iEngage: A digital health education program designed to enhance physical activity in young adolescents

Abstract

iEngage is a modular health education and behavioural change program designed to help adolescents increase moderate to vigorous physical activity (MVPA). The program is delivered through the iEngage app which integrates activity trackers data (Misfit Ray©) within 10 interactive learning modules. Key features include guidance to set goals, self-monitor and assess achievements, and experiential learning via the connected activity trackers which allows for continuous steps recording during the program. iEngage was implemented in two schools over 5 weeks with 10-12 years old adolescents (n = 57) and PA outcomes compared to control group (n = 26). Results show that adolescents successfully set goals and self-assessed achievements during the program, progressing toward higher physical activity (PA) levels as shown by the 30% increase in daily steps through the program (+ 2647 steps/day, P < .001) with boys increasing goals and achievements faster than girls. The consistency in days totalling at least 11,000 steps/day increased from 35% at the start to 48% at the end of the program. The increase in PA is confirmed through the assessment of MVPA during schooldays pre- and post- program via research grade wrist accelerometers in both iEngage and control participants. Contrasting with the control group, MVPA was increased in the week following the program (~+5 min/day, P = .023) in short bouts, particularly during lunch time, recess and after school. This study shows that a digital program integrating activity trackers data, health education, goals setting and self-monitoring of PA, helped young adolescents enhance PA goals, improve achievements and increase MVPA.

Fig 1. iEngage structure.

Description of the content of each module and the progression through the various stages of behaviour change. Panel A: Individual goal setting (daily steps goals and missions) started in module 2. Panel B: Mapping of each module content with behavioural change techniques. Panel C: mapping with the Australian physical literacy framework. Each square represents an activity which is colour coded to show mapping with the framework. Panel D: mapping of all activities within each module across the program. Each activity is coded as per the legend.

Fig 2. iEngage design.

Design of the iEngage app interface and overview of the user experience. The iEngage kit including a tablet, a Misfit Ray activity tracker, earphones and a booklet (A). The digital environment supporting the diverse activities (B to H) included a welcome screen displaying learning objectives (B), health education, quiz and badges reward (C), synchronisation with trackers (D), self-assessment and goals setting (E) that included visuals of daily steps and time spent in MVPA, experiential learning (F), goals setting and mission (G) and the iEngage journey mapping showing progress toward the iEngage secret message (H).

Fig 3. Goals setting.

Panel A: average daily steps goals set by adolescents over the course of the program for each module. Goals increased from module 2 to module 10 (Wilks’ Lambda F(8,17) = 91.1, P<0.001). There was a significant gender effect (F(1, 24) = 4.46, P<0.05) with boys aiming for higher daily steps goals. Panel B: proportion of adolescents choosing a given step goal for each module. Note: From M6, goals also included a minimum amount of MVPA (10,000 steps and at least 15 min MVPA, 11,000 steps and at least 15 min MVPA, 12,000 steps and at least 30 min MVPA). All: all participants (n = 57), B: boys (n = 28), G: girls (n = 29).

Fig 4. Self-reported achievements.

Daily steps reported by the adolescents in each module. The step value reported for each module is the average of daily steps performed during the 2 or 3 previous days (between 2 modules). Panel A: averaged daily steps goals and achievements reported by adolescents in the app as part of each module’s self-monitoring activities. Panel B: proportion of days on which individual step goals were achieved (based on self-report of step data). Panel C: % of days on which 11,000 steps/d were achieved calculated from self-reported step data. **: P<0.01, Chi Square test. Compared to predicted form M2 (30% Yes and 70% No). All: all participants (n = 57), B: boys (n = 28), G: girls (n = 29).

Fig 5. Self-assessment of achievements.

Self-assessment of individual step goals achievements (A) and completion of missions (B) during the program (Inc: incomplete, no answer to the question). Results are expressed as percentage of participants. There was no significant difference between boys’ and girls’ report of achievements based on individual goals. All: all participants (n = 57), B: boys (n = 28), G: girls (n = 29).

Fig 6. Objective PA data extracted from the Misfit trackers integrated in the platform or GENEactiv acidity trackers.

Panel A: daily steps in all students, girls and boys, during the 5 weeks of the iEngage program. Panel B: consistency (%) of daily steps displaying at least 11,000 steps) over the course of the program. Panel C: hourly average of physical activity per intensity category (SED, light and MVPA) measure by GENEactiv trackers pre and post program from 8am to 8pm. This shows patterns of PA before and after the iEngage program during a school day. All: all participants (n = 57), B: boys (n = 28), G: girls (n = 29).