Improving Teen Care With Health IT

Adolescents often turn to clinicians first when discussing health risk behaviors and report being more satisfied with care when clinicians are willing to engage in these sensitive discussions. This population is also more comfortable and more likely to answer questions honestly when using electronic screening tools rather than traditional methods such as clinician interviews and pen-and-paper surveys. However, there is a documented lack of risk-behavior screening and counseling by clinicians in primary care settings. To address this, the research team improved and tested a previously developed, tablet-based interactive health assessment, called the iHA. This tool was designed to conduct multi-risk screening; provide personalized youth-directed prevention and risk reduction feedback; and summarize youth-reported risk behaviors, goals, and consequences for primary care providers.

In a two-phase study, the research team evaluated the effects of this iHA tool on patients’ reported risk behaviors, patient satisfaction, and clinician-delivered counseling about prevention and risk reduction during well-visits. The interactive health assessment included multiple areas of health risk, including substance use, activity and sleep, diet behavior, sexual health, emotions, and safety.

The specific aims of the research were as follows:

• Optimize the iHA design and content for adolescents and clinicians. 
• Develop implementation processes and training materials to facilitate the use of iHA. 
• Examine the impact of iHA on clinician counseling and patient satisfaction. 
• Examine the efficacy of iHA in reducing adolescent health risk behaviors. 

In the first phase of the study, the research team conducted individual, semi-structured qualitative interviews with 31 adolescents recruited from a children’s hospital. Participants completed the iHA prior to the interview and were asked about their overall perception of the screening tool and ways to improve the content. The research team used the results of the semi-structured interviews to inform the revision of the iHA. In the second phase of the study, 300 adolescents were recruited from 5 pediatric primary care practices to participate in a randomized control trial and assigned to receive either usual care or the revised interactive health assessment. Patients who were assigned to usual care received the electronic screening only, whereas patients assigned to the full revised interactive health assessment also received personalized feedback about their risk behaviors and reporting of screening results to their clinician. Patients completed online followup surveys 1 day, 3 months, and 6 months after their well-visit appointments to assess the content of their visit, delivery of counseling during the visit, and risk behaviors over time.

Participants who received the full interactive health assessment were more likely to report having been counseled by their clinicians on their health risk behaviors, compared to participants who received usual care only. However, the full interactive health assessment was not associated with changes in reported health risk behaviors or patient satisfaction. Despite these mixed findings, this research contributes to the growing body of literature on multi-behavior screening and preventive counseling in adolescent primary care and underscores the need for more research to identify effective health risk reduction strategies in this setting.