Teen CHAT:Improving physician communication with adolescents about healthy weight

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DESCRIPTION (provided by applicant): The rise in adolescent obesity contributes to diabetes, cardiovascular disease, and eventually will lead to adulthood obesity. Physicians counsel overweight adolescent patients about nutrition and physical activity; however, few theory-based, easily disseminable interventions have been tested to improve physician counseling. We propose a randomized, controlled trial to assess the efficacy of a staggered delivery intervention to improve physician communication. The proposed intervention should increase physician Motivational Interviewing (MI) communication (e.g., eliciting "change talk", exploring ambivalence, etc.) and increase counseling time via a Summary Report that details adolescent's risk behaviors that contribute to unhealthy weight (i.e., sweetened beverages, fast food, breakfast, physical activity, screen time, and sleep). Our multidisciplinary team plans to audio record 200 baseline adolescent patient-physician visits (50 pediatricians and family physicians practicing in the community; 4 visits each). Then, half of the physicians will be randomly assigned to receive a tailored CD-ROM that contains didactic information and audio clips from physicians' own baseline visits to demonstrate MI communication. We then will audio record a new set of 200 post CD-ROM visits for all physicians. Then all physicians will receive the Summary Report, and we will audio record a new set of 200 Post Summary Report visits. Our innovative design allows us to test the effects of the CD-ROM alone, Summary Report alone and the combination. The primary outcome is physician adherence to MI techniques. Secondary outcomes are physicians discussing the six health risk behaviors and adolescent changes in nutrition, physical activity, and weight three months after the visit. We hypothesize that, compared to physicians in the control arm, physicians in the intervention arm will provide more effective (MI adherent) nutrition and physical activity counseling. Results of this study will expand the field of patient- physician communication by testing a low intensity, self-directed communication intervention for physicians to improve counseling, which over time and multiple visits, will improve adolescent patients' nutrition and physical activity.