≥50 years., Methods: The study comprised two randomized controlled trials (RCTs) with an identical design. RCT 1 was conducted with adults with T2DM. RCT 2 was performed in adults aged ≥50 years. Data were collected via face-to-face assessments. The participants decided either to increase their level of PA or to decrease their level of SB. The participants were randomly allocated with a 2:1 ratio to the intervention group or the waiting-list control group. They were not blinded for their group allocation. The participants in the intervention group were instructed to go through MyPlan 2.0, comprising 5 sessions with an interval of 1 week between each session. The primary outcomes were objectively measured and self-reported PA (ie, light PA, moderate-to-vigorous PA, total PA, number of steps, and domain-specific [eg, transport-related] PA) and SB (ie, sitting time, number of breaks from sitting time, and length of sitting bouts). Secondary outcomes were self-reported behavioral determinants for PA and SB (eg, self-efficacy). Separate linear mixed models were performed to analyze the effects of MyPlan 2.0 in the two samples., Results: In RCT 1 (n=54), the PA intervention group showed, in contrast to the control group, a decrease in self-reported time spent sitting (P=.09) and an increase in accelerometer-measured moderate (P=.05) and moderate-to-vigorous PA (P=.049). The SB intervention group displayed an increase in accelerometer-assessed breaks from sedentary time in comparison with the control group (P=.005). A total of 14 participants of RCT 1 dropped out. In RCT 2 (n=63), the PA intervention group showed an increase for self-reported total PA in comparison with the control group (P=.003). Furthermore, in contrast to the control group, the SB intervention group decreased their self-reported time spent sitting (P=.08) and increased their accelerometer-assessed moderate (P=.06) and moderate-to-vigorous PA (P=.07). A total of 8 participants of RCT 2 dropped out., Conclusions: For both the samples, the HAPA-based eHealth and mHealth intervention, MyPlan 2.0, was able to improve only some of the primary outcomes., Trial Registration: ClinicalTrials.gov NCT03291171; http://clinicaltrials.gov/ct2/show/NCT03291171. ClinicalTrials.gov NCT03799146; http://clinicaltrials.gov/ct2/show/NCT03799146., International Registered Report Identifier (irrid): RR2-10.2196/12413., (©Louise Poppe, Ilse De Bourdeaudhuij, Maïté Verloigne, Samyah Shadid, Jelle Van Cauwenberg, Sofie Compernolle, Geert Crombez. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.08.2019.)

Background: Sufficient physical activity and a limited amount of sedentary behaviour can prevent a range of chronic diseases. However, most adults do not meet the recommendations for physical activity and sedentary behaviour. Effective and engaging interventions are needed to change people's behaviour. E- and m-health interventions are promising, but unfortunately they result in small effects and suffer from high attrition rates. Improvements to intervention content and design are required. Qualitative research has revealed the need for clear and concise interventions. Furthermore, many interventions use a range of behaviour-change techniques, and it is yet unknown whether these techniques are equally important to obtain behaviour change. It may well be that a limited set of these techniques is sufficient. In this study, the aim is to experimentally investigate the efficacy of three behaviour-change techniques (i.e. action planning, coping planning and self-monitoring) on physical activity, sedentary behaviour and related determinants among adults., Methods: In a 2 x 2 x 2 factorial trial participants will be randomly allocated to eight groups (including one control group). Each group will receive a different version of the self-regulation-based e- and m-health intervention 'MyPlan 2.0', in which three behaviour-change techniques (i.e. action planning, coping planning, self-monitoring) will be combined in order to achieve self-formulated goals about physical activity or sedentary behaviour. Goal attainment, and levels of physical activity and sedentary behaviour will be measured via self-report questionnaires., Discussion: This study should provide insight into the role of various behaviour-change techniques in changing health behaviour and its determinants. Its experimental and longitudinal design, with repeated measures of several determinants of behaviour change, allows an in-depth analysis of the processes underlying behaviour change, enabling the authors to provide guidance for the development of future e- and m-health interventions., Trial Registration: This study is registered as MyPlan 2.0 as a clinical trial (ID number: NCT03274271 ). Release date: 20 October 2017.

This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) "Health Behaviour in School-aged Children" 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents' psychological symptoms. Future interventions improving adolescents' mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.

