Healthy Teens TXT ME: Information Technology to Change Teen Health Risk Behaviors (New Hampshire)

Project Final Report (PDF, 243.68 KB) Disclaimer

Project Details - Ended

Project Categories

Summary:

This project utilized information technology (IT) to develop an integrated screening, counseling, and post-visit support system to increase physical activity among adolescents. Dr. Olson and her research team programmed and tested the Healthy Teens personal digital assistant (PDA) screening program software that supports effective clinician counseling about exercise uptake. The technology, called Healthy Teens TXT ME, included tailored cell phone text messaging to teenagers interested in behavior change and a social Web site for project participants to share experiences and support their change efforts. In addition, the software was programmed to produce a summary report that transfers data into patient electronic medical records for future reference. The system included tailored cell phone text messaging to teenagers who indicated that they were interested in behavior change, and a social network for participants to share experiences and support their change efforts.

The aims of the project were to:

  • Enhance effective counseling for increased exercise and tobacco cessation in the Healthy Teens PDA-based health risk screening tool through appropriate clinician prompts, drawing from evidence-based literature, and existing public health and patient counseling programs.
  • Develop the format, message delivery algorithm, and technological processes linking PDA-based teen health screening data from the primary care visit to tailored followup behavior change messages delivered as cell phone text.
  • Develop the prototype of an Internet social network site where adolescents are linked to other project participants who are trying to change a specific health behavior (increasing exercises or tobacco cessation) and where they can access other Web-based resources.
  • Conduct a feasibility trial of the exercise component of the TXT ME model to evaluate the use of PDA technology to screen and prompt clinicians, and cell phone technology to provide post-visit reinforcement in changing teen exercise behavior.

The results of the study indicate that clinician counseling is an important catalyst for teens to exercise more and try new exercise. The text messaging intervention was effective at increasing exercise throughout the study. The text messages combined with counseling from providers resulted in two interventions. Utilizing heath IT to enhance screening and counseling by clinicians is a promising integrated approach to enhance adolescent exercise habits.

Healthy Teens TXT ME: Information Technology to Change Teen Health Risk Behaviors - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 018214
  • Project Period: 
    November 2009 – March 2012
  • AHRQ Funding Amount: 
    $299,978
  • PDF Version: 
    (PDF, 203.78 KB)

Summary: Adolescence is a time of rapid and complex change during which health risks may stem more from behavioral than biomedical factors. While many behaviors are experimental, habits and coping patterns acquired during this developmental stage may continue into adulthood. Research has shown that school-based interventions for major risks are often nominally or not at all effective. Interventions that use motivational interviewing and technology to enhance screening and counseling of adolescents are costly, intensive, and require additional time, staff, and computer resources not generally available to most primary care providers. This project utilized information technology (IT) to develop an integrated screening, counseling, and post-visit support system to increase physical activity among adolescents.

Dr. Olson and her research team programmed and tested the Healthy Teens personal digital assistant (PDA) screening program software that supports effective clinician counseling about exercise uptake. A system of IT-based post-health visit supports was created to help teens increase exercise. The first support was tailored cell phone text messaging to teenagers who indicated that they were interested in behavior change. A Healthy Teens TXT ME social network site was established for project participants to share experiences and support their efforts to change. The text messages also informed teens about developments and new network site links.

Specific Aims:

  • Enhance the TXT ME PDA-based health risk screening tool with clinician prompts to support effective counseling for exercise uptake and tobacco cessation from evidence-based literature and existing public health and patient counseling programs. (Achieved)
  • Develop the format, message delivery algorithm, and technological processes to link PDA-based teen health screening data from the primary care visit to tailored followup health behavior change text messages delivered by cell phone. (Achieved)
  • Develop the prototype of adolescent health behavior change support via a social network Web site that links adolescents in the project and provides access to Web-based resources. (Achieved)
  • Conduct a small feasibility trial of the exercise component of the TXT ME model that will use PDA technology to screen adolescents who are interested in changing exercise patterns and prompt clinicians to provide reinforcement via post-visit text messaging to help teens make these changes. Evaluation will include short-term outcomes related to text message design and health behavior outcomes. (Achieved)

2012 Activities: The focus of 2012 was quantitative data analysis and dissemination of study results. A 6-month no-cost extension was used to allow for a lengthier recruitment period so that the research team could meet their recruitment goals. As last reported in the AHRQ Research Reporting System, project progress was on track and budget spending was on target. This project was completed in March 2012.

