Patient-Provider Communication to Promote Health Behavior Change in African Ameri

描述(由申请人提供)：儿童人口的超重和肥胖率正在达到危机水平，其中非裔美国青少年的风险最高。虽然有效的减肥策略(例如，监测食物摄入量和活动水平、环境控制以减少食用不健康食物的线索、设定目标)是众所周知的，但为非裔美国肥胖青少年(AAAO)构建有效的行为减肥干预措施的尝试基本上失败了。成功的一个主要障碍是参与对成功至关重要的减肥策略的动机。因此，成功的减肥治疗要求治疗提供者能够激励家庭做出持续减肥所必需的具有挑战性的行为改变。患者-提供者沟通是治疗提供者在任何情况下对患者使用的主要治疗策略。尽管患者与提供者的沟通被认为是一项关键的临床技能， 几乎没有指导方针来帮助治疗提供者与患者有效沟通。动机访谈(MI)是一种基于证据的沟通策略，它使用以客户为中心的指导方法来增强内在动机和自我效能。MI提供了一个框架来研究提供者沟通和患者结果之间的关系。MI最初是为治疗成人药物滥用者而开发的，已被广泛适应于治疗包括肥胖和不良饮食习惯在内的其他行为健康问题，现在已被列入儿童肥胖预防和治疗的专家建议。此外，MI已在美国和世界各地的不同人群中成功使用。尽管MI被应用于多种行为问题，但MI引起行为改变的机制还不是很清楚，特别是在儿科和少数民族人群中。换句话说，尚不清楚MI的哪些组成部分对于与非裔美国青少年和照顾者合作的医疗保健提供者最重要，以促使行为改变。识别MI在引发行为变化方面的关键组成部分，将有助于开发有针对性的健康沟通培训，旨在最大限度地提高非裔美国青少年和照顾者减肥的动机。这项拟议的研究将使用来自父母临床试验的数据，该试验是美国国立卫生研究院资助的韦恩州立大学肥胖中心拨款(U01 HL097889)的一部分，为AAAO及其主要照顾者提供基于家庭的减肥干预措施。新开发的代码方案将用于对来自父临床试验的184个减肥治疗疗程进行二次分析。本研究的目标是：(1)识别提供者沟通行为，预测AAAO及其照顾者的行为改变的动机和意图；(2)通过改变AAAO及其照顾者的行为改变的动机和意图，将提供者沟通行为与AAAO及其照顾者健康行为的变化联系起来，如饮食、健身、体脂成分和体重的变化。

DESCRIPTION (provided by applicant): Rates of overweight and obesity in pediatric populations are reaching crisis levels, with African American adolescents at highest risk. Although effective weight loss strategies (e.g., monitoring of food intake and activity level, environmental control to reduce cues to eat unhealthy foods, goal setting) are well known, attempts to construct effective behavioral weight loss interventions for African American adolescents with obesity (AAAO) have largely failed. A primary barrier to success has been motivation to engage in the weight loss strategies critical for success. Therefore, successful weight loss treatment requires that treatment providers be able to motivate families to make the challenging behavioral changes necessary for sustained weight loss. Patient-provider communication is the primary treatment strategy that treatment providers, in any setting, use with their patients. Although patient-provider communication is recognized as a key clinical skill, there are few guidelines to help treatment providers communicate effectively with patients. Motivational Interviewing (MI) is an evidence-based communication strategy that uses client-centered, directive methods for enhancing intrinsic motivation and self-efficacy. MI provides a framework to study the relationship between provider communication and patient outcomes. Originally developed to treat adult substance abusers, MI has been widely adapted to the treatment of other behavioral health problems including obesity and poor dietary practices and is now included the expert recommendations for pediatric obesity prevention and treatment. In addition, MI has been successfully utilized in diverse populations in the U.S. and around the world. Despite the application of MI to multiple behavioral problems, the mechanisms by which MI elicits behavior change are less clear, particularly in pediatric and minority populations. In other words, it is unclear which components of MI are most important for health care providers working with African American adolescents and caregivers to elicit behavior change. Identifying the key components of MI in eliciting behavioral changes would enable the development of targeted health communication training designed to maximize African American adolescents' and caregivers' motivation for weight loss. The proposed study will use data from a parent clinical trial that is part of an NIH-funded obesity center grant (U01 HL097889) at Wayne State University providing family-based weight loss interventions to AAAOs and their primary caregivers. A newly developed code scheme will be used to conduct a secondary analysis of 184 weight loss treatment sessions from the parent clinical trial. The goals of this research are to (1) identify provider communication behaviors that predict motivation and intention for behavior change among AAAOs and their caregivers and (2) to link provider communication behaviors to changes in the health behavior of AAAOs and their caregivers, such as changes in diet, fitness, body fat composition and weight, through changes in their motivation and intention for behavior change.