Background: Adoption of an active lifestyle plays an important role in the management of type 2 diabetes. Online interventions targeting lifestyle changes in adults with type 2 diabetes have provided mixed results. Previous research highlights the importance of creating theory-based interventions adapted to the population's specific needs. The online intervention "MyPlan 2.0" targets physical activity and sedentary behavior in adults with type 2 diabetes. This intervention is grounded in the self-regulation framework and, by incorporating the feedback of users with type 2 diabetes, iteratively adapted to its target population., Objective: The aim of this paper is to thoroughly describe "MyPlan 2.0" and the study protocol that will be used to test the effectiveness of this intervention to alter patients' levels of physical activity and sedentary behavior., Methods: A two-arm superiority randomized controlled trial will be performed. Physical activity and sedentary behavior will be measured using accelerometers and questionnaires. Furthermore, using questionnaires and diaries, patients' stressors and personal determinants for change will be explored in depth. To evaluate the primary outcomes of the intervention, multilevel analyses will be conducted., Results: The randomized controlled trial started in January 2018. As participants can start at different moments, we aim to finish all testing by July 2019., Conclusions: This study will increase our understanding about whether and how a theory-based online intervention can help adults with type 2 diabetes increase their level of physical activity and decrease their sedentary time., International Registered Report Identifier (irrid): DERR1-10.2196/12413., (©Louise Poppe, Ilse De Bourdeaudhuij, Maïté Verloigne, Laurent Degroote, Samyah Shadid, Geert Crombez. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 22.03.2019.)

Plain English Summary: Background: Society has to cope with a large burden of health issues. There is need to find solutions to prevent diseases and help individuals live healthier lifestyles. Individual needs and circumstances vary greatly and one size fit all solutions do not tend to work well. More tailored solutions centred on individuals' needs and circumstances can be developed in collaboration with these individuals. This process, known as co-creation, has shown promise but it requires guiding principles to improve its effectiveness. The aim of this study was to identify a key set of principles and recommendations for co-creating public health interventions. Methods: These principles were collaboratively developed through analysing a set of case studies targeting different health behaviours (such as reducing sitting and improving strength and balance) in different groups of people (such as adolescent schoolgirls and older adults living in the community). Results: The key principles of co-creation are presented in four stages: Planning (what is the purpose of the co-creation; and who should be involved?); Conducting (what activities can be used during co-creation; and how to ensure buy-in and commitment?); Evaluating (how do we know the process and the outcome are valid and effective?) and Reporting (how to report the findings?). Three models are proposed to show how co-created solutions can be scaled up to a population level. Conclusions: These recommendations aim to help the co-creation of public health interventions by providing a framework and governance to guide the process., Abstract: Background: Due to the chronic disease burden on society, there is a need for preventive public health interventions to stimulate society towards a healthier lifestyle. To deal with the complex variability between individual lifestyles and settings, collaborating with end-users to develop interventions tailored to their unique circumstances has been suggested as a potential way to improve effectiveness and adherence. Co-creation of public health interventions using participatory methodologies has shown promise but lacks a framework to make this process systematic. The aim of this paper was to identify and set key principles and recommendations for systematically applying participatory methodologies to co-create and evaluate public health interventions. Methods: These principles and recommendations were derived using an iterative reflection process, combining key learning from published literature in addition to critical reflection on three case studies conducted by research groups in three European institutions, all of whom have expertise in co-creating public health interventions using different participatory methodologies. Results: Key principles and recommendations for using participatory methodologies in public health intervention co-creation are presented for the stages of: Planning (framing the aim of the study and identifying the appropriate sampling strategy); Conducting (defining the procedure, in addition to manifesting ownership); Evaluating (the process and the effectiveness) and Reporting (providing guidelines to report the findings). Three scaling models are proposed to demonstrate how to scale locally developed interventions to a population level. Conclusions: These recommendations aim to facilitate public health intervention co-creation and evaluation utilising participatory methodologies by ensuring the process is systematic and reproducible., Competing Interests: Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: Wearables for monitoring physical activity (PA) are increasingly popular. These devices are not only used by consumers to monitor their own levels of PA but also by researchers to track the behavior of large samples. Consequently, it is important to explore how accurately PA can be tracked via these devices., Objectives: The aim of this study was, therefore, to investigate convergent validity of 3 Android Wear smartwatches-Polar M600 (Polar Electro Oy, Kempele, Finland), Huawei Watch (Huawei Technologies Co, Ltd, Shenzhen, Guangdong, China), Asus Zenwatch3 (AsusTek Computer Inc, Taipei, Taiwan)-and Fitbit Charge with an ActiGraph accelerometer for measuring steps and moderate to vigorous physical activity (MVPA) on both a day level and 15-min level., Methods: A free-living protocol was used in which 36 adults engaged in usual daily activities over 2 days while wearing 2 different wearables on the nondominant wrist and an ActiGraph GT3X+ accelerometer on the hip. Validity was evaluated on both levels by comparing each wearable with the ActiGraph GT3X+ accelerometer using correlations and Bland-Altman plots in IBM SPSS 24.0., Results: On a day level, all devices showed strong correlations (Spearman r=.757-.892) and good agreement (interclass correlation coefficient, ICC=.695-.885) for measuring steps, whereas moderate correlations (Spearman r=.557-.577) and low agreement (ICC=.377-.660) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for measuring steps but a variation between over- and undercounting of MVPA. On a 15-min level, all devices showed strong correlations (Spearman r=.752-.917) and good agreement (ICC=.792-.887) for measuring steps, whereas weak correlations (Spearman r=.116-.208) and low agreement (ICC=.461-.577) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for steps but under- or overestimation for MVPA depending on the device., Conclusions: In sum, all 4 consumer-level devices can be considered accurate step counters in free-living conditions. This study, however, provides evidence of systematic bias for all devices in measurement of MVPA. The results on a 15-min level also indicate that these devices are not sufficiently accurate to provide correct real-time feedback., (©Laurent Degroote, Ilse De Bourdeaudhuij, Maïté Verloigne, Louise Poppe, Geert Crombez. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 13.12.2018.)

