Teen CHAT:Improving physician communication with adolescents about healthy weight

描述(申请人提供)：青少年肥胖的增加导致糖尿病、心血管疾病，并最终导致成年肥胖。医生就营养和体力活动向超重的青少年患者提供咨询；然而，很少有基于理论、易于传播的干预措施被测试来改善医生咨询。我们提出了一项随机对照试验来评估交错分娩干预改善医生沟通的有效性。建议的干预应该增加医生动机访谈(MI)的沟通(例如，引发“改变谈话”，探索矛盾心理等)。并通过一份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危险行为(即含糖饮料、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制200次基线青少年患者-医生访问的音频(50名在社区执业的儿科医生和家庭医生；每人4次访问)。然后，一半的医生将被随机分配到一个定制的CD-ROM，其中包含来自医生自己的基线访问的教学信息和音频片段，以演示MI交流。然后，我们将为所有医生录制一套新的200张后CD-ROM访问。然后，所有医生都将收到总结报告，我们将录制一组新的200次总结后报告访问。我们的创新设计使我们能够单独测试光盘、摘要报告及其组合的效果。主要结果是医生对心肌梗死技术的坚持。次要结果是医生在访问三个月后讨论六种健康危险行为和青少年在营养、体力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(MI依从者)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、自我定向的医生沟通干预来扩大医患沟通的领域，以改善咨询，随着时间的推移和多次就诊，将改善青少年患者的营养和体力活动。与公共健康相关：青少年肥胖症处于历史高位。医生可以在帮助青少年达到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向青少年提供营养和体育活动方面的咨询。这种干预应该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.