User experience, game satisfaction and engagement with the virtual simulation VR FestLab for alcohol prevention: A quantitative analysis among Danish adolescents.

VR FestLab is a virtual reality party simulation application. The tool allows users to make decisions while experiencing a virtual party where they are offered alcohol. This study examines the user experience, game satisfaction, and engagement of 181 adolescent users (aged 15-18) with VR FestLab involving seven schools in Denmark. All user experience factors of the short user experience questionnaire were rated positively or neutral, and 66% of the students liked the VR experience. Neither the user experience score nor a score for game satisfaction and engagement were associated with sex, age, perceived family affluence, school performance, alcohol consumption and attitudes or mental health of students. Overall, positive user experiences and game satisfaction of VR FestLab were found not to differ according to student characteristics. We conclude that virtual simulations offer new ways for developing drinking refusal skills that are attractive and acceptable for adolescent users.

Advertising appeals effectiveness: a systematic literature review.

Positive, negative and coactive appeals are used in advertising. The evidence base indicates mixed results making practitioner guidance on optimal advertising appeals difficult. This study aims to identify the most effective advertising appeals and it seeks to synthesize relevant literature up to August 2019. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework a total of 31 studies were identified and analyzed. Emotional appeals, theory utilization, materials, results and quality were examined. Across multiple contexts, results from this review found that positive appeals were more often effective than coactive and negative appeals. Most studies examined fear and humour appeals, reflecting a literature skew towards the two emotional appeals. The Effective Public Health Practice Project framework was applied to assess the quality of the studies and identified that there remains opportunity for improvement in research design of advertising studies. Only one-third of studies utilized theory, signalling the need for more theory testing and application in future research. Scholars should look at increasing methodological strength by drawing more representative samples, establishing strong study designs and valid data collection methods. In the meantime, advertisers are encouraged to employ and test more positive and coactive advertising appeals.

From co-design to co-production: Approaches, enablers, and constraints in developing a public health, capacity-building solution.

INTRODUCTION: Investigating how co-designed knowledge can be translated to co-produce a public health capacity-building solution for difficult-to-engage population groups drawing on the co-production experience of a prevention-focused, capacity-building mental health solution targeting primary producers. DESIGN: A qualitative study undertaken in rural and regional Victoria involving members of the design working group including project team (7px), digital design team (5px), marketing team (3px), and funding partner representatives. The study design involved reflective practice to collect data to identify the phases of co-production and assess the design working group members' experiences. The analysis involved inductive coding using Braun and Clarke's thematic analysis. OBJECTIVE: Identifying major points of divergence and/or convergence; enablers and/or constraints; and ways to better navigate and strengthen the co-production process. FINDING: Given members of the design working group, diverse skills sets divergence was experienced in all co-production phases. Divergence was also experienced between the project team and the funding partner given the uniqueness of working conditions and requirements of workers in the primary production industry. The project team applied an iterative development process to project management; encouraging iterative cycles to create/test/revise among the teams, and with the funding partner, until each was satisfied with the end result (convergence). DISCUSSION & CONCLUSION: When developing a co-created public health prevention campaign it is critical that the project team focuses on relationship building among the members of the design working group and ensures adequate resourcing, development of shared understanding of project goals and target audience, ongoing communication, and a commitment to working iteratively.

Actions Speak Louder Than Words: Sentiment and Topic Analysis of COVID-19 Vaccination on Twitter and Vaccine Uptake.

