Abstract
Health risk behaviors are a leading cause of morbidity during adolescence. Screening and counseling for health risk behaviors are recommended but infrequently performed. To test the effect of an electronic screening and feedback tool on clinician counseling and adolescent-reported health risk behaviors. A randomized clinical trial compared electronic screening and feedback on an intention-to-treat basis with usual care among 300 youths 13 to 18 years of age at 5 pediatric clinics in the Pacific Northwest. Outcomes were assessed via electronic survey at 1 day and 3 months after the initial visit. Study data collection occurred from March 13, 2015, to November 29, 2016, and statistical analysis was conducted between February 6, 2017, and June 20, 2018. Youths in the intervention group (n = 147) received electronic screening and personalized feedback with clinician clinical decision support. Youths in the control group (n = 153) received standard screening and counseling as provided by their clinic. Youths' report of receipt of counseling during the visit and risk behaviors at 3 months. In the final study sample of 300 youths (intervention group, 75 girls and 72 boys; mean [SD] age, 14.5 [1.4 years]; and control group, 80 girls and 73 boys; mean [SD] age, 14.5 [1.4] years), 234 (78.0%) were aged 13 to 15 years. After adjusting for age, sex, and random effect of clinic, youths in the intervention group were more likely to receive counseling for each of their reported risk behaviors than were youths in the control group (adjusted rate ratio, 1.32; 95% CI, 1.07-1.63). Youths in the intervention group had a significantly greater reduction (β = -0.48; 95% CI, -0.89 to -0.02; P = .02) in their risk behavior scores at 3 months when compared with youths in the control group. Electronic screening of health risk behavior with clinical decision support and motivational feedback to teens can improve care delivery and outcomes. ClinicalTrials.gov identifier: NCT02360410.
Highlights
In recognition of the effect of these behaviors, screening is recommended by Bright Futures[3] and the Guidelines for Adolescent Preventive Services,[4 2] leading US adolescent well-child care guidelines
This study found that use of the electronic screening and personalized feedback tool increased the delivery of counseling and was associated with reduced overall rates of adolescent risk behaviors 3 months later
This finding suggests that electronic screening with integrated personalized feedback holds promise as a strategy for improving screening and counseling for risk reduction and adolescent behavior change
Summary
Health-compromising behaviors, such as risky sexual behaviors and substance use, often increase in adolescence and are associated with significant short-term and long-term morbidity.[1,2] In recognition of the effect of these behaviors, screening is recommended by Bright Futures[3] and the Guidelines for Adolescent Preventive Services,[4 2] leading US adolescent well-child care guidelines. Despite the availability of guidelines and training materials, implementation of preventive screening remains low.[5,6,7] Less than half of youths who are seen for well care are screened and even fewer receive counseling regarding risk behaviors.[8,9,10,11,12]. The addition of standardized screening methods, including electronic screening tools, has been shown to increase detection and clinician discussion.[13,14] A recent review article identified only 9 studies of screening for multiple risk behaviors and health care–based interventions with youth outcome data.[15] There was considerable variation across the studies in the intensity of the interventions, the behaviors studied, and the outcomes.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
