Online interventions to prevent mental health problems implemented in school settings: the perspectives from key stakeholders in Austria and Spain.

BACKGROUND: Schools are key settings for delivering mental illness prevention in adolescents. Data on stakeholders' attitudes and factors relevant for the implementation of Internet-based prevention programmes are scarce. METHODS: Stakeholders in the school setting from Austria and Spain were consulted. Potential facilitators (e.g. teachers and school psychologists) completed an online questionnaire (N=50), policy makers (e.g. representatives of the ministry of education and health professional associations) participated in semi-structured interviews (N=9) and pupils (N=29, 14-19 years) participated in focus groups. Thematic analysis was used to identify experiences with, attitudes and needs towards Internet-based prevention programmes, underserved groups, as well as barriers and facilitators for reach, adoption, implementation and maintenance. RESULTS: Experiences with Internet-based prevention programmes were low across all stakeholder groups. Better reach of the target groups was seen as main advantage whereas lack of personal contact, privacy concerns, risk for misuse and potential stigmatization when implemented during school hours were regarded as disadvantages. Relevant needs towards Internet-based programmes involved attributes of the development process, general requirements for safety and performance, presentation of content, media/tools and contact options of online programmes. Positive attitudes of school staff, low effort for schools and compatibility to schools' curriculum were seen as key factors for successful adoption and implementation. A sound implementation of the programme in the school routine and continued improvement could facilitate maintenance of online prevention initiatives in schools. CONCLUSIONS: Attitudes towards Internet-based mental illness prevention programmes in school settings are positive across all stakeholder groups. However, especially safety concerns have to be considered.

Online prevention programmes for university students: stakeholder perspectives from six European countries.

BACKGROUND: Students beginning university are at a heightened risk for developing mental health disorders. Online prevention and early intervention programmes targeting mental health have the potential to reduce this risk, however, previous research has shown uptake to be rather poor. Understanding university stakeholders' (e.g. governing level and delivery staff [DS] and students) views and attitudes towards such online prevention programmes could help with their development, implementation and dissemination within university settings. METHODS: Semi-structured interviews, focus groups and online surveys were completed with staff at a governing level, university students and DS (i.e. student health or teaching staff) from six European countries. They were asked about their experiences with, and needs and attitudes towards, online prevention programmes, as well as the factors that influence the translation of these programmes into real-world settings. Results were analyzed using thematic analysis. RESULTS: Participating stakeholders knew little about online prevention programmes for university settings; however, they viewed them as acceptable. The main themes to emerge were the basic conditions and content of the programmes, the awareness and engagement, the resources needed, the usability and the responsibility and ongoing efforts to increase reach. CONCLUSIONS: Overall, although these stakeholders had little knowledge about online prevention programmes, they were open to the idea of introducing them. They could see the potential benefits that these programmes might bring to a university setting as a whole and the individual students and staff members.

Efficacy of a cognitive and behavioral treatment for childhood obesity supported by the ETIOBE web platform.

Recently, the prevalence of childhood obesity has increased alarmingly. Interventions combining eating habits, physical activity (PA), behavioral components, and family support have been shown to be effective, although variables such as self-efficacy beliefs and motivation seem to be important in achieving stable changes. Information and communication technologies (ICTs) can provide additional resources to traditional treatments. The objective is to analyze the efficacy of two treatments: a cognitive and behavioral treatment (CBT) focused on the promotion of healthy eating and PA habits, and this CBT intervention supported by a web platform (ETIOBE). Forty-seven obese children were randomized to these two conditions. Anthropometrical measures were evaluated before and after treatment and at follow-up. Self-efficacy and motivation questionnaires were filled out in the first and last intervention sessions. Mixed ANOVAs were performed for all variables. Simple mediation analyses were conducted to test whether the effect of condition on the post-intervention anthropometrical variable scores were mediated by self-efficacy. Results revealed that both treatments produced an improvement in the anthropometrical variables. CBT-E participants showed more PA self-efficacy as the treatment progressed and lower BMIz, lower fat mass, and higher lean mass. These results suggest that ICT help to improve the effects of childhood obesity interventions.

Improving Childhood Obesity Treatment Using New Technologies: The ETIOBE System.

Childhood obesity is an increasing public health problem in western culture. Sedentary lifestyles and an "obesogenic environment" are the main influences on children leading to an increase in obesity. The objective of this paper is to describe an e-health platform for the treatment and prevention of childhood obesity called ETIOBE. This e-health platform is an e-therapy system for the treatment of obesity, aimed at improving treatment adherence and promoting the mechanisms of self-control in patients, to obtain weight loss maintenance and to prevent relapse by establishing healthy lifestyle habits. ETIOBE is composed of three different applications, the Clinician Support System (CSS), the Home Support System (HSS) and the Mobile Support System (MSS). The use of new Information and Communication (ICT) technologies can help clinicians to improve the effectiveness of weight loss treatments, especially in the case of children, and to achieve designated treatment goals.