BACKGROUND: The lack of trust in vaccines is a major contributor to vaccine hesitancy. To overcome vaccine hesitancy for the COVID-19 vaccine, the Australian government launched multiple public health campaigns to encourage vaccine uptake. This sentiment analysis examines the effect of public health campaigns and COVID-19-related events on sentiment and vaccine uptake. OBJECTIVE: This study aims to examine the relationship between sentiment and COVID-19 vaccine uptake and government actions that impacted public sentiment about the vaccine. METHODS: Using machine learning methods, we collected 137,523 publicly available English language tweets published in Australia between February and October 2021 that contained COVID-19 vaccine-related keywords. Machine learning methods were used to extract topics and sentiments relating to COVID-19 vaccination. The relationship between public vaccination sentiment on Twitter and vaccine uptake was examined. RESULTS: The majority of collected tweets expressed negative (n=91,052, 66%) rather than positive (n=21,686, 16%) or neutral (n=24,785, 18%) sentiments. Topics discussed within the study time frame included the role of the government in the vaccination rollout, availability and accessibility of the vaccine, and vaccine efficacy. There was a significant positive correlation between negative sentiment and the number of vaccine doses administered daily (r267=.15, P<.05), with positive sentiment showing the inverse effect. Public health campaigns, lockdowns, and antivaccination protests were associated with increased negative sentiment, while vaccination mandates had no significant effect on sentiment. CONCLUSIONS: The study findings demonstrate that negative sentiment was more prevalent on Twitter during the Australian vaccination rollout but vaccine uptake remained high. Australians expressed anger at the slow rollout and limited availability of the vaccine during the study period. Public health campaigns, lockdowns, and antivaccination rallies increased negative sentiment. In contrast, news of increased vaccine availability for the public and government acquisition of more doses were key government actions that reduced negative sentiment. These findings can be used to inform government communication planning.

Is social media a panacea for social marketing communication? A scoping review.

Recognizing the potential of social media as an integral driver of communication that facilitates two-way conversations, this scoping review seeks to identify and synthesize salient benefits and challenges of social media usage reported in social marketing communication. Following a systematic literature review procedure, 31 social marketing studies utilizing social media communications channels were identified. The findings were thematically grouped under eight main topics: targeted reach and raising awareness, continuous consumer insight, ongoing interaction and dialogue, promoting behavior change, cost and time efficiency, discussing sensitive issues, building relationships and social media challenges. Identified taxonomies inform future research.

Improving Well-Being in Young Adults: A Social Marketing Proof-of-Concept.

Approximately 1 in 5 Australians experience a mental disorder every year, costing the Australian economy $56.7 billion per year; therefore, prevention and early intervention are urgently needed. This study reports the evaluation results of a social marketing pilot program that aimed to improve the well-being of young adults. The Elevate Self Growth program aimed to help participants perform various well-being behaviors, including screen time reduction, quality leisure activities, physical activity, physical relaxation, meditation and improved sleep habits. A multi-method evaluation was undertaken to assess Elevate Self Growth for the 19 program participants who paid to participate in the proof-of-concept program. Social Cognitive Theory was used in the program design and guided the evaluation. A descriptive assessment was performed to examine the proof-of-concept program. Considerations were given to participants' levels of program progress, performance of well-being behaviors, improvements in well-being, and program user experience. Participants who had made progress in the proof-of-concept program indicated improved knowledge, skills, environmental support and well-being in line with intended program outcomes. Program participants recommended improvements to achieve additional progress in the program, which is strongly correlated with outcome changes observed. These improvements are recommended for the proof-of-concept well-being program prior to moving to a full randomized control trial. This paper presents the initial data arising from the first market offerings of a theoretically mapped proof-of-concept and reports insights that suggest promise for approaches that apply Social Cognitive Theory in well-being program design and implementation.

Integrating student and teacher insights to a school-based alcohol program through co-design.

School-based programs may be more effective when an array of stakeholders, including users, are involved during the relevant stages of program co-creation-specifically during key development stages such as design, implementation and evaluation. How such programs can be operationally co-created and tested is less known and is therefore the purpose of this article. Two sequential co-design phases underpin this study. First, a co-design session with 20 health and physical education (HPE) teachers focussed on reviewing, testing and critically discussing initial prototype online modules for an alcohol education program. Teacher insights were assessed and incorporated, and the updated online modules were tested with secondary school students (n = 120) capturing their experience in a classroom setting. Insights from each group were analysed using thematic analysis. Teachers and students serve important roles in program co-creation. Teachers remain an underutilized stakeholder group whom are however critical in delivering important insights to enhance educational program design. Teachers demanded more relevance to the national curriculum, further alignment with curriculum assessment standards, and age appropriate content. Student feedback focussed largely on realistic content, personalization and gamification elements. This study represents an application of the seven-step co-design process and advances understanding of the 'fuzzy back-end' of the process, namely reflecting on feasibility of integrating teacher and student feedback and ideas. More specifically, how these key-yet distinct-stakeholder groups can be involved, and the merits of their involvement are discussed.

