Piloting an intervention to provide tailored feedback on health behaviors to adolescents in pediatric primary care

Background: The pediatrician’s office frequently provides the first opportunity for behavioral health intervention. However, pediatricians are limited in time, tools, and training to assess and treat behavioral health problems. Even a brief intervention Motivational Interviewing intervention more than doubles the length of a physical exam appointment. Studies investigating the usefulness of technology to assist with behavioral health interventions in pediatric primary care are limited, but one study found that technology was a feasible approach for use in pediatric primary care (Harris et. al., 2012). That study assessed for alcohol with computer technology and provided the findings to the attending physicians who then delivered the MI intervention (Harris et. al., 2012). A next step approach would be to include a computerized intervention. One such computer intervention is by delivering electronic feedback messages targeting a specific behavior, such as smoking. Additionally, tailored feedback interventions based on unique characteristics of an individual have been demonstrated to be more successful than generic informational feedback (Kreuter, 1999; Noar, 2007). Another innovative approach to creating feedback is may be to take a harm reduction approach with adolescents to encourage an increase in healthy behaviors rather than solely focus on discouraging risk behaviors (Mauriello, 2010; Velicer, 2013). Furthermore, tailored feedback messages are more successful when supported by an underlying theory of behavior change. For example, The Transtheoretical Model (TTM), which is based on the decision making of an individual for intentional change, identifies change as a process involving progress through a series of stages primarily seen as related to Decisional Balance and Self-efficacy. In sum, the best evidence tells us that a theory-based tailored feedback intervention using computer technology evokes successful behavior change in a manner that is feasible for in primary care (Noar, 2007). To date, no one study has completely integrated behavioral assessment with a feedback intervention based on the TTM in a pediatric primary care setting. The primary aim of this project was to use a step-by-step approach to Program Evaluation to develop, pilot, and test the feasibility of a computerized assessment of behaviors followed by brief stage-tailored feedback promoting health behaviors to patients and physicians in a pediatric primary care setting. (Abstract shortened by ProQuest.