Preventing risk behaviour in adolescence - emerging lines from a realist enquiry

Aims and objectives: The aim of the research is to explore - using a realist approach - how, when, and in what circumstances risk behaviour prevention programmes succeed (or fail) in reducing multiple risk behaviours in... [ view full abstract ]

Aims and objectives: The aim of the research is to explore - using a realist approach - how, when, and in what circumstances risk behaviour prevention programmes succeed (or fail) in reducing multiple risk behaviours in adolescents.
Background: Although adolescence is typically a healthy life stage, health risk behaviours, such as alcohol consumption, smoking, substance misuse and sexual behaviours (Hagell, 2013) have been highlighted as a cause for concern. Evidence suggests that many risk behaviours begun in adolescence impact significantly on longer term health and well-being (Kipping, Smith, Heron, Hickman, & Campbell, 2014). Poor longer term outcomes include; substance abuse, poor physical, mental, and sexual health, and lower educational and occupational achievement, making this critical transitional period a key focus for public health programmes. Until recently, research has focused on single behaviours; however, it is now thought more efficacious to look at clusters of risk behaviours concurrently (Hale, 2014). While many prevention programmes have been found to be moderately effective in the original target population, they tend to have little success when replicated at scale (Jackson et al, 2012). It is unclear why success is so variable, but one reason may be the low level of attention paid in trials to the behaviour change mechanisms or underpinning causal mechanisms implicit in the programmes.
Methods: The research uses a mixed methods approach consisting of a realist synthesis, alongside primary data collection including: interviews, focus groups, and expert consultations with young people and secondary analysis of questionnaire data. Professionals have been recruited across a broad range of roles to consider the evidence from all points of the programme implementation chain, such as the commissioning, design, and delivery of such programmes.
Findings: A number of key themes have been identified from the literature, these include: training and resources for programme deliverers, adolescents’ relationships with key deliverers within the programme, their family, and wider community, understanding and interpretation of programme content, mode of delivery and end user engagement. Relevant middle range theories being explored at present include the situational leadership model, social development model, attachment theory and family stress theory, and social learning theory. These findings will be presented, along with the emerging programme theories, and framework development throughout the synthesis.