Impact and Findings: Feasibility pilots of the TXT ME program were implemented at eight primary care practices. Adolescents were screened for health risks at preventive care visits and those interested in improving health behaviors were eligible to participate in the study. In Phase One of the study, participants were offered exercise counseling during office visits. In Phase Two, intervention arm participants received 6 weeks of brief, daily text messages to provide motivational and practical support. Enrollees participated in data collection at baseline, at the end of the intervention period, and 1 month after the intervention. The following information was collected at baseline: physical exercise in last 24 hours and past 3 days; whether the doctor discussed exercise during the last clinic visit; exercise goals and changes for the next month; attitude about exercise; stress level; access to exercise equipment; barriers to exercise; time spent on computer and watching television; and health risks. At the end of the intervention period, followup data was collected on changes in attitude about exercise, level and amount of time spent exercising, stress, and access to exercise equipment. One month after the intervention, the same followup data was collected.

A total of 3,811 adolescents were screened for health risks. Forty-eight percent (1,840) expressed interest in increasing their exercise level, and 35 percent (622) of those expressed interest in learning about the study. Four-hundred-and-eighty-nine patients met the eligibility criteria and 208 enrolled in the study. The study cohort was 69.5 percent female and the mean age was 15.5 years.

Quantitative analyses indicated that providers discussed exercise 44.7 percent of the time and that 97 percent of participants found the discussions somewhat or very helpful. Forty-eight percent of children started exercising when counseled by their doctor, while 30 percent initiated exercise without counseling. Physician counseling was positively associated with increasing exercise and beginning new types of exercise. Increased exercise was also predicted by body mass index greater or equal to 95 percent, perceived stress, and importance of exercise. The TXT ME intervention improved time spent exercising
by an average of 48 minutes compared to control.

Qualitative interviews to assess usability and likeability were conducted with a subset of 20 participants. Overall, feedback was positive and indicated that the study was well received. The nutrition text messages were very popular among participants. Most study participants preferred pragmatic messages that provided useful tips or information, as opposed to the motivational messages. About half of the participants who used the social network Web site ranked it favorably; the half who did not use it did not because it was viewed as another system to log into. Feedback on early morning text messages was mixed but there was agreement that the frequency of messages was appropriate.

Overall, the study indicated that coupling motivational counseling with text messages is a feasible approach to support improvement in adolescent exercise habits.

Target Population: Obesity, Pediatrics*, Teenagers

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

* This target population is one of AHRQ’s priority populations.

Healthy Teens TXT ME: IT to Change Teen Health Risk Behaviors - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (R21)
  • Grant Number: 
    R21 HS 018214
  • Project Period: 
    November 2009 - March 2012
  • AHRQ Funding Amount: 
    $299,978
  • PDF Version: 
    (PDF, 482.74 KB)

Summary: Adolescence is a time of rapid and complex change during which health risks stem more from behavioral factors than biomedical factors. While many behaviors are experimental, habits and coping patterns developed during this developmental stage may continue into adulthood. Research has shown that school-based interventions for major risks are often nominally effective or ineffective. Interventions that use motivational interviewing and technology to enhance screening and counseling of adolescents are costly, intensive, and require additional time, staff, or computer resources not generally available to most primary care providers. This project seeks to utilize information technology (IT) to develop an integrated screening, counseling, and post-visit support system to increase physical activity among adolescents.

Dr. Olson and her research team programmed and tested the Healthy Teens personal digital assistant (PDA) screening program software that supports effective clinician counseling about exercise uptake. In addition, the software was programmed to produce a summary report that will transfer data into patient electronic medical records for future reference. A system of IT-based post-health visit supports was created to help teens increase exercise. The first support was tailored cell phone text messaging to teenagers who indicated that they were interested in behavior change. A Healthy Teens TXT ME social network site was established for project participants to share experiences and support their change efforts. The text messages sent to teens informed them about developments and new links on the network site.

