Background
Regular physical activity benefits youth physical, social, mental and emotional health, including psychological well-being, bone health and fitness [
1]. In contrast, low levels of physical activity are associated with the increased likelihood of cardiovascular disease risk factors including metabolic syndrome, higher waist circumference, and overweight/obesity [
2]. However, only 13% of Australian 12–14 year olds [
3] engage in 60 min of moderate- to vigorous-intensity physical activity (MVPA) every day - the current recommendation for health [
4]. Low guideline compliance has also been observed in other developed countries [
5‐
7]. Adolescence is an age where declines in physical activity levels are common [
8]. This is of particular concern as this life-stage represents a time where health inequities start to emerge, and these may extend into adulthood [
9]. For example, those living in socioeconomically disadvantaged areas are at a greater risk of declines in their activity levels [
10] and are less likely to meet national activity guidelines [
11]. Consequently, primary preventative measures targeting adolescents, particularly among those living in disadvantage, are warranted.
The majority of physical activity interventions in young people have targeted primary school children, with fewer initiatives designed specifically to increase activity levels in adolescents [
12,
13]. There is also a lack of intervention studies that have specifically targeted the promotion of activity levels of adolescents living in disadvantaged neighbourhoods [
14]. Of those conducted, a number targeted a single sex [
15‐
18] and most have used multicomponent approaches delivered through school-based settings [
15,
16,
19‐
21]. Such interventions can be resource-intensive, costly and are usually conducted in class, which can be difficult to implement due to an already crowded curriculum. All of these factors have a negative impact on the reach and sustainability of such approaches. In addition, existing approaches have often focused on sport [
13,
20,
21], which may not be appealing to inactive adolescents who have little or no involvement in organised sport [
22]. As such, there is a need for further research to examine non-curriculum based, lower resource intensive approaches for promoting physical activity levels in adolescents living in socioeconomically disadvantaged areas.
Recent technological advances provide an alternative, yet underutilised opportunity for promoting physical activity in youth. Wearable activity trackers (e.g. Fitbit®, Garmin®, etc.) are self-monitoring tools that have the capacity to track physical activity in real-time and provide individualised feedback against set goals and physical activity recommendations. They are accompanied by apps and/or web-based portals that incorporate a range of behaviour change techniques, including social support, prompts/cues, biofeedback, and focus on past successes [
23,
24]. Notably, such technologies have considerable mass market appeal, are increasingly popular, and are being widely adopted across all age and socioeconomic groups [
25]. For example, in the US, one in 10 adults own an activity tracker and ~60% continue to use it after 12 months [
26]. In Australia, 20% of adults own a wearable activity tracker [
25]. Whilst there are no data available concerning adolescent ownership or use of activity trackers, these technologies are likely to have substantial appeal to youth as they are often early adopters of new technologies [
27]. Despite this, little research has examined whether these devices can be effectively utilised to increase physical activity among adolescents [
28]. The majority of interventions using such devices have focused on adults, with mixed evidence concerning the efficacy of wearable devices for increasing overall activity levels [
24,
29,
30].
Some research has suggested that wearable activity trackers can motivate individuals to make enduring changes to their daily activity [
31]. However, several recent studies conducted with adults have questioned the value of such devices for promoting physical activity levels, suggesting that self-monitoring alone may not be sufficient to increase activity levels and that additional support may be required to help change behaviour [
29,
32]. Online programs (e.g., web-based programs providing social support, tailored programs), social media platforms (e.g., Facebook groups), and digital resources such as videos, images, and infographics may help to overcome this limitation and educate and provide individuals with behaviour change techniques and skills. In addition, online programs have significant advantages in that they are able to reach a large target audience, are readily accessible, and use social connections and networks to engage and motivate participants [
33]. Since recent data suggest that 96% of adolescents in this target age group have home internet access [
34], and Facebook is the most popular and frequently used social media platform [
35], integrating wearable activity trackers with digital behaviour change resources hosted online on social media platforms may be one intervention strategy that can positively influence physical activity levels in this target group.
