Team-based Learning Intervention in Adolescents to Prevent Risk Factors for Chronic Diseasers - a Cluster Randomized Controlled Trial

Introduction Chronic diseases are leading causes of mortality worldwide, affecting both developed and developing countries. Chronic diseases include cardiovascular diseases, diabetes, stroke, cancer and mental diseases. These diseases have been and continue to be the major causes of worldwide morbidity. They significantly strain healthcare systems and contribute to reduce quality of life and workforce productivity. The estimated cost of chronic disease is expected to reach $47 trillion worldwide by 2030.

Modifiable risk factor for chronic diseases are unhealthy diet, physical inactivity and sedentary behavior, irregular sleep, tobacco use, and excessive alcohol consumption. These risk factors usually begin during childhood and adolescence and persist into adulthood. This age period is critical as they become more exposed to external influences, including peers, media, and their environment, while developing autonomy in decision-making. Intervening during these formative years is essential to promote healthier behaviors and prevent chronic diseases in adulthood.

Some studies on educational interventions for adolescents to prevent chronic disease risk factors have demonstrated promising outcomes in different countries. The Health4Life program, which uses web-based modules to address risk factors, showed increased student engagement and knowledge retention. Another study highlighted the importance of combining education with parental and community involvement to achieve more sustainable behavioral changes. However, other studies including systematic review report limited or no significant changes in healthy behaviors.

Team-based learning (TBL) is an active teaching method with a student-centered approach in which students learn about a subject by working in groups to solve an open-ended problem. This educational approach has several advantages compared to the usual education provided by school teachers, such as improved engagement and active learning andencouragement ofcritical thinking and problem-solving skills.By working in teams, students develop collaboration and communication skills, receive immediate feedback, peer learning, andincrease their motivation, accountability and self-confidence. By presenting real-world problems to solve, TBL also results in better practical knowledge and retention, encourages active engagement and self-directed learning, and fairer assessment of diverse perspectives. TBL appears to be appropriate in improving the knowledge, critical thinking and enhancing their skills and behaviours. The hypothesis that TBL can be use to address risk factors for chronic diseases among adolescents, such as unhealthy diets, physical inactivity, sedentary behavior, irregular sleep patterns, tobacco use, and excessive alcohol consumption, was not tested yet. Studies with education intervention applying the TBL method to adolescents students aiming to preventrisk factor for chronic diseases have not yet been conducted. TBL may contribute to Health Behavior Education enhancingadolescents' understanding of the links between lifestyle choices and health outcomes. TBL may also foster a sense of responsibility and self-efficacy, which are critical for adopting healthier habits. In addition to knowledge, TBL may build skills such as problem-solving, communication, and teamwork, which are vital for sustaining healthy habits into adulthood. Despite its advantages, TBL may present some challenges, such asrequiringmore preparation time for both students and instructors, may be challenging to implement in very large classes, some students may struggle with group dynamics or prefer individual learning styles, and assessment and grading may be more complex compared to traditional methods. However, TBL can offer significant advantages over traditional teaching regarding how we deal with a health problem that potentially affects all adolescent students (a risk factor for chronic diseases), being part of their dailylife, which require practical application of knowledge, collaboration, and the development of real world skills.

Based on all this the objective of this study is to verify if an educational intervention, based on TBL, can prevent risk factors (unhealthy diet, physical inactivity, sedentary behavior, excessive screen time, irregular sleep, tobacco use and excessive alcohol use) for chronic diseases may modify the knowledge and habits of adolescent students.