Teen CHAT:Improving physician communication with adolescents about healthy weight

描述（由申请人提供）：青少年肥胖的增加会导致糖尿病、心血管疾病，并最终导致成年肥胖。医生向超重的青少年患者提供营养和身体活动方面的咨询；然而，很少有理论基础，易于传播的干预措施已被测试，以提高医生咨询。我们提出一项随机对照试验来评估交错分娩干预改善医生沟通的效果。建议的干预措施应该增加医生动机访谈（MI）沟通（例如，引出“改变谈话”，探索矛盾心理等），并通过总结报告增加咨询时间，详细说明青少年导致不健康体重的风险行为（即加糖饮料，快餐，早餐，体育活动，屏幕时间和睡眠）。我们的多学科团队计划录音记录200次基线青少年患者-医生就诊（50名在社区执业的儿科医生和家庭医生，各4次就诊）。然后，随机分配一半的医生接收定制的CD-ROM，其中包含教学信息和医生自己基线访问的音频片段，以演示心肌梗死沟通。然后，我们将为所有医生录制一套新的200次光盘访问录音。然后，所有的医生都将收到总结报告，我们将录音记录一组新的200次总结报告后的访问。我们的创新设计使我们能够单独测试CD-ROM， Summary Report和组合的效果。主要结果是医生对心肌梗死技术的依从性。次要结果是医生在随访三个月后讨论六种健康风险行为和青少年在营养、身体活动和体重方面的变化。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营养和体育活动咨询。本研究的结果将扩展医患沟通的领域，通过测试低强度，自我导向的沟通干预，医生改善咨询，随着时间和多次就诊，将改善青少年患者的营养和身体活动。公共卫生相关性：青少年肥胖正处于历史最高水平。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就营养和体育活动向青少年提供咨询。这种干预可以改善医生之间的沟通，进而改善青少年的营养和体育活动行为。

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.