Whittemore 2013.

Study characteristics
Methods	Study name: Health(e)teen Study design: cluster‐RCT Intervention period: 3 months? Follow‐up period (post‐intervention): 3 months? Differences in baseline characteristics: reported Reliable outcomes: reported Protection against contamination: NR Unit of allocation: class Unit of analysis: individual accounting for clustering
Participants	N (control baseline) = 177 Health(e)teen N (control follow‐up) = 166 N (intervention baseline) = 207 Health(e)teen + coping skills training (CST) N (intervention follow‐up) = 199 Setting (and number by study group): 3 high schools, 35 classes; 2 schools provided the program in class (N = 26 classes), and 1 school provided the program as homework (N = 9 classes). Recruitment: convenience sample of students enrolled in health or biology classes Geographic region: 2 cities in North East USA Percentage of eligible population enrolled: 64% participants Mean age: intervention + control: 15.31 ± 0.69 Sex: intervention + control: 62% female
Interventions	To compare the effectiveness of 2 school‐based internet obesity prevention programs, Health(e)teen and Health(e)teen + CST in diverse adolescents on BMI, health behaviours, and self‐efficacy at 3 and 6 months Components of the Health(e)teen and Health(e)teen + CST program were lessons including self‐assessment, simulations, problem‐solving, repetition, and individualised feedback there were 8 lessons on the topics of nutrition, PA, metabolism, and portion control lessons provided content, goal‐setting and self‐monitoring A reality TV concept of the program included diverse relatable characters who demonstrated typical situations (social modelling) in videos, text, and lesson commentary Lessons were highly interactive, and students received individualised feedback via self‐assessments and questions on content. goal setting self‐monitoring health coaching: providing individualised feedback, encouragement and social persuasion social networking: providing individualised feedback, encouragement and social persuasion Students were encouraged to record their food intake and PA each time they logged on, and the program provided a visual display of their progress. Students also set goals and monitored progress with completing goals. A blog by a “coach” the opportunity to interact with a health coach (graduate nursing student) and other students, and a personal journal section were other components of the program. Health(e)teen + CST included all the aforementioned components and the addition of 4 lessons on coping skills training (total of 12 lessons). CST lessons included social problem solving stress reduction assertive communication conflict resolution Lessons provided content on stress reduction, assertive communication, conflict resolution, and social problem solving as it relates to healthy eating and PA Teachers were provided access to the websites and guidelines to promote student participation. The program was developed to be self‐standing, with teacher involvement required only to help students log onto the program and monitor student activity to assure that students were participating in the program (rather than exploring other websites). Teachers were also instructed to prompt students to complete lessons and self‐monitoring as well as explore all components of the program Diet and PA combination intervention vs diet and PA combination (internet)
Outcomes	Outcome measures Primary outcome: BMI Secondary outcomes: sedentary behaviour, nutrition behaviour, self‐efficacy Process evaluation: reported (satisfaction at 3 months, data usage)
Implementation‐related factors	Theoretical basis: theory of interactive technology, Social Learning theory Resources for intervention implementation: reported Who delivered the intervention: reported PROGRESS categories assessed at baseline: child, gender, race/ethnicity; parent: SES (income), education PROGRESS categories analysed at outcome: NR Outcomes relating to harms/unintended effects: NR Intervention included strategies to address diversity or disadvantage: NR Economic evaluation: NR
Notes	NCT01560676 Funding: NIH/NINR: RC1NR011594 Study participants received a gift card for completion of data collection (USD 25.00 at time 1; USD 30.00 at times 2 and 3). Because program implementation was different in some classes (homework vs classroom), a mixed model analyses was done exploring the effect of implementation by program. Satisfaction with the programs was high. The mean satisfaction score was 3.58 (+.68). There was no significant difference between groups with respect to satisfaction (P = 0.26). Participation was also high, with adolescents completing 83% of lessons (median 100%). In each group, more than half of participants completed all lessons (53% of participants in Health(e)teen + CST and 70% in Health(e)teen). Adolescents completed self‐monitoring assessments 5.26 times (+ 2.75; median 5) over the 8‐12 lessons. Adolescents of the Health(e)teen + CST completed fewer lessons (P = 0.001) yet had higher participation in self‐monitoring (P < 0.001)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomisation no further details
Allocation concealment (selection bias)	Unclear risk	Randomisation no further details
Blinding (performance bias and detection bias) All outcomes	Unclear risk	NR
Incomplete outcome data (attrition bias) All outcomes	Low risk	Low attrition: 5%
Selective reporting (reporting bias)	Low risk	Protocol/trial registration document seen. All outcomes reported
Other bias	Low risk	No additional threats to validity
Other bias‐ timing of recruitment of clusters	Low risk	Figure shows recruitment happened prior to randomisation