There is much research existing for designing change programs across many contexts. Commonly, involving consumers and other related people in the design of these programs is recommended. However less is known about who to involve in the design of programs, what they can be expected to tell you when involved, and when in the design they should be involved. This study explores these questions when involving teachers and students in the design of a school based online education program. Focussing on alcohol education and moderation strategies, the findings of this study support that different stakeholders contribute their own unique insights, whether based on personal bias or based on the nature of their involvement as stakeholders (e.g. as teachers, as parents, as loyal consumers etc.). Furthermore, this study highlights the need for research to distinguish which recommendations to adopt between students and teachers, in a manner generalizable to other contexts and stakeholder groups. From the findings of the current study, the authors recommend multi-disciplinary teams to contrast and enhance a research teams' perceptions regarding stakeholder insights.

Designing an eHealth Well-Being Program: A Participatory Design Approach.

In recent years, the relevance of eHealth interventions has become increasingly evident. However, a sequential procedural application to cocreating eHealth interventions is currently lacking. This paper demonstrates the implementation of a participatory design (PD) process to inform the design of an eHealth intervention aiming to enhance well-being. PD sessions were conducted with 57 people across four sessions. Within PD sessions participants experienced prototype activities, provided feedback and designed program interventions. A 5-week eHealth well-being intervention focusing on lifestyle, habits, physical activity, and meditation was proposed. The program is suggested to be delivered through online workshops and online community interaction. A five-step PD process emerged; namely, (1) collecting best practices, (2) participatory discovery, (3) initial proof-of-concept, (4) participatory prototyping, and (5) pilot intervention proof-of-concept finalisation. Health professionals, behaviour change practitioners and program planners can adopt this process to ensure end-user cocreation using the five-step process. The five-step PD process may help to create user-friendly programs.

Social Advertising Effectiveness in Driving Action: A Study of Positive, Negative and Coactive Appeals on Social Media.

BACKGROUND: Social media offers a cost-effective and wide-reaching advertising platform for marketers. Objectively testing the effectiveness of social media advertising remains difficult due to a lack of guiding frameworks and applicable behavioral measures. This study examines advertising appeals' effectiveness in driving engagement and actions on and beyond social media platforms. METHOD: In an experiment, positive, negative and coactive ads were shared on social media and promoted for a week. The three ads were controlled in an A/B testing experiment to ensure applicable comparison. Measures used included impressions, likes, shares and clicks following the multi-actor social media engagement framework. Data were extracted using Facebook ads manager and website data. Significance was tested through a series of chi-square tests. RESULTS: The promoted ads reached over 21,000 users. Significant effect was found for appeal type on engagement and behavioral actions. The findings support the use of negative advertising appeals over positive and coactive appeals. CONCLUSION: Practically, in the charity and environment context, advertisers aiming to drive engagement on social media as well as behavioral actions beyond social media should consider negative advertising appeals. Theoretically, this study demonstrates the value of using the multi-actor social media engagement framework to test advertising appeal effectiveness. Further, this study proposes an extension to evaluate behavioral outcomes.

Co-creating Virtual Reality Interventions for Alcohol Prevention: Living Lab vs. Co-design.

