A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data

The LifeCycle Project-EU Child Cohort Network : a federated analysis infrastructure and harmonized data of more than 250,000 children and parents

Early life is an important window of opportunity to improve health across the full lifecycle. An accumulating body of evidence suggests that exposure to adverse stressors during early life leads to developmental adaptations, which subsequently affect disease risk in later life. Also, geographical, socio-economic, and ethnic differences are related to health inequalities from early life onwards. To address these important public health challenges, many European pregnancy and childhood cohorts have been established over the last 30 years. The enormous wealth of data of these cohorts has led to important new biological insights and important impact for health from early life onwards. The impact of these cohorts and their data could be further increased by combining data from different cohorts. Combining data will lead to the possibility of identifying smaller effect estimates, and the opportunity to better identify risk groups and risk factors leading to disease across the lifecycle across countries. Also, it enables research on better causal understanding and modelling of life course health trajectories. The EU Child Cohort Network, established by the Horizon2020-funded LifeCycle Project, brings together nineteen pregnancy and childhood cohorts, together including more than 250,000 children and their parents. A large set of variables has been harmonised and standardized across these cohorts. The harmonized data are kept within each institution and can be accessed by external researchers through a shared federated data analysis platform using the R-based platform DataSHIELD, which takes relevant national and international data regulations into account. The EU Child Cohort Network has an open character. All protocols for data harmonization and setting up the data analysis platform are available online. The EU Child Cohort Network creates great opportunities for researchers to use data from different cohorts, during and beyond the LifeCycle Project duration. It also provides a novel model for collaborative research in large research infrastructures with individual-level data. The LifeCycle Project will translate results from research using the EU Child Cohort Network into recommendations for targeted prevention strategies to improve health trajectories for current and future generations by optimizing their earliest phases of life.Peer reviewe

Preconception health and the life course approach to prevention of non-communicable diseases: Implications for informing policy and practice

The life course approach and developmental origins of health and disease (DOHaD) concepts suggest that early intervention in critical periods reduces the risk of developing non-communicable diseases (NCDs) in later life and prevents the intergenerational transmission of this risk. The preconception period is increasingly cited as a platform for preventive interventions, however, while international health organisations have recognised the importance of such early prevention, specific recommendations have not been made. This mixed-methods thesis aimed to explore the use of evidence from life course epidemiology in policy-making and health care practice, with a focus on the preconception period to prevent NCDs in later life and the transmission of risk across generations. The two main streams of implementation that underpinned this thesis were clinical practice and policy.For the clinical stream, a narrative review of reviews of preconception interventions highlighted that intervening in the preconception period can potentially prevent the intergenerational passage of risk of NCDs. In contrast, a rapid review of published and grey literature showed that most studies and policies adopting the life course approach targeted the pregnancy or early childhood periods. Additionally, there was a need for better measurement strategies as a range of indicators have been proposed to measure health outcomes for different life stages or diseases risks, but with no clear guidelines on how the life course approach can be operationalised through interventions or programmes.These reviews above informed the development of three subsequent studies. First, a qualitative study of obstetricians and midwives explored their understanding of DOHaD concepts and identified barriers and opportunities for intervening through routine clinical care for NCD prevention. Though understanding of the scientific findings from the field of DOHaD was high, practical factors such as lack of time, practitioners’ views on their role in preconception care and a lack of resources hindered translation in routine care. The second study comprised an online survey to test the acceptability of i.) a nutritional risk assessment tool and ii.) the routine discussion of nutrition and pregnancy intention between reproductive-aged women and healthcare practitioners in the UK. Results showed high acceptability for the tool. The discussion of nutrition and pregnancy intention was considered important, provided that the reasons for doing so were communicated clearly, in a non-stigmatising manner. Finally, a document analysis of meeting minutes and observations of five advocacy groups in the field of DOHaD showed that policy translation has been affected by the lack of a clear message on what needs to be done when communicating to the public and policy-makers. The study also revealed insights into several opportunities with recommendations on framing messages, key stakeholders, and the need to acknowledge the influence of wider determinants of health e.g., economic policies and the environment.Overall, the findings contribute to the understanding of how opportunities before and during pregnancy can be harnessed to prevent NCDs, improve women’s health and wellbeing and provide a better start to life for the next generation. A framework for implementing the life course approach is discussed and along with an overview of future work needed to address evidence gaps and improve the translation of evidence to policy and practice

