{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:07:32Z","timestamp":1790834852620,"version":"4.1.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016053","name":"Paul Ramsay Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016053","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Sydney Horizon Fellowship"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Disadvantaged adolescents, including those from lower socioeconomic status (SES) or geographically remote backgrounds, engage in higher rates of risk behaviours, including poor diet, alcohol and tobacco use. While digital interventions targeting lifestyle risk behaviours show potential, few studies have focused on their implementation and relevance for this population. This study conducted a process evaluation of \u2018Health4Life\u2019, a universal school-based digital program targeting multiple behaviours, among a sample of disadvantaged adolescents. Participants were from six schools classified as low SES (Index of Community Socio-educational Advantage percentile score \u2264 25%), and\/or regional using the Australian Statistical Geography Standard. Self-reported student (n = 214) and teacher evaluations (n = 16) assessed Health4Life\u2019s acceptability, with qualitative questions capturing areas for improvement. Teacher-reported implementation data (n = 16) measured intervention fidelity and feasibility. Quantitative data were analysed using descriptive statistics and open-ended responses were thematically analysed. Compared to the entire sample, this subset of students evaluated Health4Life less favourably (66% versus 75%), with fewer enjoying the stories (63% versus 75%) and planning to use the skills and information (60% versus 70%). Teacher evaluations were mostly positive and aligned closely with the entire sample. Fidelity data also indicated comparable levels of student engagement (~92% versus ~85%). Key themes for refinement included improving content relevance and technical execution to better resonate with disadvantaged adolescents. While teacher evaluations suggest Health4Life is a valuable program in low SES or regional contexts, students\u2019 lower ratings indicate refinements are needed. Identified areas for improvement will guide co-designing the program\u2019s adaptation to improve effectiveness and relevance for disadvantaged adolescents.<\/jats:p>\n               <jats:p>Trial registration: The Health4Life trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000431123).<\/jats:p>","DOI":"10.1093\/heapro\/daae170","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T15:06:56Z","timestamp":1732892816000},"source":"Crossref","is-referenced-by-count":5,"title":["Process evaluation of the digital Health4Life intervention among a sample of disadvantaged adolescents and teachers"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0922-4396","authenticated-orcid":false,"given":"Lyra","family":"Egan","sequence":"first","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, The University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A","family":"Gardner","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, The University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola C","family":"Newton","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, The University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina E","family":"Champion","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building, The University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"2024112915064861300_CIT0001","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1186\/s12889-020-09988-5","article-title":"Non-communicable diseases among adolescents: current status, determinants, interventions and policies","volume":"20","author":"Akseer","year":"2020","journal-title":"BMC Public Health"},{"key":"2024112915064861300_CIT0002","doi-asserted-by":"crossref","first-page":"e34229","DOI":"10.2196\/34229","article-title":"The barriers and facilitators of ehealth-based lifestyle intervention programs for people with a low socioeconomic status: scoping review","volume":"24","author":"Al-Dhahir","year":"2022","journal-title":"Journal of Medical Internet Research"},{"key":"2024112915064861300_CIT0003","doi-asserted-by":"crossref","first-page":"e13374","DOI":"10.1111\/obr.13374","article-title":"Do adolescents\u2019 experiences of the barriers to and facilitators of physical activity differ by socioeconomic position? 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