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Behaviour change interventions targeting physical activity, diet, sleep and sedentary behaviour of teenagers show promise when delivered through smartphones. However, to date there is no evidence of effectiveness of multicomponent smartphone-based interventions. Utilising a user-centred design approach, we developed a theory-based, multi-dimensional system, PEGASO Fit For Future (PEGASO F4F), which exploits sophisticated game mechanics involving smartphone applications, a smartphone game and activity sensors to motivate teenagers to take an active role in adopting and maintaining a healthy lifestyle. This paper describes the study protocol to assess the feasibility, usability and effectiveness (knowledge/awareness and behavioural change in lifestyle) of the PEGASO system.We are conducting a quasi-experimental controlled cluster trial in 4 sites in Spain, Italy, and UK (England, Scotland) over 6 months. We plan to recruit 525, in a 2:1 basis, teenagers aged 13-16 years from secondary schools. The intervention group is provided with the PEGASO system whereas the comparison group continues their usual educational routine. Outcomes include feasibility, acceptance, and usability of the PEGASO system as well as between and within group changes in motivation, self-reported diet, physical activity, sedentary and sleeping behaviour, anthropometric measures and knowledge about a healthy lifestyle.PEGASO F4F will provide evidence into the cross-cultural similarities and differences in the feasibility, acceptability and usability of a multi-dimensional smartphone based behaviour change intervention for teenagers. The study will explore facilitating factors, challenges and barriers of engaging teenagers to adapt and maintain a healthy lifestyle when using smartphone technology. Positive results from this ICT based multi component intervention may have significant implications both at clinical level, improving teenagers health and at public health level since it can present an influential tool against the development of chronic disease during adulthood.https://clinicaltrials.gov Registration number: NCT02930148, registered 4 October 2016.

Background Behaviour change interventions targeting physical activity, diet, sleep and sedentary behaviour of teenagers show promise when delivered through smartphones. However, to date there is no evidence of effectiveness of multicomponent smartphone-based interventions. Utilising a user-centred design approach, we developed a theory-based, multi-dimensional system, PEGASO Fit For Future (PEGASO F4F), which exploits sophisticated game mechanics involving smartphone applications, a smartphone game and activity sensors to motivate teenagers to take an active role in adopting and maintaining a healthy lifestyle. This paper describes the study protocol to assess the feasibility, usability and effectiveness (knowledge/awareness and behavioural change in lifestyle) of the PEGASO system. Methods We are conducting a quasi-experimental controlled cluster trial in 4 sites in Spain, Italy, and UK (England, Scotland) over 6 months. We plan to recruit 525, in a 2:1 basis, teenagers aged 13–16 years from secondary schools. The intervention group is provided with the PEGASO system whereas the comparison group continues their usual educational routine. Outcomes include feasibility, acceptance, and usability of the PEGASO system as well as between and within group changes in motivation, self-reported diet, physical activity, sedentary and sleeping behaviour, anthropometric measures and knowledge about a healthy lifestyle. Discussion PEGASO F4F will provide evidence into the cross-cultural similarities and differences in the feasibility, acceptability and usability of a multi-dimensional smartphone based behaviour change intervention for teenagers. The study will explore facilitating factors, challenges and barriers of engaging teenagers to adapt and maintain a healthy lifestyle when using smartphone technology. Positive results from this ICT based multi component intervention may have significant implications both at clinical level, improving teenagers health and at public health level since it can present an influential tool against the development of chronic disease during adulthood. Trial registration https://clinicaltrials.gov Registration number: NCT02930148, registered 4 October 2016.

Background: The prevalence of adolescent obesity is high in the UK. Engaging adolescent boys and girls in health behaviour related to the prevention of obesity proves to be challenging. Mobile and wireless technology shows promise for increasing knowledge and motivation to increase physical activity and healthy eating by capturing the interest of many adolescents. However, solutions for overcoming the novelty effect to enable habit formation and thus long-lasting behaviour change needs to be explored. Aim: This study aimed to explore Scottish adolescents’ perception of the usability and acceptability of a serious mobile game, wearable activity sensors and a smart phone eDiary application (app) for promoting physical activity and healthy eating.Methods: The game, sensors and app are being developed following the COM-B model of the Behaviour Change Wheel. The technology is interlinked in that physical activity tracked by the wearable activity sensors and healthy eating captured by using the eDiary app are central to recover the player’s energy levels in the serious game. The player replenishes their in-game energy to progress in the game and to boost abilities. Applying a user-centred approach for developing the technology, 11 adolescents aged 13-16 years (6 boys, 5 girls) participated in semi-structured focus groups. This was the first of three pre-pilot study iterations. Mock-up versions of the serious mobile game, wearable activity sensors and the prototype of the eDiary app were presented. Focus groups were audio-recorded, transcribed and thematically analysed.Results: All adolescents responded positively to the general idea of the game and all were keen to play the actual game once developed. Adolescents understood the importance and novelty of the link between player’s real-life health behaviours and in-game activities for improving obesity-related health behaviour. It became evident that the adolescents would only be motivated to be more physically active and eat healthily for the benefits of the game and not for improving their health and wellbeing. To increase their interest in the game, adolescents reported that they wanted to receive in-game rewards for engaging in health behaviour. A recurrent topic was the desire for more challenges in the game via introduction of new characters and environments. Another dominant topic was to have options of varying story lines, to reset the game and to unlock secret levels. The adolescents believed that being sufficiently challenged and having choices would increase their interest in the game, keep them interested for longer and so this would encourage them longer to be physically active and eat healthily.Conclusion: Mobile game and wireless technology connecting in-game and real-life activities were perceived to increase physical activity and healthy eating in adolescents. To allow exposure to mechanisms of behaviour change for an adequate amount of time, the novelty effect of new technology needs to be sustained. Age-appropriate in-game challenges, rewards and choices might trigger adolescents’ interests in the technology for longer. This in turn might result in long-lasting behaviour changes independently of playing the game.