Two feasibility pilots of the TXT ME program were implemented with post-visit support in eight primary care practices over 3 months. Two cohorts per pilot were recruited from adolescents who indicated at their clinic visit that they wanted to increase their physical exercise. The first cohort was the control and its participation was limited to survey completion. The second cohort received post-visit supports for exercise via cell phone text messaging and had access to the social network site. Teen acceptability and short-term-change efforts were assessed.

Specific Aims:

  • Enhance the TXT ME PDA-based health risk screening tool with clinician prompts to support effective counseling for exercise uptake and tobacco cessation from evidence-based literature and existing public health and patient counseling programs. (Achieved)
  • Develop the format, message delivery algorithm, and technological processes to link PDA-based teen health screening data from the primary care visit to tailored followup health behavior change text messages delivered by cell phone. (Achieved)
  • Develop the prototype of adolescent health behavior change support via a social network Web site that links adolescents in the project and provides access to Web-based resources. (Achieved)
  • Conduct a small feasibility trial of the exercise component of the TXT ME model that will use PDA technology to screen adolescents who are interested in changing exercise patterns and prompt clinicians to provide reinforcement via post-visit text messaging to help teens make these changes. Evaluation will include short-term outcomes related to text message design and health behavior outcomes. (Ongoing)

2011 Activities: The study staff recruited patients for study participation. In Phase One of the study, participants were offered counseling about exercise during office visits. In Phase Two, intervention arm participants received 6 weeks of brief daily text messages to provide motivational and practical support. Enrollees participated in three phases of data collection. The following information was collected at baseline: physical exercise in last 24 hours and past 3 days; whether the doctor discussed exercise during the last clinic visit; exercise goals and changes for the next month; attitude about exercise; stress level; access to exercise equipment; barriers to exercise; time spent on computer and watching television; and health risks. At the end of the intervention period, follow-up data was collected on changes in attitude about exercise, level and amount of time spent exercising, stress, and access to exercise equipment. One month after the intervention, the same follow-up data was collected. Qualitative interviews were conducted with a subset of participants to assess usability and likeability.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track with the revised timeline, and the project budget is roughly on target. A 6-month no-cost extension was used to allow for a lengthier recruitment period so that the research team was able to meet their recruitment goals.

Preliminary Impact and Findings: A total of 3,811 adolescents in eight primary care practices were screened for health risks. Forty-eight percent (1,840) expressed interested in increasing their exercise level, and 35 percent (622) of those expressed interest in learning about the study. Four-hundred-and- eighty-nine patients met the eligibility criteria and 208 enrolled in the study. The study cohort was 69.5 percent female and the mean age was 15.5 years.

Qualitative interviews were conducted with 20 study participants. Overall, feedback was positive and indicated that the study was well received. The nutrition text messages were very popular among participants. Most study participants preferred pragmatic messages that provided useful tips or information, as opposed to the motivational messages. About half of the participants who used the social network Web site ranked it favorably. The other half of study participants did not use the Web site because it was viewed as another system to log into. Feedback was mixed regarding early morning text messages; however, there was agreement that the frequency of messages was appropriate.

Quantitative data analysis indicated that providers discussed exercise 44.7 percent of the time and that 97 percent of participants found the discussions somewhat or very helpful. Forty-eight percent of children started exercising when counseled by their doctor, while 30 percent initiated exercise without counseling. Physician counseling was positively associated with increasing exercise and beginning new types of exercise. The text messages combined with counseling from providers resulted in a two-fold intervention. In 2012, the research team will focus on the analysis of the next messaging intervention.

Target Population: Obesity, Teenagers

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Healthy Teens TXT ME; IT to Change Teen Health Risk Behaviors - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (R21)
  • Grant Number: 
    R21 HS 018214
  • Project Period: 
    November 2009 – October 2011
  • AHRQ Funding Amount: 
    $299,978
  • PDF Version: 
    (PDF, 361.67 KB)


Target Population: Obesity, Teenagers

Summary: Adolescence is a time of rapid and complex change during which health risks stem more from the behavioral factors than the biomedical factors. While many behaviors are experimental, habits and coping patterns developed during this developmental stage may continue into adulthood. Research has shown that school-based interventions for major risks are often nominally effective or ineffective. Interventions that use motivational interviewing and technology to enhance screening and counseling of adolescents are costly; intensive; and require additional time, staff, or computer resources not generally available to most primary care providers. This project seeks to utilize information technology (IT) to develop an integrated screening, counseling, and post-visit support system to change two key adolescent health risks: limited physical activity and tobacco use.