Efficacy and acceptability of a web platform to teach nutrition education to children.

INTRODUCTION: Introduction: Nutrition Education (NE) has been identified as a key factor to prevent children obesity. Teachers and dietitians are the professionals in charge of transmitting this knowledge to children; however, it has been identified that they do not possess either proper training, or the proper tools to perform this activity. Objectives: to evaluate the acceptability and usability of a NE Internet platform and its two "Serious Games" (SGs) among a sample of elementary school teachers, dietitians, and education students. In addition, to evaluate the efficacy of this platform to teach NE in a sample of children aged 9 to 12 years. Methods: a total of 66 NE professionals and 135 children participated. Usability and acceptability questionnaires of the platform and an instrument to measure the acceptability, immersion, and playability of the SGs were administered to the professionals. The children fulfilled a questionnaire on nutritional knowledge. Descriptive statistics analyzed the main responses of the professionals involved, and an ANOVA compared the differences observed. For the children´s data a t-test of repeated samples and a repeated-measures ANOVA were performed. Results: dietitians and education students responded with a favorable opinion about the platform; however, the scores given by all professionals to the SGs ranged from low to moderate. Children increased their nutritional knowledge from pre to post evaluation (p < 0.001). This increase was observed in 10-year-old children and in children with 11 to 12 years of age, but not in 9-year-olds. Conclusions: this platform proved to be an effective tool to increase children's nutritional knowledge. Professionals expressed a medium level in terms of acceptability and usability for this platform, but also effectiveness in providing NE to children.

INTRODUCCIÓN: Introducción: la Educación Nutricional (EN) se ha identificado como un factor clave para prevenir la obesidad infantil. Los profesionales encargados de transmitir este conocimiento a los niños son maestros y dietistas; sin embargo, se ha identificado que no cuentan ni con la capacitación ni con las herramientas adecuadas para realizar esta actividad. Objetivos: evaluar la aceptabilidad y la facilidad de uso de una plataforma de Internet de EN y sus dos "Juegos Formativos" (JF) en una muestra de maestros de primaria, nutricionistas y estudiantes de educación. Además, evaluar la eficacia de esta plataforma para enseñar EN en una muestra de niños de 9 a 12 años. Métodos: participaron un total de 66 profesionales de EN y 135 niños. Se administraron a los profesionales cuestionarios de usabilidad y aceptabilidad de la plataforma, y un instrumento para medir la aceptabilidad, la inmersión y la jugabilidad de los JF. Los niños completaron un cuestionario sobre conocimiento nutricional. Se analizaron con estadísticas descriptivas las principales respuestas de los profesionales y las diferencias se compararon con un ANOVA. Para los datos de los niños se realizaron una prueba "t" de muestras repetidas y un ANOVA de medidas repetidas. Resultados: los nutricionistas y los estudiantes de educación dieron una opinión favorable sobre la plataforma; sin embargo, las puntuaciones de todos los profesionales acerca de los JF fueron de bajas a medias. Los niños aumentaron su conocimiento nutricional al comparar la evaluación antes y después de la plataforma (p < 0.001). El aumento se observó en los niños de 10 años y en los niños de 11 a 12 años, pero no en los niños de 9 años. Conclusiones: esta plataforma demostró ser una herramienta efectiva para aumentar el conocimiento nutricional de los niños. Los profesionales expresaron un nivel medio en términos de aceptabilidad y usabilidad para esta plataforma, pero también efectividad para impartir EN a los niños.

Healthy Teens @ School: Evaluating and disseminating transdiagnostic preventive interventions for eating disorders and obesity for adolescents in school settings.

