Design Issues
adolescent behaviors
SECONDARY
Choice of practical intervention strategies: The HHS Study was inspired by previous studies showing that school-based multi-component interventions targeting multiple adolescent behaviors simultaneously seem to be the most effective way to promote well-being and healthy behaviors among adolescents [The teaching material was developed in close collaboration with high school teachers to ensure that the material appealed to the target group and covered the learning goals for the included subjects as defined by the Danish Ministry of Education. It was, however, more challenging than expected to integrate stress and health in the academic curriculum. The teachers were provided with templates which specified important change objectives of the HHS Study to be achieved during each lesson. Some of the involved teachers did not find the health-related topics relevant to their subject. Particularly, teachers found it irrelevant to incorporate elements where students were encouraged to reflect on their own behavior (to raise awareness) and set goals for behavior change. Thus, most lessons ended up targeting knowledge only. The effect of a single behavior change technique may be very small and insufficient to produce a behavior change [Selection of determinants to be addressed by the intervention: Intervention strategies were developed to address the important and changeable determinants of stress identified in the needs assessment. There have been several education reforms in Denmark during the last decade, increasing the pressure on young people, e.g., (1) stricter entry requirements for higher education programs, (2) a ‘speed start bonus’: if students apply for a higher education program within two years of completing upper secondary education, their grade point average (entrance qualification for higher education programs) will be multiplied by a factor of 1.08, and (3) an A-level bonus: if students take an extra A-level subject during upper secondary education, their grade point average will be multiplied by a factor of 1.03. Furthermore, today’s society is characterized by a culture that values competition, an extreme focus on performance, and a constant search for perfection in every part of life [