The Effect of Web-Based COPE Healthy Lifestyles Teen Program on Hearing-Impaired Adolescents: A Randomized Controlled Trial

Abstract

Background Hearing-impaired children and adolescents face increased risks of chronic diseases due to insufficient physical activity, unhealthy diets, substance use, and high stress. Health promotion programs targeting these risks can improve their health knowledge and lifestyle behaviors. Objective This study evaluated the effect of the Web-based COPE Healthy Lifestyles TEEN Programme on nutrition, physical activity, stress management, and mental health in hearing-impaired (HI) adolescents. Methods Seventy-two HI adolescents aged 12–18 years were randomly assigned. A web-based COPE Healthy Lifestyles TEEN program integrated with sign language was delivered online to the experimental group for 8 weeks. Physical, behavioral, and cognitive measurements were completed pre-intervention and at 1 week, 3 months, and 6 months post-intervention. Results The experimental group showed a significant increase in healthy lifestyle choices, nutrition and physical activity knowledge, physical activity behavior scores, weekly step counts, and daily water, fruit, and vegetable consumption, alongside a significant decrease in sugary beverage consumption compared to the control group. While stress management, anxiety, and depression scale scores were not statistically significant, a positive effect size was observed as scores decreased over time. Conclusion The sign-language-delivered, web-based COPE program demonstrated positive effect sizes, indicating improvements in nutrition and physical activity knowledge/behaviors and reductions in stress, anxiety, and depression among HI adolescents. Implications for practice Nurses can develop practical strategies using accessible, technology-based health promotion programs to encourage HI adolescent participation, support their healthy lifestyle behaviors and psychological well-being, and strengthen equitable access to health education. Trial registration This study was prospectively registered ClinicalTrials.gov (ID: NCT05329207 ). © 2025 Elsevier Inc.