BACKGROUND: The worldwide prevalence of overweight and obesity is at alarming levels. Nearly one in three children in Europe is overweight or obese. Disordered eating and body image concerns are equally widespread and increase risk for more chronic and severe weight-related problems. Research has shown that online interventions that address both healthy weight regulation and body image can reduce risk for eating disorders and obesity simultaneously and are feasible to implement in school settings. To date, evaluation and dissemination of such programs in Europe is scant. METHODS: The Healthy Teens @ School study is a multi-country cluster-randomized controlled trial (RCT) comparing the effectiveness of an unguided, online, multi-level intervention for promoting a healthy lifestyle and reducing problematic eating behavior, eating disorder and obesity risk among students aged 14 to 19 years with control condition. As part of the Horizon 2020 funded project ICare (GA No. 634757) the trial is conducted in Austria and Spain. Cluster randomization by school is used. The intervention is an adapted version of an evidence-based program developed in the USA (StayingFit). Participants of the intervention group are assigned to one of two possible program tracks based on the results of the initial online-assessment: Overweight adolescents are assigned to the "Weight Management" track emphasizing balanced eating and exercise for weight maintenance, and all other individuals are assigned to the "Healthy Habits" track which aims at promoting healthy habits related to e.g., nutrition, physical activity, sleep. The participants of both tracks work on ten modules (one 20-30 min module per week) during school hours and/or at home. Assessments are conducted at pre- and post-intervention, and at 6- and 12-months after baseline assessment. The primary outcome is intuitive eating, secondary outcomes are eating disorder symptomatology, body image concerns, body mass index, food intake, physical activity, self-esteem, stress coping, depression, and anxiety. Following the initial assessment, individuals in the control group do not have access to the prevention program but continue as normal and are only prompted to the assessments at all time points. At the end of the 12-month study they will get access to the program. DISCUSSION: The results from this study will add to the understanding of how to address eating and weight related problems in adolescents and will shed light on the feasibility of implementing online prevention programs in school routine in Austria and Spain. As part of the larger ICare project this RCT will determine how an adapted version of StayingFit is disseminated within Europe.

An electronic system (PDA) to record dietary and physical activity in obese adolescents; data about efficiency and feasibility.

INTRODUCTION: Recently, the prevalence of childhood obesity is increasing significantly. Dietary and physical activity registers are frequently referred to as the "cornerstone" of behavioral weight control programs. Mobile devices such as Personal Digital Assistants (PDAs) are showing their usefulness to facilitate these self-registers. OBJECTIVE: This study is aimed to analyze and compare the efficiency and feasibility of a PDA and Paper and Pencil (P&P) registers to record dietary and physical activity in a sample of Spanish adolescents with overweight. METHODS: Sample was composed by 30 overweight participants aged 9-15 years seeking for obesity treatment. This is a counterbalance study, all participants completing both experimental conditions: PDA and P&P registers. RESULTS: For dietary records, participants filled out more records using P&P than PDA when "total" number of self-registers was considered, but when "complete" records were taken into account, these differences disappeared, and when percentages of "complete" records were analyzed, PDA produced more accurate registers than P&P. For physical activity, PDA produced more records than P&P. PDA was the preferred system. According to participants, the PDA´s strengths are the comfort, easiness to use and to transport. CONCLUSIONS: Results showed that P&P produced more incomplete dietary records than PDA. PDA is a reliable system that allows the clinician to be confident in the data recorded. Recently, several applications for mobile devices have been developed, but there are few studies supporting evidence of their efficacy and feasibility in assessment and treatment of childhood obesity. This study tries to provide some evidence in this field.

INTRODUCCIÓN: En los últimos años, la prevalencia de la obesidad infantil se ha incrementado de forma significativa. Los registros de ingesta y actividad física son considerados la "piedra angular" de los programas comportamentales de control del peso. Los dispositivos móviles, como las Personal Digital Assistant (PDAs), están mostrando su utilidad en la realización de estos registros. OBJETIVO: El presente estudio tiene como objetivo analizar y comparar la eficiencia y viabilidad de un sistema PDA y un sistema de Lápiz y Papel (P&P) para el registro de ingesta y movimiento físico en una muestra de adolescentes españoles con sobrepeso. MÉTODO: La muestra estuvo compuesta por 30 niños de entre 9 y 15 años con sobrepeso que asisten a un tratamiento para obesidad infantil. Se trata de un estudio contrabalanceado, por lo que los participantes completaron ambas condiciones experimentales: PDA y P&P. RESULTADOS: Considerando los registros de ingesta, cuando se consideran los registros "totales" los participantes realizaron más registros utilizando el sistema P&P que el sistema PDA, pero cuando se consideran los registros "completos", estas diferencias desaparecieron y al considerar el porcentaje de registros "completos", el sistema en PDA produjo más registros que el sistema P&P. Respecto a los registros de actividad física, el sistema PDA produjo más registros que el sistema P&P. La PDA fue considerada el sistema preferido por los participantes. De acuerdo con las opiniones de éstos, las potencialidades de la PDA es su comodidad, su facilidad de uso y de transporte. CONCLUSIONES: Los resultados obtenidos indican que el sistema P&P produce mayor cantidad de registros de ingesta incompletos que el sistema en PDA. La PDA es un sistema fiable que permite al clínico confiar en los datos registrados por los niños respecto a la ingesta y a la actividad física. Recientemente, se han desarrollado diversas aplicaciones para llevar a cabo registros en dispositivos móviles, pero aún son escasos los estudios disponibles que avalan la eficacia y viabilidad de estos sistemas para la evaluación y el tratamiento de la obesidad infantil. Este estudio pretende proporcionar evidencia al respeto.