Addressing the need for collaborative involvement in health intervention design requires application of processes that researchers and practitioners can apply confidently to actively involve end-users and wider stakeholder groups. Co-creation enables participation by focusing on empowering a range of stakeholders with opportunities to influence the final intervention design. While collaboration with users and stakeholders during intervention design processes are considered vital, clear articulation of procedures and considerations for various co-creation methodologies warrants further research attention. This paper is based on two case studies conducted in Australia and Denmark where researchers co-created virtual reality interventions in an alcohol prevention context. This paper explored and reflected on two co-creation methods-co-design and the Living Lab-and showcased the different processes and procedures of each approach. The study demonstrates that both approaches have merit, yet highlights tensions in distinguishing between the application of each of the respective steps undertaken in each of the processes. While a lot of similarities exist between approaches, differences are evident. Overall, it can be said that the Living Lab is broader in scope and processes applied within the Living Labs approach are more abstract. The co-design process that we applied in the first case study is described more granularly delivering a clear a step-by-step guide that practitioners can implement to co-design solutions that end-users value and that stakeholders support. An agenda to guide future research is outlined challenging researchers to identify the most effective co-creation approach.

Translating Co-Design from Face-to-Face to Online: An Australian Primary Producer Project Conducted during COVID-19.

Primary producers face considerable risks for poor mental health. While this population can be difficult to engage in programs to prevent poor mental health, approaches tailored to reflect the context of primary producers' life and work have been successful. This paper reports on the co-design phase of a project designed to prevent poor mental health for primary producers-specifically, the advantages, challenges and considerations of translating face-to-face co-design methods to an online environment in response to COVID-19 restrictions. The co-design phase drew upon the existing seven-step co-design framework developed by Trischler and colleagues. Online methods were adopted for all steps of the process. This paper models how this co-design approach can work in an online, primary producer context and details key considerations for future initiatives of this type. The development of online co-design methods is an important additional research method for use not only during a pandemic but also when operating with limited resources or geographic constraints. Results demonstrate the following: (i) co-designing online is possible given adequate preparation, training and resource allocation; (ii) "hard to reach" populations can be engaged using online methods providing there is adequate early-stage relationship building; (iii) co-design quality need not be compromised and may be improved when translating to online; and (iv) saved costs and resources associated with online methods can be realigned towards intervention/service creation, promotion and user engagement. Suggestions for extending Trischler and colleagues' model are incorporated.

User Experiences with a Virtual Alcohol Prevention Simulation for Danish Adolescents.

This pilot study explores 31 Danish adolescent user experiences for the newly developed virtual party simulation app-Virtual Reality (VR) FestLab. The main objective of this study was to investigate usability for VR FestLab, which aims to improve alcohol resistance skills for Danish adolescents. A secondary objective was to understand gameplay experiences. The study is a mixed method study that draws on questionnaire data (n = 31) and focus group interviews (n = 10) of boarding school students participating in the pilot study. Descriptive statistics were used to examine quantitative data, and qualitative data were analyzed thematically. Quantitative findings indicated that gameplay experiences of the VR simulation were positive, and all User Experience Questionnaire (UEQ) items were answered positively. The focus group interviews showed that adolescents found the simulation to be realistic. Feedback indicated that the group pressure experienced in the simulation was regarded to be less than in real life. Adolescents had varying approaches to playing the VR simulation, they thought the quality of the simulation was good, and only a few users experienced technical difficulties. These initial study findings indicate that VR FestLab is a promising tool for the prevention of alcohol use among adolescents.

Co-Creating a Virtual Alcohol Prevention Simulation with Young People.

Collaborative knowledge generation and involvement of users is known to improve health promotion intervention development, but research about the roles and perspectives of users in the co-creation process is sparse. This research aimed to study how young people perceived their involvement in a co-creation process focussed on the development of a gamified virtual reality (VR) simulation-VR FestLab. The Living Lab methodology was applied to structure and guide the co-creation process. Living Lab participants were comprised of students, health promotion practitioners, researchers, and film and gaming experts who collaboratively designed and created the content and structure of the VR FestLab. Semi-structured interviews were conducted with nine students who participated in the Living Lab and represented young end users. Interviews were tape-recorded, transcribed and thematically analysed. Students described that they had influence on their tasks. They felt included and expressed that the collaboration with and feedback from peers and other stakeholders increased their self-efficacy and empowered them to take ownership and generate new ideas. Participants voiced that they lacked information about the final production of VR FestLab. Co-creation guided by the Living Lab methodology produced added value in terms of empowerment and increased self-efficacy for the students involved. Future Living Labs should plan for communication with participants about further development and implementation processes following ideation and prototyping phase.