The project team will program and test the Healthy Teens personal digital assistant (PDA) screening program software that will support effective clinician counseling about exercise uptake and tobacco cessation. In addition, the software will be programmed to produce a summary report that will transfer data into patient electronic medical records for future reference. A system of IT-based post-health visit supports will be created to help teens increase exercise and decrease tobacco use. The first support will be tailored cell phone text messaging provided to teenagers who indicate that they are interested in behavior change. A Healthy Teens TXT ME social network site will be established for project participants to share experiences and support their change efforts. The text messages sent to teens will inform them about developments and new links on the network site.

Two feasibility pilots of the TXT ME program will be implemented with post-visit support in four primary care practices over 3 months. Clinicians and office staff assessment will determine the utility of and any barriers encountered with the enhanced office system. Two cohorts per feasibility pilot will be recruited from adolescents who indicate at their clinic visit that they want to increase their physical exercise. The first cohort will be the control and its role limited to survey completion. The second cohort will receive the post-visit supports for tobacco or exercise via cell phone text messaging and will have access to the social network site. Teen acceptability and short-term-change efforts will be assessed. Tobacco use messages will be developed during year 2 for later delivery.

Specific Aims:
  • Enhance the TXT ME PDA-based health risk screening tool with clinician prompts to support effective counseling for exercise uptake and tobacco cessation from evidence-based literature and existing public health and patient counseling programs. (Ongoing)
  • Develop the format, message delivery algorithm, and technological processes to link PDA-based teen health screening data from the primary care visit to tailored followup health behavior change text messages delivered by cell phone. (Ongoing)
  • Develop the prototype of adolescent health behavior change support via a social network Web site that links adolescents in the project and provides access to Web-based resources. (Ongoing)
  • Conduct a small feasibility trial of the exercise component of the TXT ME model that will use PDA technology to screen adolescents who are interested in changing exercise patterns and prompt clinicians to provide reinforcement via post-visit text messaging to help teens make these changes. Evaluation will include short-term outcomes related to text message design and health behavior outcomes. (Ongoing)

2010 Activities: The study staff explored different models of support for exercise, investigated smoking cessation Web sites for adolescents, and sought input from the target population. Message development included a literature review and key informant data gathering about motivators to change exercise habits. Messages were developed to help teens advance through the following phases: priming to take action, initiating, relapse, and maintenance. Beta testing of the software was completed and modifications were finalized. A social network site was developed to support adolescent health behavior change by linking adolescences to others in the project trying to change a specific health behavior, either exercise or tobacco. Each of the 11 participating sites had clinician training to demonstrate the features of the PDA that prompt counseling with a motivational interviewing approach.

The principal investigator has met with each participating site to discuss and initiate recruitment and enrollment. Given that the study subjects are adolescents, the recruitment process requires contacting both the parent and the adolescent. As of the end of 2010, 105 control patients were recruited, the majority of which have transitioned into the intervention phase. Approximately 40 percent of those who expressed interest in more frequent exercise provided telephone contact information to learn about the study. Sixty-one percent of contacted control subjects ages 15-19 years enrolled in the study. For younger teens, who often did not have a cell phone, the enrollment rate was approximately 20 percent.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): The project is progressing as scheduled. Project milestones are being achieved on time and budget spending is roughly on target.

Preliminary Impact and Findings: Early data indicate that 44 percent of younger teens and 57 percent of older teens are interested in increasing their exercise.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Healthy Teens TXT ME: Information Technology to Change Teen Health Risk Behaviors - Final Report

Citation:
Olson, A. Healthy Teens TXT ME: Information Technology to Change Teen Health Risk Behaviors - Final Report. (Prepared by Dartmouth College under Grant No. R21 HS018214). Rockville, MD: Agency for Healthcare Research and Quality, 2012. (PDF, 243.68 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
Medical Condition: 
This project does not have any related resource.
This project does not have any related survey.
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.