Impact and learning
The EACH-B programme aimed to design, implement and evaluate a multicomponent health behaviour change intervention for young people in the UK all of which it has achieved. This work has been conducted on time and on budget (a 12-month no-cost extension, covering the period 1 January 2024–31 December 2024 was awarded due to delays in the project caused by the COVID-19 pandemic). The programme allowed us to engage thousands of young people in meaningful health research, across the development work, the RCT, the process evaluation and various satellite projects.
Production of a series of outputs and activities for dissemination to schools meant the following have been distributed to all schools who took part in EACH-B:
- a 10-minute professionally produced documentary-style film detailing the aims and key findings of EACH-B
- a poster describing the findings of EACH-B
- lesson plans for schools to deliver lessons to their students to discuss and evaluate the findings, and to conduct an analysis of data similar to those collected as part of EACH-B.
Engagement with the stakeholder community, including young people, is being continued through the NxtGen Researcher Training Programme and the UKRI-funded Pathways to Health Consortium.
Main success of the programme
The EACH-B programme successfully developed and tested a complex intervention to improve the diets and PA levels of young people aged 12–14 years. Despite running through the years of the COVID-19 pandemic, the programme met all of its objectives and completed the trial in schools. Collecting data from 45 schools and over 2000 students during such a challenging time for schools is a recognised success for the programme. Evidence synthesis and stakeholder engagement informed a sophisticated process of intervention development, generating data that not only informed elements of EACH-B but also provided a basis for all our knowledge translation and subsequent research with young people. Our process evaluation of the trial has been remarkably informative about both challenges and opportunities inherent in working in schools. We have contributed 18 published papers in peer-reviewed journals, another 2 which are with journals awaiting editorial decisions, a huge number of conference presentations and posters and 4 doctoral theses, and, in addition, a host of other less-traditional research outputs. Our research indicates that interventions have to support young people’s basic need for autonomy, competence and relatedness to be effective and that the key to involving young people in promoting their health and well-being is to offer activities that are meaningful and that support them in achieving their aspirations for the future.
Implications for decision-makers
Creating meaningful engagement opportunities is the basis for all dissemination, engagement with decision-makers, including establishing the UKRI-funded Pathways to Health Consortium, an extensive network of local government and third-sector stakeholders involved with young people across Southampton and the Wessex region. The consortium continues to work with local infrastructure, such as the NIHR Health Determinant Research Collaboration in Southampton, to involve young people in local policy and practice decision-making. Another substantial success is the NxtGen Researcher training, a programme designed by young people for young people to develop their skills in generating evidence-based policy ideas, to understand the science behind the health messages they see and hear, collect data from peers, and have confidence to advocate for change (see Patient and public involvement and engagement). Our latest roll-out of this training programme culminated in a youth jury where young people cross-examined policy-makers from the Hampshire and Isle of Wight ICB and ICP on youth health policy and practice, producing collective learning and a Young People’s Manifesto for Change. The manifesto contains twelve policy recommendations based on young people’s research and evidence which aim to improve young people’s health and well-being. The document was agreed and endorsed by health leaders for the ICB and ICP with responsibility for health and social care policy and implementation in the UK. The NxtGen Researcher Training Programme is being rolled out to other under-represented groups in urban and rural settings, and our young people have been commissioned by Southampton City Council to develop a Southampton Youth Voice service. In this way, EACH-B has already had impact on youth health policy and practice and has, therefore, extensive implications for decision-makers.
Recommendations for research
The major recommendation from our work on the EACH-B programme is that activity intended to motivate young people in improving their health and well-being has to be meaningful to them and engaging. Activities have to offer them something they value. What we have established is that young people do indeed value health and well-being but that other parts of their lives have a more immediate imperative. Developing friendships and social networks, establishing themselves as autonomous and competent human beings, are both of higher priority for them than protecting themselves from ill health that they may experience as older adults.
Many hours of conversation in interviews, focus groups and group work with young people have suggested that the way forward is to support young people in activities and towards goals that matter to them and to do this in experiential, ‘hands-on’ ways. This is what we mean by activities that are meaningful to them, engaging and providing them with skills or other capacities that they value. Our NxtGen Researcher Training Programme is an illustration of this principle.
We have a number of specific recommendations for research that draw on this approach to working with young people:
Recommendation for research number 1
We as a community need to find effective ways to support young people in meaningful and engaging activities, such as LifeLab and the NxtGen Researcher Training Programme. There is substantial evidence that young people do not find interventions that make direct appeals to them to improve their health and well-being engaging. Our systematic reviews identified that their effectiveness is therefore limited. We need to find new ways to make these appeals more engaging.
Recommendation for research number 2
We need to develop new methods for evaluating the long-term impact of these activities on their health and well-being. The trial of the EACH-B intervention was designed using classic trial design principles. There is increasing evidence that such designs are not appropriate for evaluating impact of large-scale public health interventions where so few of the conditions in which the research is taking place can be controlled. Woods-Townsend is currently involved in piloting methods of using routinely collected data to track outcomes for young people who have been through programmes such as LifeLab and the NxtGen Researcher Training Programme. Funders of research need to support new ways of evaluation outcomes for interventional programmes like these.
Recommendation for research number 3
Involve young people as researchers in studies that are about young people’s health and well-being. Young people are more likely to speak openly to other young people about issues that concern them than they are to adult researchers with whom they may have no prior relationship. If we involve young people in setting the RQs to be answered as well as designing the interventions, then we may have more success in developing interventions in addressing issues which are actually important to young people in a way that they will actually engage with.
Recommendation for research number 4
Build research consortia of local government and third-sector organisations to develop and test system-wide solutions to young people’s health and well-being. Do this work with young people. EACH-B worked primarily with schools and the local educations and public health departments. Insights from the other stakeholders were sought but only at specific time points. Establishing the Pathways to Health Consortium in 2023 enabled more consistent and active engagement in improving policy and practice in young people’s health and well-being. EACH-B communications with parents were largely ineffective. Working with this large consortium to develop the intervention from the start of the programme might have situated the intervention in schools in an environment which was more genuinely enabling of behaviour change.
Recommendation for research number 5
Continue to conduct public health research in schools but recognise that schools will not be able to facilitate this unless it meets their curriculum needs. Research studies have to offer address education priorities if schools have to be able to justify making time for them in a packed national curriculum; teachers enjoyed and understood the value of healthy conversations with their students but simply could not find time for them. While teachers and schools might recognise challenges for young people in terms of health, unless it meets their curriculum needs or other priorities, such as mental health which they are increasingly mandated to address, they aren’t going to be able to justify giving curriculum time to the research we want to do.
Recommendation for research number 6
Digital platforms are clearly important in delivering public health interventions to young people. They are central to young people’s lives and hence cannot be ignored. We need, however, to understand much better how to use and engage with young people’s online lives. Our learning is that nothing that health researchers could design by way of new smartphone applications will compete with social media for young people’s attention or is likely to have the resources to be agile and responsive to constantly changing trends as the most engaging apps are. We need more research to help us understand how we can work with young people in a digital space to give them the support for their health and well-being they actually want and can use.