A systematic review of parent based programs to prevent or reduce alcohol consumption in adolescents.

BACKGROUND: Adolescent alcohol consumption is an issue of ongoing concern and programs targeting parents have been identified as an important component in minimizing and preventing alcohol related harm in adolescents. This paper aims to evaluate existing parent based alcohol education programs with a focus on understanding parent specific outcomes including parental attitudes, parent-child communication, alcohol specific rule setting and parental monitoring; study quality, the extent of stakeholder engagement in program design and the level of theory application. METHOD: A systematic review of electronic databases EBSCO, Emerald, ProQuest, PubMed, Ovid, ScienceDirect, Taylor and Francis and Web of Science was conducted from database inception to August 2019. A total of 4288 unique records were retrieved from the eight databases. Studies were included if they evaluated school based alcohol education programs that included a parent component and detailed outcome measures associated with parent data. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool. RESULTS: In total 17 studies qualified for assessment, detailing 13 individual parent programs. Of these, ten programs demonstrated positive effects in at least one parent reported outcome measure. Stakeholder engagement during the design of programs was lacking with the majority of programs. One third of the programs did not report theory use and when theory was used reporting was weak with three programs applying theory, five testing theory and none building theory. According to the EPHPP tool, overall ten programs were rated as weak, three as moderate and none as strong. CONCLUSION: Future studies are recommended to further enhance the effectiveness of parental programs by improving study quality, increasing stakeholder engagement and increasing the level of theory application and reporting.

Measuring adolescent drinking-refusal self-efficacy: Development and validation of the Drinking Refusal Self-Efficacy Questionnaire-Shortened Adolescent version (DRSEQ-SRA).

BACKGROUND: This study aimed to develop and validate a shortened version of the Drinking Refusal Self-Efficacy Questionnaire-Revised Adolescent version (DRSEQ-RA) using a large sample of adolescents. METHODS: Secondary school students (N = 2609, M = 14.52 years, SD = 0.94) completed the DRSEQ-RA (consisting of subscales: Social Pressure; Opportunistic; Emotional Relief) and the Alcohol Use Disorders Identification Test (AUDIT). These data were analysed using non-parametric item response theory (NIRT) including Mokken scalability coefficients, and confirmatory factor analysis. RESULTS: Social Pressure subscale items were better able to distinguish between adolescents with lower or higher levels of drinking refusal self-efficacy, while the Opportunistic and Emotional Relief subscale items were able to distinguish adolescents with low drinking-refusal self-efficacy. The DRSEQ-RA was reduced from 19-items to a 9-item scale and retained the original three-factor structure. The reduced scale was named the Drinking Refusal Self-Efficacy Questionnaire-Shortened Revised Adolescent version (DRSEQ-SRA). The DRSEQ-RA and the DRSEQ-SRA have almost identical psychometric properties. They both demonstrated good fit to the data, each explained 18% of the variance in alcohol consumption, Adj. R2 = 0.18, p < .001 respectively. The DRSEQ-RA and the DRSEQ-SRA also have excellent scale and subscale internal reliability (αs = 0.92-0.99). CONCLUSIONS: The DRSEQ-SRA is a short, 9-item, measure of adolescent drinking-refusal self-efficacy which demonstrates both reliability and validity. A significant advantage is brevity. The DRSEQ-SRA may be a valuable tool for identifying risk of adolescent drinking and prevention/treatment planning in settings where survey administration time is critical.

Validation of the Adolescent Drinking Expectancy Questionnaire and development of a short form.

