Marie Löf

Research problem and specific questions: The promotion of healthy lifestyle behaviours needs to start early in life as once obesity is established it is difficult to treat. The overall aim of this project is to evaluate the effectiveness and implementation of a mobile health intervention (Health4Life) to support parents to create healthy lifestyle behaviours from the start of their infant’s life, in order to prevent overweight and obesity.Data and method: Health4Life will utilize a type I hybrid implementation-effectiveness study design. A cluster randomized controlled trial will be conducted in 44 child healthcare centers in Regions Halland and Jönköping (n = 620 parents with a 1-month-old infant). All parents/infants will receive standard care

however, the intervention group will receive the 17-month Health4Life app. Primary outcomes are: children´s dietary intake (mobile based), physical activity and sleep (accelerometry), and screen time (parental report). Secondary outcomes include children´s BMI z-scores (measured at child healthcare), as well as motor skills and parenting practices (questionnaires). The implementation outcomes that will be assessed (in the 22 child healthcare centers in the intervention group) are: acceptability, appropriateness, feasibility, costs, sustainability, and reach. These will be measured quantitatively (questionnaires) and quantitatively (semi-structured interviews). A cost-effectiveness analysis will determine if the implementation of Health4Life represents value for money when measured incrementally against usual practice.Societal relevance and utilization: Primary child healthcare’s mission is to promote healthy lifestyle habits to prevent poor health. The Health4Life app will support this mission through providing constant support for parents in their everyday lives. As it is well established that overweight and obesity are associated with numerous diseases and disorders, coupled with the fact that it is well established that overweight and obesity tracks from childhood to adulthood, it is a public health priority to intervene early on.Plan for project realization: Within this application we are applying for funding for a PhD student (100%), a post-doc (50%), salary for the applicants, and project costs. The highly competent research team, staff, and collaborators coupled with the carefully selected methodology make the proposed project highly feasible to conduct over the next 3 years.

The human papillomavirus (HPV) is responsible for most cervical and anogenital cancers. The HPV vaccine can effectively reduce invasive cervical cancer

however, HPV vaccine uptake is low in certain groups due to hesitancy and refusal, which undermines the success of the vaccine. In Sweden, HPV vaccine hesitancy has mainly been observed among parents and adolescents in socioeconomically disadvantaged communities with large immigrant populations.The purpose of this project is therefore to co-design and assess the feasibility and preliminary effects of digital health intervention tools to reduce HPV vaccine hesitancy and increase uptake of this vaccine in socioeconomically disadvantaged communities in Stockholm, Sweden. Several research questions shall assess whether a co-designed digital health intervention has the potential to improve HPV uptake, awareness and confidence.The project involves three sub-studies implemented by an interdisciplinary team.  Study 1 will involve a formative stage whereby adolescents, parents/guardians and school nurses situated in socially disadvantaged areas in Stockholm will be interviewed to understand their perspectives and concerns related to the HPV vaccine. Thereafter, study 2 will use knowledge gained from study 1 to inform the co-design phase where adolescent boys/girls and their parents/guardians are invited to develop and provide feedback on content and prototypes for digital health interventions. Finally, study 3 will involve pilot-testing of the intervention for feasibility, acceptability and preliminary effect, using a cluster-randomized design.This project is highly feasible as it builds on the study team’s previous research, which show that immigrant communities in Sweden experience poorer health outcomes as well as vaccine hesitancy. Because 1 in 5 Swedes have a migrant background this study is relevant to Swedish society. An appropriate and accessible digital health intervention has the potential to prevent cervical cancer, saving lives and reducing future burdens on an overstretched Swedish healthcare system. The results from this project will be generalizable to similar contexts in Sweden and possibily beyond.