Process evaluation of a digital school-based intervention: lessons learned from the Health4Life study

Katrina E. Champion; Lauren A. Gardner; Bridie Osman; Siobhan O'Dean; Emily Hunter; Louise Thornton; Cath Chapman; Tim Slade; Nyanda McBride; Courtney Stewart; Matthew Sunderland; Leanne Hides; Steve Allsop; David R. Lubans; Belinda Parmenter; Bonnie Spring; Lyra Egan; Scarlett Smout; Maree Teesson; Nicola C. Newton

doi:10.1093/tbm/ibag060

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Process evaluation of a digital school-based intervention: lessons learned from the Health4Life study

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Process evaluation of a digital school-based intervention: lessons learned from the Health4Life study

Katrina E. Champion, Lauren A. Gardner, Bridie Osman, Siobhan O'Dean, Emily Hunter, Louise Thornton, Cath Chapman, Tim Slade, Nyanda McBride, Courtney Stewart, …

Translational Behavioral Medicine, Vol.16(1), pp.1-12

2026

DOI: https://doi.org/10.1093/tbm/ibag060

PMID: 42734936

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Abstract

prevention

school-based

intervention

implementation

risk behaviors

Background Process evaluations of preventive health interventions are essential for enhancing their implementation and impact. Purpose This study presents the process evaluation of Health4Life, a digital school-based program designed to modify multiple health risk behaviors among adolescents. Methods Data were derived from a cluster randomized controlled trial in 71 Australian secondary schools from 2019 to 2022, including data from 2085 students and 118 teachers. Based on the Medical Research Council guidance for process evaluations this study explored three key questions: (i) Was the Health4Life intervention delivered and received as intended? (ii) How did participants respond? and (iii) What contextual factors influenced implementation? Fidelity, dose and exposure to intervention components were assessed through teacher self-report and website analytics. Participant responsiveness included student and teacher acceptability, and factors associated with a positive program evaluation (i.e. students’ ratings of enjoyment, relevance, and utility). Contextual factors relating to schools and the intervention were assessed via teacher-reported open-ended feedback. The Consolidated Framework for Implementation Research (CFIR) was applied to support interpretation of findings. Results Fidelity to the online modules was high based on teacher self-report, but the dose received by students was moderate (62% full dose), and use of the supplementary components varied. Program acceptability was high, with most students (73%) and teachers (84%) rating Health4Life favorably overall. Key factors associated with a positive student evaluation were identifying as female, and having higher baseline knowledge of health risk behaviors, greater self-control and higher socioeconomic advantage. Qualitative data identified key contextual barriers and facilitators relating to program design, technology and school contextual issues. Conclusions These findings provide valuable insights to support the ongoing refinement and broader implementation of Health4Life. A set of recommendations are proposed to inform the future development, implementation, and evaluation of digital health interventions in school environments. Clinical Trial information The Health4Life study was pre-registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000431123).

Details

Title: Process evaluation of a digital school-based intervention: lessons learned from the Health4Life study
Authors: Katrina E. Champion (Corresponding Author) - The University of Sydney
Lauren A. Gardner - The University of Sydney
Bridie Osman - The University of Sydney
Siobhan O'Dean - The University of Sydney
Emily Hunter - The University of Sydney
Louise Thornton - The University of Sydney
Cath Chapman - The University of Sydney
Tim Slade - The University of Sydney
Nyanda McBride - Curtin University
Courtney Stewart - Curtin University
Matthew Sunderland - The University of Sydney
Leanne Hides - The University of Queensland
Steve Allsop - Curtin University
David R. Lubans - University of Newcastle Australia
Belinda Parmenter - University of the Sunshine Coast
Bonnie Spring - Florida State University
Lyra Egan - The University of Sydney
Scarlett Smout - The University of Sydney
Maree Teesson - The University of Sydney
Nicola C. Newton - The University of Sydney
Publication details: Translational Behavioral Medicine, Vol.16(1), pp.1-12
Publisher: Oxford University Press
Date published: 2026
DOI: 10.1093/tbm/ibag060
ISSN: 1613-9860
PMID: 42734936
Copyright note: © Society of Behavioral Medicine 2026. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Data Availability: De-identified data from this study are not available in a public archive. Requests for de-identified data from this study will be considered (as allowable according to institutional ethics committee standards) by emailing the corresponding author.
Grant note: The Health4Life Study was funded by the Paul Ramsay Foundation and the Australian National Health and Medical Research Council. K.E.C. was funded by a University of Sydney Horizon Fellowship. L.A.G. [#2033054], C.C. [#2026552], and M.T. [#1195284] were funded by NHMRC Investigator grants. L.T. was funded by a grant from the Medical Research Future Fund [MRF2017307]. B.S. was funded by U.S. National Institutes of Health R01 grant (DK125404).
Organisation Unit: Healthy Ageing Research Cluster; School of Health - Nutrition & Dietetics; School of Health - Sports & Exercise Science
Language: English
Record Identifier: 991261896202621
Output Type: Journal article

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