Purpose: A great proportion of children and adolescents do not achieve the WHO guidelines, which recommend an average of 60 minutes of moderate-to-vigorous physical activity (PA) per day. In addition, children and adolescents spend the majority of the day sedentary. This inactive lifestyle is associated with adverse health outcomes, suggesting effective interventions are needed. Using a co-creation approach, in which children and adolescents are actively involved in the intervention development, might increase the effectiveness of such interventions. This systematic review aims to (1) give an overview of co-created interventions targeting PA and/or sedentary behaviour (SB) at school and (2) summarize the effect of these interventions on pupils’ PA and SB.

Methods: A search strategy was conducted in six databases (MEDLINE, Embase, Web of Science, CENTRAL, Scopus and SPORTDiscus). Two reviewers screened titles and abstracts independently. Full texts were screened by one reviewer. Interventions were defined as co-created when there was (at least) shared decision making between researchers and children/adolescents during the development of the intervention. A quality assessment was completed using the QualSyst tool. Extracted data included: aim, design, country, participants, description of co-creation process (co-creation group members, duration, number and content of sessions), description of the intervention, outcomes, measurement tools, results and key findings.

Results: Nine studies were included (Europe: n=6, USA: n=2, New Zealand: n=1) of which most were conducted among adolescents. Six studies included a control condition receiving no intervention. Only four studies found significant favourable intervention effects, but effects were generally small. The co-creation process of these studies was very different and often little described or not described at all.

Conclusion: It cannot be concluded that co-created interventions automatically lead to more behaviour change as no study compared such an intervention with an intervention developed by researchers, and intervention effects were generally small or absent. Future interventions should better describe the co-creation process, to evaluate whether intervention effects differ depending on the intensity of co-creation. Using a structured approach to co-create health promoting interventions (like the Intervention Mapping Protocol) could help to report the co-creation process.

Purpose: Overweight and obesity is a major public health problem. Adolescents are experts in their own behaviour, so it is important to involve them when promoting healthy lifestyles. Participatory research may be a way to actively involve and empower young people in research projects to co-create innovative interventions that match their living environment. Knowledge is lacking so far at which levels of engagement participatory approaches are being used in health promotion ranging from citizens as interprets to collaboration in all steps of the research-process and whether these approaches are effective. The aim of this systematic review is to investigate the effectiveness of participatory research interventions on obesity-related behaviours in adolescents.

Methods: Nine databases were searched from 2000 to July 2021 by two independent reviewers. Studies were included if evaluating a participatory research intervention on obesity-related behaviours in adolescents (11-18 years), by means of a controlled trial with pre- and post-assessment in high-income countries. Studies not published in English were excluded. Two reviewers independently extracted data and carried out a quality assessment. Primary outcomes on physical activity (PA), nutrition and other obesity-related behaviours will be extracted. Studies reporting on similar outcomes will be pooled by means of random-effect meta-analysis.

Results: The search resulted in 6363 articles; 11 studies met the inclusion criteria. Three studies focused on dietary behaviour, four studies focused on PA and four studies focused on both behaviours. Participatory elements included peer-led interventions (n=6), adolescent-led social marketing strategies (n=1), co-created interventions (n=1) or a combination of those (n=3). Nine interventions took place at school, whereas two focused on communities. Frequent reported outcomes were PA measured by accelerometers, self-reported questionnaires on PA and snacking behaviours and Body Mass Index. The results of the meta-analysis will be presented during the ISBNPA conference in May 2022.

Conclusions: This review will give insight in the different participatory health promotion interventions related to healthy lifestyles of adolescents and the effects of various strategies on obesity-related behaviour.

Purpose: The heightened influence of the obesity pandemic in adolescents from Middle Eastern (ME) backgrounds predicates the need to champion co-designed lifestyle initiatives. Parents remain an important stakeholder to consider in intervention design given their influence on adolescent health and behavior. Thus, this qualitative study aimed to capture the perceptions and practices of ME parents of adolescents that would enable or prove a barrier for their adolescent’s physical activity and screen time behaviours.

Methods: A total of twenty-six semi structured interviews were conducted with mothers of adolescents from ME backgrounds in Australia over zoom or phone. A reflexive thematic analysis was performed using the Capability, Opportunity, Motivation-Behaviour model and the Theoretical Domain Framework to guide the process.

Results/Findings: Mothers recruited were aged 35-59 years, and mostly residing in lower socioeconomic areas (n=19). Parents demonstrated confidence in adolescent’s knowledge of need to participate in physical activity and limit screen time but were pessimistic in their ability to activate these behaviours in their children, especially for older adolescents. This was particularly evident in efforts for limiting screen time which increased during COVID-19. Irrespective of adolescent’s skills and ability to engage in sports and exercise, parents revealed deep fears regarding their neighbourhood and social environment and admitted to limiting their independent mobility. Gender differences were also distinguished with parents reporting limited opportunities for girls and their mutual disinterest especially as they age. Parents pleaded for upstream policy and financial initiatives to help overcome financial obstacles and provide greater opportunity for long term sports engagement. They also reinforced the importance of schools in facilitating initiatives for girls and older adolescents and not just one-off tokenistic events.

Conclusions: The findings illustrate the need for efforts to be galvanized across schools and community organisations alongside social and policy reform to organize real-world sporting and physical activity interventions. Such interventions should be contextualized and culturally safe with special emphasis for girls and older adolescents.

