Teen CHAT:Improving physician communication with adolescents about healthy weight

描述（由申请人提供）：青少年肥胖的增加有助于糖尿病，心血管疾病，并最终导致成年肥胖。医生建议超重的青少年患者营养和体育活动，但是，很少有理论为基础的，易于传播的干预措施已被测试，以提高医生的咨询。我们提出了一个随机对照试验，以评估交错分娩干预改善医生沟通的有效性。建议的干预措施应增加医生的动机性访谈（MI）沟通（例如，引发“变革谈话”，探索矛盾心理等）并通过总结报告增加咨询时间，该报告详细说明了青少年导致不健康体重的风险行为（即，甜饮料、快餐、早餐、体力活动、屏幕时间和睡眠）。我们的多学科团队计划录音200基线青少年患者-医生访问（50名儿科医生和家庭医生在社区执业; 4次访问）。然后，一半的医生将被随机分配接受定制的CD-ROM，其中包含来自医生自己的基线访视的教学信息和音频剪辑，以证明MI沟通。然后，我们将为所有医生录制一组新的200次CD-ROM后访视。然后，所有医生将收到总结报告，我们将对新的200次总结报告后访视进行录音。我们的创新设计使我们能够测试单独的光盘、单独的总结报告和组合的效果。主要结局是医生对MI技术的依从性。次要结果是医生在随访3个月后讨论6种健康风险行为和青少年营养、体力活动和体重的变化。我们假设，与对照组的医生相比，干预组的医生将提供更有效的（MI依从性）营养和体力活动咨询。本研究的结果将通过测试一种低强度、自我导向的沟通干预来扩大患者与医生沟通的领域，以改善医生的咨询，随着时间的推移和多次访问，这将改善青少年患者的营养和身体活动。 公共卫生相关性：青少年肥胖症处于历史最高水平。医生可以在帮助青少年获得健康体重方面发挥作用。这项研究将测试一种干预措施，以帮助医生更有效地为青少年提供营养和体育活动方面的咨询。这种干预措施应该改善医生的沟通，这反过来又应该改善营养和身体活动行为。

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. PUBLIC HEALTH RELEVANCE: Adolescent obesity is at an all time high. Physicians can play a role in helping adolescents attain a healthy weight. This study will test an intervention to help physicians counsel adolescents about nutrition and physical activity more effectively. This intervention should improve physician communication, which then in turn, should improve adolescents9 nutrition and physical activity behaviors.