Study protocol of the Healthy High School study: a school-based intervention to improve well-being among high school students in Denmark

• Published in: BMC public health Vol. 20; no. 1; pp. 95 - 16
• Main Authors: Bonnesen, Camilla Thørring, Toftager, Mette, Madsen, Katrine Rich, Wehner, Stine Kjær, Jensen, Marie Pil, Rosing, Johanne Aviaja, Laursen, Bjarne, Rod, Naja Hulvej, Due, Pernille, Krølner, Rikke Fredenslund
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22-01-2020; BioMed Central; BMC
• Subjects: Accelerometers; Adolescent; Behavior; Childhood stress (Psychology); Clusters; Data collection; Denmark; Diet; Economic analysis; Education; Environmental changes; Evaluation; Exercise; Female; Health aspects; Health Behavior; Health care; Health care reform; Health Education - organization & administration; Health promotion; Health Status; High school students; Humans; Influence; Intervention; Intervention (Psychology); Male; Mapping; Meal habits; Meals; Mental Health; Methods; Objectives; Peer Group; Physical activity; Physical fitness; Planning; Psychological aspects; Public health; Quality of life; Randomization; Randomized Controlled Trials as Topic; Recruitment; School Health Services - organization & administration; Schools; Secondary education; Secondary school students; Secondary schools; Sedentary behavior; Sedentary behaviour; Short message service; Sleep; Sleep - physiology; Social aspects; Social Participation; Stress; Stress, Psychological - prevention & control; Students; Studies; Study Protocol; Teachers; Teenagers; Theory; Time; Well being; Workshops (Educational programs); World health; Denmark; Study design; Sleep; Well-being; Physical activity; Sedentary behaviour; Randomised controlled trial; Meal habits; Sense of community; Stress; High school
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-020-8194-y

The prevalence of low well-being, perceived stress and unhealthy behaviours is high among high school students, but few interventions have addressed these problems. The aim of this paper is to present a study protocol of a cluster randomised controlled trial evaluating the Healthy High School (HHS) intervention programme. The intervention programme is designed to improve well-being (primary outcome) by preventing 1) stress and promoting 2) sleep, 3) sense of community, 4) physical activity (PA) and 5) regular and healthy meals among high school students in Denmark.
The development of the HHS study was guided by the Intervention Mapping protocol. The intervention comprises four components: 1) a teaching material, 2) a smartphone app, 3) a catalogue focusing on environmental changes, and 4) a peer-led innovation workshop aiming at inspiring students to initiate and participate in various movement activities. The HHS study employs a cluster-randomised controlled trial design. Thirty-one high schools across Denmark were randomly allocated to intervention (16 schools) or control (15 schools) groups. The study included all first-year students (~ 16 years of age) (n = 5976 students). Timeline: Intervention: August 2016 - June 2017. Collection of questionnaire data: Baseline (August 2016), 1st follow-up (May 2017) and 2nd follow-up (April 2018). All students were invited to participate in a monthly sub-study about perceived stress using text messages for data collection (September 2016 - June 2017). PA was objectively assessed among a sub-sample of students using accelerometers (Axivity, AX3) in August 2016 and May 2017.
Student well-being measured by the Cantril Ladder and the five item World Health Organisation Well-being Index (individual level outcomes).
Stress (10-item Perceived Stress Scale), sleep (quantity and quality), PA (hours of moderate-to-vigorous PA per week, hours of daily sedentary time and average daily PA), meal habits (daily intake of breakfast, lunch, snacks and water), and strong sense of community in class and at school, respectively (individual level outcomes). The study encompasses process and effect evaluation as well as health economic analyses.
ISRCTN ISRCTN43284296, 28 April 2017, retrospectively registered.