针对德国职业学校学生的基于应用程序的成瘾预防项目中的预防需求和目标行为偏好：整群随机对照试验

Prevention Needs and Target Behavior Preferences in an App-Based Addiction Prevention Program for German Vocational School Students: Cluster Randomized Controlled Trial.

作者信息

Guertler Diana, Kraft Elaine, Bläsing Dominic, Möhring Anne, Meyer Christian, Schmidt Hannah, Rehbein Florian, Neumann Merten, Dreißigacker Arne, Bischof Anja, Bischof Gallus, Sürig Svenja, Hohls Lisa, Wurm Susanne, Borgwardt Stefan, Haug Severin, Rumpf Hans-Jürgen

机构信息

Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.

DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.

出版信息

JMIR Mhealth Uhealth. 2025 Jun 24;13:e59573. doi: 10.2196/59573.

DOI:10.2196/59573

PMID:40553509

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12238790/

Abstract

BACKGROUND

Vocational school students exhibit a high prevalence of addictive behaviors. Mobile phone-based prevention programs targeting multiple addictive behaviors and promoting life skills are promising. Tailoring intervention content to participants' preferences, such as allowing them to choose behavior modules, may increase engagement and efficacy. There is limited understanding of how personal characteristics relate to module choices.

OBJECTIVE

This study examined the prevention needs of German vocational school students as well as their prevention preferences through self-determined module choice in the multibehavior app-based addiction prevention program ready4life.

METHODS

A 2-arm cluster randomized controlled trial recruited German vocational school students aged ≥16 years. Among 376 classes from 35 schools, ready4life was introduced during a school lesson. Students were invited to download the ready4life app and completed an anonymous screening with individualized risk and competence feedback in the form of a traffic light system. Informed consent was provided by 2568 students. Intervention classes received individual app-based coaching with weekly chat contacts with a conversational agent over 4 months. They could choose 2 of 6 modules: alcohol, tobacco, cannabis, social media and gaming, stress, and social competencies. Control group classes received a link to health behavior information and could access coaching after 12 months.

RESULTS

Prevention need was high. For 86.2% (2213/2568), ≥2 risks were reported based on yellow or red traffic light feedback. Within the intervention group, stress (818/1236, 66.2%) and social media and gaming (625/1236, 50.6%) were the most chosen topics, followed by alcohol (360/1236, 29.1%), social competencies (306/1236, 24.8%), tobacco (232/1236, 18.8%), and cannabis (131/1236, 10.6%). Module choices closely aligned with received traffic light feedback among those with 1 or 2 risks. Multilevel regression models showed that women were significantly more likely to choose the stress module (odds ratio [OR] 2.38, 95% CI 1.69-3.33; P<.001); men preferred social media and gaming (OR 0.52, 95% CI 0.40-0.69; P<.001), alcohol (OR 0.50, 95% CI 0.37-0.67; P<.001), and cannabis (OR 0.37, 95% CI 0.21-0.63; P<.001) when holding age, educational track, and prevention need for the corresponding behavior constant. Younger students were significantly more likely to choose the cannabis module (OR 0.81, 95% CI 0.74-0.90; P<.001). Educational track also influenced module choice (eg, those with a lower educational level were more likely to choose alcohol and cannabis, suggesting a positive equity impact). Students' prevention needs significantly influenced choice of the module (eg, higher alcohol consumption increased the likelihood of choosing the alcohol module; OR 1.31, 95% CI 1.20-1.43; P<.001).

CONCLUSIONS

Our study confirms vocational school students' high prevention needs regarding addictive behaviors. Students' module choices were highly congruent to their demonstrated needs, with most students being interested in the stress module. Module choice also differed by age, gender, and educational track.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00022328; https://drks.de/search/en/trial/DRKS00022328.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1024/0939-5911/a000811.

摘要

背景

职业学校学生成瘾行为的发生率较高。针对多种成瘾行为并提升生活技能的基于手机的预防项目前景广阔。根据参与者的偏好来定制干预内容，比如让他们选择行为模块，可能会提高参与度和效果。对于个人特征与模块选择之间的关系，人们了解有限。

目的

本研究通过在基于应用程序的多行为成瘾预防项目ready4life中让德国职业学校学生自主选择模块，来考察他们的预防需求以及预防偏好。

方法

一项双臂整群随机对照试验招募了年龄≥16岁的德国职业学校学生。在35所学校的376个班级中，在一堂学校课程期间引入了ready4life。邀请学生下载ready4life应用程序，并通过交通信号灯系统的形式完成一份带有个性化风险和能力反馈的匿名筛查。2568名学生提供了知情同意书。干预班级接受基于应用程序的个性化辅导，并在4个月内通过与对话代理每周进行聊天联系。他们可以从6个模块中选择2个：酒精、烟草、大麻、社交媒体与游戏、压力以及社交能力。对照组班级收到健康行为信息链接，并在12个月后可以获得辅导。

结果

预防需求很高。基于黄色或红色交通信号灯反馈，86.2%（2213/2568）的学生报告了≥2种风险。在干预组中，压力（818/1236，66.2%）和社交媒体与游戏（625/1236，50.6%）是最常被选择的主题，其次是酒精（360/1236，29.1%）、社交能力（306/1236，24.8%）、烟草（232/1236，18.8%）和大麻（131/1236，10.6%）。在有1种或2种风险的学生中，模块选择与收到的交通信号灯反馈密切相关。多水平回归模型显示，在年龄、教育路径和相应行为的预防需求保持不变的情况下，女性选择压力模块的可能性显著更高（优势比[OR]2.38，95%置信区间1.69 - 3.33；P<.001）；男性更喜欢社交媒体与游戏（OR 0.52，95%置信区间0.40 - 0.69；P<.001）、酒精（OR 0.50，95%置信区间0.37 - 0.67；P<.001）和大麻（OR 0.37，95%置信区间0.21 - 0.63；P<.001）。年龄较小的学生选择大麻模块的可能性显著更高（OR 0.81，95%置信区间0.74 - 0.90；P<.001）。教育路径也影响模块选择（例如，教育水平较低的学生更有可能选择酒精和大麻，表明有积极的公平影响）。学生的预防需求显著影响模块选择（例如，较高的酒精消费量增加了选择酒精模块的可能性；OR 1.31，95%置信区间1.20 - 1.43；P<.001）。