Heart Attack Prevention Program for You (HAPPY)

Excess weight in children is an increasing health problem worldwide and leads to many other comorbidities as a risk factor. As many as 80% of the children that are overweight, will continue being overweight at adult age, adding to the current cardiovascular disease epidemic. Intervention at an early stage is therefore warranted.



A number of small scale intervention studies conducted at elementary schools show a beneficial effect of the combination of education, more excercise and a healthier school environment on the intake of unhealthy nutrition and the decrease of excess weight. Implementing the same measures on a large scale at Dutch schools seemed to have little effect on behavior and development of overweight. This shows that implementing a successful small-scale program intervention to a national program is a difficult task.



Recently, the power of storytelling on healthy lifestyle has been demonstrated. A randomized American study showed a significant effect of storytelling via DVDs on lowering blood pressure. According to the authors of the study, the mechanism of storytelling is based on inspiration, recognition and willingness to participate in the action.



The HAPPY Health project aims to use storytelling to inspire TV show viewers to achieve a healthier lifestyle. To test the effect or storytelling we have developed a sub-plot in the script of the best watched Dutch TV show for teens. The story is build-up as a sub-plot around one of the six main characters of a well watched Dutch TV show for teens (+-200.000 daily viewers). In the middle of the season an occurrence of a heart attack in the unhealthy living father of the main character in our sub-plot will take place. This event will trigger the transformation of the family from living unhealthy to develop a healthy lifestyle. We hypothesize that this way of storytelling will inspire the viewers to live healthier.

We hypothesize that storytelling (in the form of a sub-plot), concerning the effects of (un)healthy lifestyle on heart risk, in a popular Dutch TV show for children can cause sustainable positive lifestyle change. Furthermore, we hypothesize that our sub-plot will cause a rise in posts on the world-wide-web concerning (health) issues discussed in the TV show.

1. Lifestyle change: assessed by intake of fruit and vegetables, exercise, and amount of can soda consumed (HAPPY questionnaire 'How healthy are you?'): First assessment in week 47 and 48 of 2017 during the unhealthy living part of the sub-plot. Second assessment to take place in June 2018.



2. Rise in number of posts on the world-wide-web concerning pre-defined terms (Dutch: Cardioloog, Leefstijl, VUmc, Hart, Otis, Gezondheid, Ambulance. -> Translated in English: Cardiologist, Lifestyle, VUmc, Heart, Otis, Health, Ambulance. Assessed with Brandmonitor (an ONVZ insurance company web application) an world-wide-web quantification tool (free-text analysis). Will be assessed in week 23 of 2018.



3. Reduction in the amount of stress (DASS test), reduction in the amount of being bullied (Student School Survey, Bullying Prevention Initiative Colorado), reduction in BMI (HAPPY questionnaire 'How healthy are you?'), reduction in candy intake (HAPPY questionnaire 'How healthy are you?'): First assessment in week 47 and 48 of 2017 during the unhealthy living part of the sub-plot. Second assessment to take place in June 2018.



4. Rise in posts stratified for demographics (e.g. locational: city vs rural). Assessed with Brandmonitor (an ONVZ insurance company web application) an world-wide-web quantification tool (free-text analysis). Will be assessed in week 27 of 2018.



5. 3. Attitude towards healthy lifestyle. (The National Adult Nutrition Survey (NANS)) Will be assessed in week 27 of 2018.

Storytelling:



The goal of the research project is to use storytelling to inspire viewers to achieve a healthier lifestyle. The story is built as a sub-plot around one of the six main characters (a fourteen-year-old, too heavy and unhealthy living boy) and is broadcasted five days a week (monday to friday) from September 2018 untill June 2018.



In the middle of the season 2017-2018 the unhealthy living father of the main character in our sub-plot suffered from a heart attack (took place on the 2nd of March 2018). This event triggered the transformation of the family from living unhealthy to a healthier lifestyle. In the TV show specific aspects of a healthier lifestyle (diet, exercise, sugars) are highlighted.



Through the online questionnaire "How healthy are you?" we will assess several lifestyle parameters, such as: BMI, extent of exercise, sugar intake and intake of vegetables. In addition to lifestyle parameters, the assessment of stress levels and the extent of being bullied will also take place. The survey will be presented to viewers of the show before and after the lifestyle change of the family in our sub-plot.



The "How healthy are you?" questionnaire is targeted towards (non-)viewers of the show through the website of the TV show and a social media campaign carried by Dutch Youtube stars and advertisements on Facebook and Instagram.



We assess the amount of exposure to our intervention in the HAPPY questionnaire 'How healthy are you?' by the following question: 'How many times per week do you watch the show averagely?' (answer: 0 to 5 times per week).