Implications of the Developmental Origins of Health and Disease (DOHaD) concept for policy-making

With the rising burden of non-communicable diseases (NCDs) globally and recognition that NCD risk can be transmitted across generations, there is increasing reason for the Developmental Origins of Health and Disease (DOHaD) concept to inform international policies and guidelines. However, the concept has not yet been widely adopted in national policies and healthcare settings. Appropriate dissemination of evidence and possible solutions to the challenge of NCDs is needed to build awareness among stakeholders and policy-makers. In this article, we consider the key DOHaD messages and how they are communicated to stakeholders and policy-makers, emphasising the need for population-level interventions to be communicated in a socially just and non-stigmatising manner

The preconception period as a platform for preventing diabetes and non-communicable diseases

Increasing evidence suggests that parental risk factors for non-communicable diseases (NCDs) in the period before conception could affect their lifelong health and increase the risk of NCDs in the offspring. While many of these risks such as obesity, smoking and dietary patterns are influenced by wider socio-economic factors, screening and identification of risk factors can be conducted in the clinical setting to provide appropriate preventive interventions. This article discusses the role of health care practitioners in preventing the risk of NCDs and opportunities for action in the preconception period

Acceptability of the FIGO Nutrition Checklist in Preconception and Early Pregnancy to Assess Nutritional Status and Prevent Excess Gestational Weight Gain: A Study of Women and Healthcare Practitioners in the UK

Optimum nutrition and weight before and during pregnancy are associated with a lower risk of conditions such as pre-eclampsia and gestational diabetes. There is a lack of user-friendly tools in most clinical settings to support healthcare practitioners (HCPs) in implementing them. This study aimed to evaluate the acceptability of (1) using a nutrition checklist designed by the International Federation of Gynecology and Obstetrics (FIGO) for nutritional screening of women in the preconception and early pregnancy period and (2) routine discussion of nutrition and weight in clinical care. An online cross-sectional survey was conducted with women (aged 18–45) and HCPs (e.g., general practitioners, obstetricians, and midwives). Quantitative statistical analysis and qualitative content analysis were performed. The concept and content of the checklist were acceptable to women (n = 251) and HCPs (n = 47) (over 80% in both groups). Several barriers exist to implementation such as lack of time, training for HCPs, and the need for sensitive and non-stigmatizing communication. Routine discussion of nutrition was considered important by both groups; however, results suggest that nutrition is not regularly discussed in perinatal visits in the UK. The FIGO nutrition checklist presents a valuable resource for use in clinical practice, offering long-term and intergenerational benefits for both mother and baby

What quantitative and qualitative methods have been developed to measure the implementation of a life-course approach in public health policies at the national level?

A life-course approach to health and well-being has become a pillar in health policy-making; for example, Member States of the WHO European Region in the 2015 Minsk Declaration resolved to make greater use of a life-course approach in health policies. However, strategies for implementation of a life-course approach, and a plan for monitoring and evaluating this implementation, are lacking. This scoping review identified a lack of literature with a focus on measurement of the implementation of a life-course approach. The report provides suggestions from research on a life-course approach in public health interventions and national-level strategies that could aid policy-makers in developing a measurement framework. For example, Member States using a life-course approach in policy at a population level could report on existing interventions in key stages of the life-course using existing survey platforms and routinely collected quantitative data. Ideally, a monitoring and evaluation framework collecting data longitudinally across different life stages over time should be created for Member States

HCP’s and women’s survey data in support of the Southampton doctoral thesis 'Preconception health and the life course approach to prevention of non-communicable diseases: Implications for informing policy and practice'

Dataset with HCP&#39;s survey data, women&#39;s survey data and data used for qualitative content analysis (anonymised). This informed the PhD thesis entitled &quot;Preconception Health and the Life Course Approach to Prevention of Non-Communicable Diseases: Implications for Informing Policy and Practice&quot;. The data was collected through two online surveys in 2021and contains quantitative and qualitative data. Dataset available to bone fide researchers only - to request the data please complete the attached request form.</span