Application of the Health Action Process Approach Model for Improving Excessive Internet use Behaviors Among Rural Adolescents in China: A School-Based Intervention Pilot Study

Objective: There are few studies regarding Internet use behaviors of Chinese rural adolescents based on behavioral theory. The aim of this study is to examine the applicability and effectiveness of the health action process approach model (HAPA) in the intervention of excessive Internet use behaviors among rural adolescents in China. Methods: : 327 participants who met the excessive Internet use criteria were involved in this study. Four interventions based on the HAPA model were conducted during 2015-2017. The structural equation model (SEM) was applied to fit the HAPA model. Results: : The rate of average daily time spent online on weekends more than four hours dropped from 57.2% to 39.1% (P<0.001). The rate of daily game time more than two hours decreased from 51.1% to 35.2% (P<0.001). The result of SEM showed that both the applicability and effectiveness of the HAPA model were well in the intervention of excessive Internet use behaviors with good fitted indicators (χ 2 /df＝2.066，GFI＝0.889，CFI＝0.938，TLI＝0.928，IFI＝0.938，RMSEA＝0.057).The direct and indirect effects of the main pathways in HAPA model were statistically significant (P <0.05). The comparison analysis of HAPA model variables identified that outcome expectancy, intention, maintenance self-efficacy had been improved significantly after interventions. Conclusion: The intervention measures based on the HAPA model can effectively improve excessive Internet use behaviors of Chinese rural adolescents, mainly through strengthen outcome expectancy, intention, and maintenance self-efficacy.