Healthy Teens TXT ME; IT to change teen health risk behaviors

描述(由申请人提供)：在青春期，一直持续到成年的健康习惯正在形成。虽然在井访中解决广泛的健康风险是重要的，但大多数临床医生缺乏有效地筛查青少年健康风险和支持基于证据的动机咨询的IT系统。在健康访问后，临床医生无法提供支持，以将改变健康行为的动机转变为青少年更好的结果。广泛使用的手机短信和基于互联网的社交网站是支持这一代“数字原住民”青少年变革的合适的社区IT场所。为了满足这些需求，健康青少年TXT ME项目将在农村初级保健环境中开发和试点一种新的信息技术支持的青少年健康咨询和访视后支持模式。将研究的两个健康风险是吸烟和运动不足。完整的模型将通过以下每一种方式利用信息技术：1)利用PDA(个人数字助理)技术对健康风险进行一致的初级保健筛查和患者动机评估；2)由PDA技术支持的针对风险和激励因素量身定做的临床咨询；以及3)访问后支持，通过手机短信加强青少年对其目标的承诺和自我效能，将青少年的意图转化为改变健康行为的行动，并通过互联网社交网站增加社会支持和获得资源。 该R21项目的具体目标是为这种方法的大规模调查做准备： 1)从循证文献和现有的公共卫生和患者咨询计划中，通过临床医生的提示来增强基于健康青少年PDA(个人数据助理)的健康风险筛查工具，以支持有效的锻炼和戒烟咨询。2)开发格式、消息传递算法和技术流程，将初级保健访问中基于PDA的青少年健康筛查数据与通过手机短信向青少年发送的定制后续健康行为改变消息联系起来，以加强锻炼或烟草使用方面的计划变化。3)通过互联网社交网站开发青少年健康行为改变支持的原型，青少年将与项目中试图改变特定健康行为(锻炼或烟草)的其他人联系起来，并访问基于网络的资源。4)对TXT ME模型的锻炼部分进行小型可行性试验，该模式将使用PDA技术提供健康风险筛查，以筛选和提示临床医生，并在青少年表示有兴趣改变锻炼时，通过访问后的IT强化进行更改。评估将包括与信息内容和健康行为结果相关的短期结果。 该项目具有潜在的广泛影响，因为青春期导致肥胖和癌症的危险健康行为显着增加。目前的临床护理系统在筛查、咨询和为青年实施戒烟或更多锻炼的步骤提供支助方面存在不足。拟议的社区信息技术支持可以由公共卫生、卫生系统、社区组织和保险公司提供，并为青年提供一种新的预防性保健模式。

DESCRIPTION (provided by the applicant): During adolescence health habits that persist into adulthood are being established. While it is important that a wide range of health risks be addressed in well visits, most clinicians lack IT systems that efficiently screen teens for health risks and support evidence-based motivational counseling. After the health visits clinicians are not able to offer supports to transform motivation to change a health behavior into better outcomes for adolescents. Appropriate community IT venues to use to support change in this generation of "digitally native" teens are the widely used cell phone text messaging and Internet based social networking sites. To meet these needs the Healthy Teens TXT ME project will develop and pilot test a new model of IT supported teen health counseling and post visit supports in rural primary care settings. The two health risks that will be studied are tobacco use and inadequate exercise. The full model will utilize IT in each of the following ways: 1) Consistent primary care screening of health risks and assessment of patient motivation utilizing PDA (personal digital assistant) technology; 2) Clinical counseling tailored to risks and motivational factors supported by PDA technology; and 3) Post-visit supports to transform teen intentions into actions changing health behaviors by strengthening teen commitment and self efficacy for their goals via cell phone text messaging, and increasing social support and access to resources via Internet social network sites. The specific aims of this R21 project to prepare for a large scale investigation of this approach are to: 1) Enhance the Healthy Teens PDA (personal data assistant)-based health risk screening tool with clinician prompts to support effective counseling for exercise and tobacco cessation from evidence based literature and existing public health and patient counseling programs. 2) Develop the format, message delivery algorithm and technological processes to link PDA-based teen health screening data from the primary care visit to tailored follow up health behavior change messages delivered to adolescents by cell phone text messaging to reinforce planned changes in exercise or tobacco use. 3) Develop the prototype of adolescent health behavior change support via an Internet Social Network site where adolescents will be linked to others in the project trying to change a specific health behavior (exercise or tobacco) and access web-based resources. 4) Conduct a small feasibility trial of the exercise component of the TXT ME model that will provide health risk screening using PDA technology to screen and prompt clinicians, and provide via post-visit IT reinforcement to make changes when a teen indicates interest in changing exercise. Evaluation will include short term outcomes related to message content and health behavior outcomes. This project has potential widespread impact because of the marked increase of risky health behaviors in adolescence that lead to obesity and cancer. The current clinical care system is inadequate in its screening, counseling and provision of supports for youth to implement steps to stop smoking or exercise more. The proposed community IT supports could be provided by public health, health systems, community organizations and insurers and offer a new model of preventive health care for youth.