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Randomized Controlled Trial
. 2019 May 3;2(5):e193581.
doi: 10.1001/jamanetworkopen.2019.3581.

Effect of Electronic Screening With Personalized Feedback on Adolescent Health Risk Behaviors in a Primary Care Setting: A Randomized Clinical Trial

Laura P Richardson  1   2 , Chuan Zhou  1   2 , Elon Gersh  3   4 , Heather Spielvogle  1 , James A Taylor  2 , Carolyn A McCarty  1   2
Affiliations
Randomized Controlled Trial

Effect of Electronic Screening With Personalized Feedback on Adolescent Health Risk Behaviors in a Primary Care Setting: A Randomized Clinical Trial

Laura P Richardson et al. JAMA Netw Open. .

Abstract

Importance: Health risk behaviors are a leading cause of morbidity during adolescence. Screening and counseling for health risk behaviors are recommended but infrequently performed.

Objective: To test the effect of an electronic screening and feedback tool on clinician counseling and adolescent-reported health risk behaviors.

Design, setting, and participants: A randomized clinical trial compared electronic screening and feedback on an intention-to-treat basis with usual care among 300 youths 13 to 18 years of age at 5 pediatric clinics in the Pacific Northwest. Outcomes were assessed via electronic survey at 1 day and 3 months after the initial visit. Study data collection occurred from March 13, 2015, to November 29, 2016, and statistical analysis was conducted between February 6, 2017, and June 20, 2018.

Interventions: Youths in the intervention group (n = 147) received electronic screening and personalized feedback with clinician clinical decision support. Youths in the control group (n = 153) received standard screening and counseling as provided by their clinic.

Main outcomes and measures: Youths' report of receipt of counseling during the visit and risk behaviors at 3 months.

Results: In the final study sample of 300 youths (intervention group, 75 girls and 72 boys; mean [SD] age, 14.5 [1.4 years]; and control group, 80 girls and 73 boys; mean [SD] age, 14.5 [1.4] years), 234 (78.0%) were aged 13 to 15 years. After adjusting for age, sex, and random effect of clinic, youths in the intervention group were more likely to receive counseling for each of their reported risk behaviors than were youths in the control group (adjusted rate ratio, 1.32; 95% CI, 1.07-1.63). Youths in the intervention group had a significantly greater reduction (β = -0.48; 95% CI, -0.89 to -0.02; P = .02) in their risk behavior scores at 3 months when compared with youths in the control group.

Conclusions and relevance: Electronic screening of health risk behavior with clinical decision support and motivational feedback to teens can improve care delivery and outcomes.

Trial registration: ClinicalTrials.gov identifier: NCT02360410.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Richardson and McCarty reported receiving grants from Health Resources and Services Administration Maternal Child Health Bureau during the conduct of the study. Drs Richardson and McCarty reported having a license agreement with Tickit Health Inc as inventors of the Check Yourself Tool whereby they will receive royalties from the future sale of the tool to other health care companies; Seattle Children’s Hospital has a management plan in place to oversee their interests with Tickit Health Inc. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram
Figure 2.
Figure 2.. Rate of Risk Behaviors for Which Youths Received Counseling
Figure 3.
Figure 3.. Change in Overall Risk Score from Baseline to 3 Months Comparing Intervention With Control Groups
Vertical lines indicate 95% CIs.
See this image and copyright information in PMC

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