The aim of this study was to examine the mediating effects of specific parenting practices on the association between family socio-economic status (SES) and screen-time of 6- to 9-year-old children from families with an increased risk of developing type 2 diabetes. This cross-sectional study, focusing on families with an increased risk of developing type 2 diabetes, used the Belgian baseline data of the Movie Models intervention, integrated within the European Feel4Diabetes intervention, and included 247 parents (57.6% lower SES family; 78.0% mothers) who completed a questionnaire. Mediating effects were tested using MacKinnon's product-of-coefficients test via multilevel linear regression analyses. Being consistent concerning rules about gaming (β = 0.127; standard error = 0.055; 95% CI = 0.020; 0.234) and avoiding negative role modeling concerning TV-time (β = -0.082; standard error = 0.040; 95% CI = -0.161; -0.003) significantly mediated the inverse association between family SES and children's screen-time. Parents from lower SES families were more consistent concerning rules about gaming and watched more TV nearby their child compared to parents from higher SES families, and these parenting practices were related to more screen-time. No other parenting practices were found to mediate this association. Thus, parents from lower SES families with a higher risk for developing type 2 diabetes might limit their own TV-time nearby their child to reduce their child's screen-time. Future research should examine other possible mediating factors to develop effective interventions targeting this important at-risk group.

Background: eHealth interventions show stronger effects when informed by solid behavioral change theories; for example, self-regulation models supporting people in translating vague intentions to specific actions have shown to be effective in altering health behaviors. Although these theories inform developers about which behavioral change techniques should be included, they provide limited information about how these techniques can be engagingly implemented in Web-based interventions. Considering the high levels of attrition in eHealth, investigating users' experience about the implementation of behavior change techniques might be a fruitful avenue., Objective: The objective of our study was to investigate how users experience the implementation of self-regulation techniques in a Web-based intervention targeting physical activity and sedentary behavior in the general population., Methods: In this study, 20 adults from the general population used the intervention for 5 weeks. Users' website data were explored, and semistructured interviews with each of the users were performed. A directed content analysis was performed using NVivo Software., Results: The techniques "providing feedback on performance," "action planning," and "prompting review of behavioral goals" were appreciated by users. However, the implementation of "barrier identification/problem solving" appeared to frustrate users; this was also reflected by the users' website data-many coping plans were of poor quality. Most users were well aware of the benefits of adopting a more active way of living and stated not to have learned novel information. However, they appreciated the provided information because it reminded them about the importance of having an active lifestyle. Furthermore, prompting users to self-monitor their behavioral change was not sufficiently stimulating to make users actually monitor their behavior., Conclusions: Iteratively involving potential end users offers guidance to optimally adapt the implementation of various behavior change techniques to the target population. We recommend creating short interventions with a straightforward layout that support users in creating and evaluating specific plans for action., (©Louise Poppe, Celien Van der Mispel, Geert Crombez, Ilse De Bourdeaudhuij, Helene Schroé, Maïté Verloigne. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.10.2018.)

