Effect of Electronic Screening With Personalized Feedback on Adolescent Health Risk Behaviors in a Primary Care Setting

Abstract

Key Points Question Does electronic risk screening with personalized feedback and clinical decision support increase clinician counseling and reduce risk behaviors in adolescents? Findings In this randomized clinical trial of 300 adolescents randomly assigned to receive electronic screening with personalized feedback vs usual care in the context of a well-child care visit, youths who received the electronic screening intervention were more likely than controls to receive risk counseling. Three months after the visit, youths who received the electronic screening also had a significantly greater reduction than controls in their risk behavior scores. Meaning Electronic screening tools that provide risk information to clinicians and motivational feedback to teens can improve care delivery and youth outcomes.

Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial

“…There were also no significant differences in satisfaction between the 2 groups. These results are in contrast to our original study [ 21 ], which showed both an increase in reported counseling and a reduction in risk behavior scores at 3 months for youth in the intervention group as compared with controls. This study further adds to the growing body of literature on multi-behavior screening and preventive counseling interventions in adolescent well-care visits, which suggests that although provider counseling can be increased, the effects on risk behavior reductions are modest and inconsistent across studies [ 7 ].…”

“…A second limitation of this study is the low prevalence of individual behaviors. Consistent with other studies in pediatric primary care [ 34 , 35 ], including our own [ 21 ], adolescents receiving well-care tended to be younger: 76% (228/300) of participants were in the 13- to 15-year-old age group. Younger adolescents are less likely to engage in risk behaviors than older adolescents, which may limit their ability to show changes in behaviors.…”

“…The tool in this study is an adapted version of the Check Yourself tool (version 2) [ 21 , 25 ], revised to increase interactive features with input from adolescent users, clinicians in collaboration with faculty, and researchers in human-centered design. Specific changes that were developed with adolescent input include increasing image-based feedback versus text, adding functionality to allow participants to choose to see more versus less information on each topic, and the option to receive more information about topics of interest in the form of a one-time text or email.…”

“…The interactive tool was developed with adolescents’ input and designed to be administered before a well-care visit to prepare adolescents to discuss risk behavior change with their clinicians when indicated. The tool tested in this study ( Figure 1 ; see additional examples in Multimedia Appendix 1 ) is a modified version of a previously tested tool [ 21 ]. The modifications were made to increase youth engagement with the tool and increase the ease with which clinicians can interpret the results with changes based on adolescent and clinician input gathered through a human-centered design process [ 22 ].…”

Opportunities and Challenges for Previsit Screening for Sexual and Gender Identity Among Adolescents in Primary Care

“…In one study of audio-recorded pediatric well visits, one-third spent no time discussing sexuality or sexual health, and the average amount of time spent was only 36 seconds [3]. To address this gap between recommendations and practice, some pediatric providers are incorporating questions about sexuality into electronic or other previsit screening tools [4]. In this issue of the Journal of Adolescent Health, Parmar et al [5] are the first to report findings from a large-scale implementation of a standardized assessment of sexual attraction at adolescent health supervision visits.…”