Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial

Abstract

Background Adolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet. Objective This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial. Methods Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models. Results In total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms. Conclusions Although adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness. Trial Registration University Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

“…Of the 33 studies analyzed, all were published over a 1-year period [ 28 - 60 ]. Only 6% (2/33) of the studies involved participants younger than 18 years [ 40 , 47 ]. The rest of the studies included participants aged from 18 to 85 years.…”

“…As these were the result of a thematic analysis, there are cases of multiple observations of the same theme in the same article; therefore, the frequency may not have aligned with the number of references. Of the 92, there were 31 (34%) instances of an increase in physical health [ 30 , 33 , 39 - 42 , 44 , 47 , 49 , 51 - 55 , 57 , 58 ]. This theme included maximum oxygen consumption, comparison of bad cholesterol with good cholesterol, pain, diastolic blood pressure, systolic blood pressure, hypoglycemia, lipids, overall blood pressure, average blood sugar over last 3 months, physical function, fasting blood glucose, cholesterol, and BMI.…”

“…This theme included maximum oxygen consumption, comparison of bad cholesterol with good cholesterol, pain, diastolic blood pressure, systolic blood pressure, hypoglycemia, lipids, overall blood pressure, average blood sugar over last 3 months, physical function, fasting blood glucose, cholesterol, and BMI. There were 17% (16/92) of instances of increased mental health [ 31 , 32 , 37 , 39 , 43 , 45 , 47 , 54 , 57 ]. This theme encompassed anxiety, well-being, stress, loneliness, depression, fear, personal satisfaction, helplessness, rumination, acceptance, suicidal ideation, and resilience.…”

“…There were 12% (11/92) of instances of 2 themes: changed behavior, which included sexual behavior, self-care, drinking, smoking, physical activity, weight loss, and salt intake [ 29 , 32 , 34 , 50 , 53 , 55 , 56 , 58 - 60 ] and increased quality of life (QoL), which included sleep, vitality, interpersonal problems, attitude, or as measured by the EuroQoL visual analog scale [ 31 , 36 , 37 , 39 - 41 , 45 , 54 , 56 , 57 , 59 , 60 ]. There were 7% (6/92) of instances of increased self-efficacy [ 28 , 35 , 36 , 41 , 47 ]. This theme included an increase in self-care, vaccinations, and preventive measures, such as Papanicolaou smears, colorectal exams, and mammograms.…”

“…All these 33 studies reported the positive effectiveness of telemedicine as a modality across all 6 domains of quality. These studies showed positive outcomes in physical [ 30 , 33 , 39 - 42 , 44 , 47 , 49 , 51 - 55 , 57 , 58 ] and mental health [ 31 , 32 , 37 , 39 , 43 , 45 , 47 , 54 , 57 ], medical engagement [ 28 , 30 , 32 , 35 , 36 , 40 , 43 , 46 , 48 , 60 ], changed behavior [ 29 , 32 , 34 , 50 , 53 , 55 , 56 , 58 - 60 ], increased QoL [ 31 , 36 , 37 , 39 - 41 , 45 , 54 , 56 , 57 , 59 , 60 ], increased self-efficacy [ 28 , 35 , 36 , 41 , 47 ], increased social support [ 28 , 32 ], and reduced costs [ 34 ].…”