Background: Children and adolescents spend a lot of time sitting at school. Implementing standing desks in the classroom is one potential strategy to reduce and break up sitting time. The first aim was to evaluate the effect of implementing standing desks in classrooms in primary and secondary schools on pupils' sitting-related behaviour and determinants. The second aim was to quantitatively and qualitatively evaluate the process of implementing the desks in the classroom., Methods: We conducted a cluster-randomised controlled trial with a pre-, mid-, and post-test design including 10 intervention schools (5 primary, 5 secondary schools) and 9 control schools (5 primary, 4 secondary schools) across Flanders, Belgium. Three standing desks were placed in one class in each intervention school for 6 months. At pre-, mid- and post-test, all pupils (n = 311; 54.5% girls) completed a questionnaire whilst a subsample of three pupils per class wore an activPAL inclinometer for one school week. Focus groups with pupils and interviews with teachers were conducted at mid-test. Process evaluation questions were added to the mid- and post-test questionnaire for the intervention group. Qualitative data were analysed using NVivo 11. Multilevel regression analyses were conducted in MLwiN 2.31., Results: Few significant intervention effects were observed, although activPAL data showed favourable intervention effects on primary school pupils' sitting and standing time and bouts. Focus groups and interviews showed a generally positive attitude towards using standing desks in both teachers and pupils, although some barriers and suggestions for future implementation were noted, for example regarding the amount of desks per classroom. Quantitative process evaluation data showed a low individual use of standing desks (between 57 and 83 min per week), which significantly decreased across the school year for primary school pupils only., Conclusions: Although pupils and teachers were generally positive about the desks, relatively few intervention effects were found. Future studies should consider how to optimise the use of standing desks in classrooms to impact on sitting time, by for example, determining the most feasible intervention design and by encouraging the continued use of standing desks throughout the school year. Moreover, additional intervention strategies (e.g. educational strategies) might be needed., Trial Registration: NCT03163004 . ClinicalTrials.gov. Registered 22 May 2017 (retrospectively registered).

Objectives: To investigate changes in children's television and computer time according to three socio-economic status (SES) indicators., Design: Prospective cohort study., Methods: Data were drawn from the European Youth Heart Study and included longitudinal data collected in 1997 and 2003 in Denmark. Television and computer time were self-reported by children. Parental education, income and ethnicity were parent-reported. Baseline data were available for 549 children (47.0% boys, 9.6 years). Generalized linear mixed models analyzed whether changes in television and computer time from baseline to follow-up differed according to the SES-indicators., Result: TV viewing time increased with 25% over time (ExpB = 1.25, 95% CI = 1.04-1.50). At both time points, children with two higher educated parents viewed 25% less hours of television than children with no higher educated parents (ExpB = 0.75, 95% CI = 0.60-0.94) and one higher educated parent (ExpB = 0.75, 95%CI = 0.59-0.97). Among children with no higher educated parents the odds of being in a higher category of computer time increased with 80% over time (OR = 1.80, 95% CI = 1.24-2.60). Among children with two higher educated parents the odds of being in a higher category of computer time decreased with 45% over time (OR = 0.55, 95% CI = 0.32-0.94). The association with ethnicity showed that white children had 42% lower odds (OR = 0.58; 95% CI = 0.34-1.00) of being in a higher category of computer time than non-white children. No significant associations were found for parental income., Conclusions: The most important SES measure of screen-based behaviors in children was parental education. Ethnicity was only associated with computer time. Financial resources were less relevant for changes in television viewing and computer use., Competing Interests: The authors have declared that no competing interests exist.