AIMS: This study aimed to validate the Drinking Expectancy Questionnaire-Adolescent version (DEQ-A) in a large adolescent sample and to develop and validate a brief measure, the Drinking Expectancy Questionnaire-Shortened Adolescent version (DEQ-SA). DESIGN AND METHODS: Cross-sectional survey of secondary school students (n = 2357, aged 13-16, M = 14.66 years, SD = 0.60). Students completed the DEQ-A in school, and measures of alcohol consumption including the Alcohol Use Disorders Identification Test-Consumption. The data were randomly split, and Exploratory Factor Analysis was performed using subsample 1, and Confirmatory Factor Analysis and reliability and validity testing were performed using subsample 2. RESULTS: The 24-item DEQ-A was successfully reduced to 12 items (DEQ-SA) without compromising psychometric properties. The DEQ-A and the DEQ-SA both demonstrated adequate-to-good fit to the data and very good internal reliability. The DEQ-A and DEQ-SA explained 20 and 18% of the variance in alcohol consumption. Adolescents who drank endorsed more positive alcohol expectancies, whereas alcohol-naïve adolescents scored higher on negative alcohol expectancies. As the DEQ-SA comprises two subscales of the DEQ-A, the endorsement rates are applicable to both scales. DISCUSSION AND CONCLUSIONS: The DEQ-A and the short form of this scale developed in this study (DEQ-SA) show good reliability, internal structure and account for a large proportion of variance in alcohol consumption. Both scales can assist in targeting cognitive change processes within tailored alcohol prevention and treatment approaches, and investigating hypothesised mechanisms of change. The DEQ-SA is recommended for more time-limited environments. [Patton KA, Connor JP, Rundle-Thiele S, Dietrich T, Young RM, Gullo MJ. Validation of the Adolescent Drinking Expectancy Questionnaire and development of a short form.

Differential segmentation responses to an alcohol social marketing program.

OBJECTIVE: This study seeks to establish whether meaningful subgroups exist within a 14-16 year old adolescent population and if these segments respond differently to the Game On: Know Alcohol (GOKA) intervention, a school-based alcohol social marketing program. METHODOLOGY: This study is part of a larger cluster randomized controlled evaluation of the GOKA program implemented in 14 schools in 2013/2014. TwoStep cluster analysis was conducted to segment 2,114 high school adolescents (14-16 years old) on the basis of 22 demographic, behavioral, and psychographic variables. Program effects on knowledge, attitudes, behavioral intentions, social norms, alcohol expectancies, and drinking refusal self-efficacy of identified segments were subsequently examined. RESULTS: Three segments were identified: (1) Abstainers, (2) Bingers, and (3) Moderate Drinkers. Program effects varied significantly across segments. The strongest positive change effects post-participation were observed for Bingers, while mixed effects were evident for Moderate Drinkers and Abstainers. CONCLUSIONS: These findings provide preliminary empirical evidence supporting the application of social marketing segmentation in alcohol education programs. Development of targeted programs that meet the unique needs of each of the three identified segments will extend the social marketing footprint in alcohol education.

One size (never) fits all: segment differences observed following a school-based alcohol social marketing program.

BACKGROUND: According to commercial marketing theory, a market orientation leads to improved performance. Drawing on the social marketing principles of segmentation and audience research, the current study seeks to identify segments to examine responses to a school-based alcohol social marketing program. METHODS: A sample of 371 year 10 students (aged: 14-16 years; 51.4% boys) participated in a prospective (pre-post) multisite alcohol social marketing program. Game On: Know Alcohol (GO:KA) program included 6, student-centered, and interactive lessons to teach adolescents about alcohol and strategies to abstain or moderate drinking. A repeated measures design was used. Baseline demographics, drinking attitudes, drinking intentions, and alcohol knowledge were cluster analyzed to identify segments. Change on key program outcome measures and satisfaction with program components were assessed by segment. RESULTS: Three segments were identified; (1) Skeptics, (2) Risky Males, (3) Good Females. Segments 2 and 3 showed greatest change in drinking attitudes and intentions. Good Females reported highest satisfaction with all program components and Skeptics lowest program satisfaction with all program components. CONCLUSION: Three segments, each differing on psychographic and demographic variables, exhibited different change patterns following participation in GO:KA. Post hoc analysis identified that satisfaction with program components differed by segment offering opportunities for further research.