Purpose: Large proportions of adolescents fail to achieve the recommended 60 minutes of moderate-to-vigorous physical activity (PA) per day. Figures are even more striking among adolescents with intellectual disability (ID). To date, adolescents with ID are a neglected population in PA research. Consequently, developing and designing PA interventions specifically tailored to the needs of youth with ID is of the utmost importance. The aim of this study was twofold: first, to describe the participatory development of a PA intervention in adolescents with ID, and second, to provide insight into the challenges associated with a participatory approach in adolescent with ID.

Methods: Six co-creation sessions were organized in two different groups of adolescents with mild-moderate ID (14-23y) (n=23) between April and June 2021. Sessions were organized at the adolescents' special needs school for two consecutive class hours. The Behavior Change Wheel was used as a theoretical framework to guide the content and flow of the sessions. A multitude of research materials were collected (e.g. recordings, transcribed interviews, ‘easy to read’ process evaluation forms, and creative materials) and analyzed with the appropriate descriptive statistical methods, and qualitative techniques.

Results: Social connectedness, self-efficacy/self-confidence, knowledge building, encouragement and enjoyment seem to be important intervention targets to promote PA. An intervention is best considered separately from the school context. In addition, the option of an mobile health intervention was discussed, where input was provided on what to consider within app development. It was indicated that an app alone would not motivate them to be more physically active, instead it needs to be embedded in a larger structure.

Conclusions: Adolescents' input on PA for intervention development will be discussed. Also challenges when working with co-creation in this target group, such as the use of different (creative) methods, the influence of the presence of the teacher, the different group dynamics, the importance of building a relationship of trust and perceived barriers concerning ethics committee, will be reflected on.

Purpose: As sleep deprivation is an important health issue among adolescents, effective interventions are needed to promote healthy sleep in adolescents. Using Participatory Action Research (PAR) to develop an intervention is promising and leads to more tailored interventions, but has not been used to develop a sleep intervention in adolescents before. This study evaluates the process of a school-based PAR intervention promoting healthy sleep, by targeting sleep hygiene, physical activity, screen usage, nutrition and relaxation among 13 to 15 year old adolescents.

Methods: In three secondary schools in Flanders (general education (GE, n=2), vocational education (VE, n=1)) an action group of students (n=6-10) and a researcher was formed to develop and implement an intervention. Throughout the implementation the action group was supported by teachers and fellow students. In all schools focus groups were held to evaluate the developed intervention components (e.g. app) with arbitrarily selected students (receivers (n=59) and implementers (n=36)). Furthermore, process evaluation questionnaires were completed by students (n=798), a random sample of teachers (n=8), teacher implementers (n=5), and students’ parents (n=55) in GE schools, to investigate their satisfaction and the students’ exposure to intervention components delivered by teachers and parents. Focus groups were audio-taped and coded using NVivo 12, questionnaires were analysed using SPSS 26.

Results: In all schools, the process evaluation showed that student implementers and teachers were poorly informed about how to implement the intervention components. Consequently, not all components were implemented as planned which resulted in relatively low student exposure. However, several intervention components were evaluated positively by students, such as Instagram, app, posters, and discussion classes in the VE school and the kick-off event and Fitbit competition in GE schools. Additionally, parents were encouraged to discuss healthy sleeping behaviour with their child but evaluation showed that most of them did not.

Conclusions: Several intervention components were positively evaluated by students, which could be explained by the participatory approach. Moreover, future research should focus on providing sufficient training and fostering good communication with the implementers of the participatory developed intervention. Therefore, it is recommended to also involve teachers from the beginning of the PAR process.

Purpose: Effective community-based programs addressing multiple factors contributing to poor health outcomes in rural communities can play a critical role in addressing rural health disparities. The study objective was to test a refined version of the multilevel Strong Hearts, Healthy Communities intervention, which used extensive process and outcome evaluation data from the original randomized trial to optimize effectiveness.

Methods: The community-randomized controlled trial was conducted in 11 rural New York communities with women ≥40 years old with 1) obesity or 2) overweight and a sedentary lifestyle. The 24-week multilevel, multicomponent intervention consisted of hour-long, twice-weekly classes including strength training, aerobic exercise, skill-based health education (individual level), and civic engagement activities regarding healthy food and physical activity environments (social, community, and policy levels). BMI and Simple 7 score, a composite measure of cardiovascular disease risk, were primary outcomes; additional biometric and behavioral measures were secondary outcomes. Multilevel models were used to compare changes in outcomes between intervention and delayed intervention participants; a sensitivity analysis among participants ≥60 years old was conducted. Analytical approaches adhered to intention-to-treat principles.

Results: 182 participants were randomized by community; average age was 57.16±8.9. Compared with control participants, the intervention group had greater improvements in BMI (difference: -1.14, p<0.01) and Simple 7 (1.03, p<0.001) and secondary outcomes: biometric (weight [-2.97 kg], body fat [-1.99%]), functional fitness (aerobic endurance [15.92 steps in two minutes], agility [-0.53 seconds, quickly stand up, walk 8 feet, and come back to seated], upper body strength [5.39 arm curls with 5-pound weights in 30 seconds], lower body strength [3.43 chair stands in 30 seconds]), physical activity (moderate to vigorous physical activity [MVPA] [702.99 MET-minutes/day, 0.86% of time spent in MVPA, 6.83 minutes/day in MVPA], total steps [1462.21 steps/day]), and eating attitudes (healthy eating attitudes [0.36, 5-point scale], cognitive restraint [2.09, 18-point scale]) measures (all p<0.05). Similar results were found in the subset analysis of women over 60 years of age.

Conclusions. The intervention demonstrated significant and clinically meaningful improvements among at-risk women and holds potential for dissemination to help address rural health disparities.