(1) Background: It has been shown that online interventions can be enhanced by providing additional support; accordingly, we developed an implementation plan for the use of an eHealth intervention targeting physical activity and healthy nutrition in collaboration with general practitioners (GPs). In this study, GPs and patients evaluated the actual implementation; (2) Methods: Two hundred and thirty two patients completed the feasibility questionnaire regarding the implementation of "MyPlan 1.0" in general practice. Individual interviews were conducted with 15 GPs who implemented "MyPlan 1.0" into their daily work flow; (3) Results: The majority of the patients indicated that general practice was an appropriate setting to implement the online intervention. However, patients were not personally addressed by GPs and advice/action plans were not discussed with the GPs. The GPs indicated that this problem was caused by the severe time restrictions in general practice. GPs also seemed to select those patients who they believed to be able to use (e.g., highly educated patients) and to benefit from the intervention (e.g., patients with overweight); (4) Conclusions: Although GPs were involved in the development of the online intervention and its implementation plan, the programme was not used in general practice as intended.

Background: The increasing prevalence of childhood overweight/obesity caused by an unhealthy diet, insufficient physical activity (PA) and high levels of sedentary behaviour (SB) is a prominent public health concern. Parenting practices may contribute to healthy behaviour change in children, but well-researched examples are limited. The aim of this study is to describe the systematic development of an intervention for parents to prevent childhood overweight/obesity through the improvement of parenting practices., Methods: The six steps of the Intervention Mapping Protocol (IMP), a theory- and evidence-based tool to develop health-related interventions, were used as a framework to develop the 'Movie Models' programme., Results: In Step 1, a needs assessment was performed to better understand the health problem of overweight/obesity in children and its association with diet, PA and SB. In Step 2, the programme goal (increasing the adoption of effective parenting practices) was sub-divided into performance objectives. Change objectives, which specify explicit actions required to accomplish the performance objectives, were also identified. Step 3 included the selection of theoretical methods (e.g. 'modelling' and 'images'), which were then translated into the practical strategy of online parenting videos. Step 4 comprised the development of a final intervention framework, and Step 5 included the planning of programme adoption and implementation. The final phase, Step 6, included the development of an effect- and process-evaluation plan., Discussion: The IMP was used to structure the development of 'Movie Models', an intervention targeting specific parenting practices related to children's healthy diet, PA, SB, and parental self-efficacy. A clear framework for process analyses is offered, which aims to increase the potential effectiveness of an intervention and can be useful for those developing health promotion programmes.

Background: Online interventions targeting a healthy lifestyle in adults with type 2 diabetes are more effective when informed by behaviour change theories. Although these theories provide guidance in developing the content of an intervention, information regarding how to present this content in an engaging way is often lacking. Consequently, incorporating users&rsquo; views in the creation of eHealth interventions has become an important target. Methods: Via a qualitative interview study with 21 adults with type 2 diabetes who had completed an online self-regulation-based intervention (&lsquo;MyPlan 2.0&rsquo;), we assessed participants&rsquo; opinions regarding the usefulness of the implemented self-regulation techniques, the design of the programme as well as their knowledge regarding physical activity and sedentary behaviour. A directed content analysis was performed to synthesize the interview data. Results : Participants experienced difficulties completing the coping planning component. The simple design of the website was considered helpful, and most participants were aware of the beneficial effects of an active lifestyle. Conclusions : &lsquo;MyPlan 2.0&rsquo; was well-accepted by the majority of participants. However, the coping planning component will need to be adapted. Based on these findings, recommendations on how to tailor eHealth interventions to the population of adults with type 2 diabetes have been formulated.

Physical inactivity is one of the major risk factors for poor health in the world. Therefore, effective interventions that promote physical activity are needed. Hence, we developed an eHealth intervention for adults, i.e., 'MyPlan 1.0', which includes self-regulation techniques for behaviour change. This study examined the effect of 'MyPlan 1.0' on physical activity (PA) levels in general practice. 615 adults (≥18 years) were recruited in 19 Flemish general practices, for the intervention group ( n = 328) or for the wait-list control group ( n = 183). Participants in the intervention group received the web-based intervention 'MyPlan 1.0' and were prompted to discuss their personal advice/action plan with their general practitioner. Participants in the wait-list control group only received general advice from the website. Self-reported physical activity was assessed with the International Physical Activity Questionnaire (IPAQ) at baseline and after one month. A three-level (general practice, adults, time) regression analysis was conducted in MLwiN. Significant intervention effects were found for total PA and moderate to vigorous PA with an increase for the intervention group compared to a decrease in the control condition. However, there was a high dropout rate in the intervention group (76%) and the wait-list control group (57%). Our self-regulation intervention was effective in increasing physical activity levels in adults. Future studies should consider strategies to prevent the large dropout from participants., Competing Interests: The authors declare no conflict of interest.