The Impact of Health Screening via PDA on Obesity Risk Counseling at the Childhood Well Visit
Background: Clinicians have limited time in well visits to assess obesity risks and motivate/support parents and patients for behavioral change. Health risk screening on hand held computers (PDAs) has been shown to enhance adolescent health counseling and outcomes. PDAs could be used by parents of younger patients at well visits to ascertain risk for obesity, and prompt clinician discussion.
Objective: To determine if PDA based health screeners alter the clinician's discussion of obesity-related topics and motivate parents to initiate obesity preventive changes.
Design/Methods: A PDA-based health screener for 4-10 year old well visits was used in 4 community primary care practices to assess diet and activity as well as development, behavior, school concerns, safety, social issues and readiness to change diet and activity. Clinicians reviewed a summary prior to the visit with counseling prompts to use brief motivational interviewing. Parental exit surveys were conducted prior to (n= 206) and during PDA use (n=105) determining topics discussed, satisfaction and willingness to implement changes after the visit. Univariate models examined predictors of parental willingness to change one or all of obesity related risks (diet, activity, screen time, family activities summed) with practice site as co-variate.
Results: Parents in the PDA prompted group reported more clinician discussion of appropriate growth for age (98% vs. 90% pre-PDA usual care), physical activity (91% vs. 78%), development/school issues (90% vs. 80%)(all p <.05). There was no difference for diet (94%), screen time (65%) and behavior (61%). For children with BMI >85%, discussion of physical activity, but not other topics, increased over usual care (93% vs. 79%, p <.02). With the PDA there was increased satisfaction with diet counseling and more parents reported they were likely to make changes in the child's diet (48% PDA vs. 32%, <.05). PDA use did not increase intentions to change screen time, physical activity or family activities. An interaction between PDA use and the number of obesity risks discussed was significant (p<.03). Discussion of more topics in the PDA group (β=.32) was more likely to result in parents planning to make changes for multiple obesity risks than in the usual care group (β =.18).
Conclusions: The use of this new PDA approach to gather data from parents and guide clinician discussion can enhance obesity risk preventive counseling and parents' motivation to make changes after the visit.
The Healthy Families Project: A two step approach to improving primary care obesity counseling and outcomes.
Background: Consistent obesity risk screening and brief counseling is difficult to provide at child well visits. Primary care obesity interventions need to enhance clinician counseling and support family change efforts post visit. Monthly mailings tailored to the family readiness to change could reinforce the clinician advice.
Objective: To determine effectiveness of an intervention of tailored educational/motivational mailings in changing BMI of overweight children when combined with a PDA-based well visit health screener to enhance well visit obesity risk counseling.
Design/Methods: PDA-based health risk screening occurred in 4 practices with parents at 4-10 yr. old well visits. Training and clinician prompts on the PDA encouraged brief motivational interviewing. Subjects with >85% BMI were recruited and randomized to follow up reinforcement with 4 innovative mailings tailored for age /stage of change that addressed nutrition/exercise/parenting topics or 1 educational mailing. Parent surveys and child BMI at baseline and 6 months assessed the impact of the office counseling plus tailored mailings on BMI compared to office counseling with minimal education. Univariate analysis predicting final BMI z-scores controlled for practice and baseline BMI with co-variates of intervention group, age, gender, and plan to make a change post visit.
Results: Of 146 parents enrolled 54% post visit planned to make >1 diet, activity or screen time change. 90 had BMI measured at 6 months. Drop-outs and completers did not differ. The overall predictive model was significant (p=.03) with a difference of -.104 BMI z-score favoring the intervention. The intervention (p=.04) resulted in a decrease in BMI z-scores of -.09 (CI -.157 to -.025). With only PDA visit, BMI z increased +.013 (CI-.058 to .084). There was no main effect for age, gender or plan to make a change but a significant group x age interaction (p=.004) and group x age x plan to change interaction(p=.04). There are limited numbers in these subgroups but the intervention effect favors younger children when the parent left the visit planning to make a change.
Conclusions: Enhanced obesity screening and counseling prepares families to change does not improve outcomes for children >85% BMI. If coupled with tailored reinforcement by mail it resulted in modest but significant improvements in BMI for age that are similar to outcomes with more intensive multi-session family interventions and school-wide interventions.
Health IT to Improve Health Care Decision-Making Through the use of Integrated Data and Knowledge Management
The overall goal of the Healthy Teens TXT ME project is to use information technology to enhance teen health risk assessment and counseling as well as support changes in teen behaviors after their primary care visit. The primary focus is on effective counseling on exercise and tobacco. The specific aims of this project include:
1. Enhance the Healthy Teens PDA-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 (increasing exercises or tobacco cessation) 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 teen indicates interest in changing exercise. Evaluation will include short term outcomes related to message content and health behavior outcomes.
The project is being conducted in a three phase approach. Phase I includes message development, PDA enhancements for counseling and preparation for the feasibility studies. Phase II will pilot message content and social network site development and Phase III will focus on field testing and evaluation. |
