P3.001: Adolescent perspectives on emotions and health behavior change intervention: A qualitative analysis

Background: Cardiovascular disease (CVD) prevention starts in childhood, with pediatric guidelines recommending intensive behavioral interventions to address CVD risk. However, such interventions are burdensome, in short supply, and evidence of their efficacy is limited in adolescents. Adolescence is a unique developmental transition with growing independence, temporarily heightened emotional intensity, and maturation of self-regulation. Emotion is likely a key mechanism underlying behavior change in this population, and engaging emotional regulation in interventions may improve efficacy in adolescents. Yet little is understood regarding adolescents’ perceptions of the relationship between emotions and health behavior.
Further, adolescents’ ubiquitous technology use may allow for virtual, largely self-guided interventions with lower burden and greater scalability. However, it is unknown how acceptable and relevant adolescents would find virtual, self-guided materials focused on emotions and health behavior change. This study qualitatively explored adolescents’ perspectives on the role of emotions in enacting health behaviors and their preferences in engaging virtually with intervention materials on these topics.

Methods: We recruited a diverse group of adolescents (aged 12-17 years) with BMI≥85th percentile for age and sex with at least one CVD risk factor out of hypertension, dyslipidemia or prediabetes/type 2 diabetes mellitus. We conducted 1:1, virtual “design sessions” during which participants interacted with emotion-related, self-guided stimuli (e.g., videos, prompts, case studies) adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents. Participants responded to semi-structured interview questions regarding concept comprehension, relevance of topics to them and their health behaviors (e.g., diet, exercise, sleep), engagement strategies, and presentation. Sessions were recorded, transcribed, and analyzed using a rapid analysis approach.

Results: A total of twelve adolescents completed sessions (42% female gender, mean age 14 years, 33% White, 33% Hispanic, 33% Black/African American). Rapid qualitative analysis revealed four themes: 1) Adolescents perceive a bidirectional relationship between emotions and health behaviors, readily identifying how negative emotions lead to poor health behaviors and how poor health behaviors in turn affect emotions. 2) Adolescents desire detailed, action-oriented solutions that they can implement immediately. 3) Adolescents prefer a variety of case study perspectives with many characters and diverse backgrounds to maximize relatability and depict diverse experiences. 4) Adolescents respond differently to expert and peer intervention delivery, with each playing a unique role in explaining concepts and providing relatable examples.

Conclusion: Diverse adolescents aged 12-17 years approached intervention materials already recognizing that emotions and health behaviors influence each other, drawing from personal experiences. Findings suggest acceptability, relevance, and possible efficacy of harnessing emotional mechanisms to improve adolescent health behaviors. Virtual, self-guided interaction with emotion and health behavior materials was acceptable to adolescents, especially when materials provided concrete action steps, included a variety of perspectives and examples, and drew from both expert knowledge and peer experiences.