This paper provides a rationale and description of the Raising Awareness of Physical Activity (RAW-PA) Study protocol; an innovative physical activity intervention that combines wearable activity trackers with online digital behaviour change resources for inactive adolescents attending schools in socioeconomically disadvantaged areas.
Aims
The primary aim of RAW-PA is to examine the short- and longer-term impact of a wearable activity tracker combined with behaviour change resources on adolescents' daily MVPA. In order to understand patterns of change in activity levels (e.g., How do activity intensities change? When during the day do changes occur?), this study will evaluate the short- and longer-term impact on sitting time and MVPA across the whole day and during periods of the day (e.g., school hours). In addition, given the scarcity of evidence with this target population, this study will evaluate the impact of the intervention on potential mediators (e.g. self-efficacy, social support, etc.) to examine how the intervention effected change. Lastly, this study will examine process factors (feasibility, acceptability/appeal, fidelity).
Discussion
Physical activity is an integral component of a healthy lifestyle. However, as only 13% of 12–14 year olds in Australia currently engage in sufficient daily physical activity to benefit their health, there is a need for efficacious strategies to increase activity levels. This is particularly true for adolescents living in socioeconomically disadvantaged areas who are an underrepresented group in physical activity interventions [
14]. This is despite the fact that disadvantage is linked with declines in physical activity during the teenage years [
10] and a greater risk of poor health outcomes across the life course [
9]. To date, only a small number of studies have delivered interventions specifically targeting adolescents living in socioeconomically disadvantaged areas, and limited effects on physical activity levels have been observed [
15,
16,
18,
20,
67].
The aim of RAW-PA, a 12 week multicomponent intervention, is to examine the effectiveness of a wearable activity tracker combined with behaviour change resources to promote physical activity in inactive adolescents attending schools in socioeconomically disadvantaged areas. It intends to capitalise on the increasing pervasiveness, appeal, and rapid uptake of wearable activity trackers, and the opportunities these devices bring to physical activity and health promotion research. RAW-PA will provide insights into how such technologies are used by adolescents, addressing an important gap in the literature to date [
68]. It will identify whether combining self-monitoring via the wearable activity tracker and the accompanying resources, which are designed to help students learn and develop key behaviour change techniques, will help the adolescents to change and maintain changes in active behaviours. Moreover, utilising individual and team ‘missions’, encouraging participants to share tips for increasing activity levels, and the focus on the accumulation of physical activity every day may address potential contextual barriers often faced by those from socioeconomically disadvantaged backgrounds, such as a lack of social support, financial constraints and safety concerns [
14].
An important aspect of this study is that the potential applications of the research findings, including translation and broader dissemination, have been considered. The translational aspect is often an overlooked component of behaviour change programs [
69,
70]. Firstly, whilst this trial is being evaluated in urban areas of Melbourne, the online delivery of the intervention facilitates potential reach into regional and rural areas. Secondly, the intervention is being delivered via a popular social media platform, highly accessed by adolescents, and has been designed to be flexible, readily accessible and interactive. This social element addresses a key motivator for physical activity in those from socioeconomically disadvantaged areas [
14]. Thirdly, as mobile phone use and internet access is ubiquitous in Australia, including in disadvantaged areas [
34], this study had the potential to address potential inequities in access to structured resources often experienced by adolescents living in disadvantaged areas [
71]. Since inexpensive trackers are increasingly available and costs are continuing to decrease, this may facilitate accessibility to a broader range of consumers.
This study has some limitations. Due to the multicomponent nature of the study, the effect of each individual component will not be able to be determined; though it is possible to assess the appeal and perceived effectiveness of each component via process evaluation. Second, a specific wearable activity tracker – the Fitbit® Flex - will be used. As the wearable activity tracker market is highly competitive and new devices are constantly being produced and marketed, it is possible the Flex will be superseded or become obsolete over the course of the study. However, there is no reason why the findings from this study will not be generalisable to other high quality, low cost devices that are available or will likely become available in the future.
Acknowledgements
The research team would like to thank Leanne Tiffen for her contribution to the pilot study that informed this project.