The rise in adolescent obesity contributes to diabetes, cardiovascular disease, and eventually will lead to adulthood obesity. Physicians counsel overweight adolescent patients about nutrition and physical activity;however, few theory-based, easily disseminable interventions have been tested to improve physician counseling. We propose a randomized, controlled trial to assess the efficacy of a staggered delivery intervention to improve physician communication. The proposed intervention should increase physician Motivational Interviewing (MI) communication (e.g., eliciting """"""""change talk"""""""", exploring ambivalence, etc.) and increase counseling time via a Summary Report that details adolescent's risk behaviors that contribute to unhealthy weight (i.e., sweetened beverages, fast food, breakfast, physical activity, screen time, and sleep). Our multidisciplinary team plans to audio record 200 baseline adolescent patient-physician visits (50 pediatricians and family physicians practicing in the community;4 visits each). Then, half of the physicians will be randomly assigned to receive a tailored CD-ROM that contains didactic information and audio clips from physicians'own baseline visits to demonstrate MI communication. We then will audio record a new set of 200 post CD-ROM visits for all physicians. Then all physicians will receive the Summary Report, and we will audio record a new set of 200 Post Summary Report visits. Our innovative design allows us to test the effects of the CD-ROM alone, Summary Report alone and the combination. The primary outcome is physician adherence to MI techniques. Secondary outcomes are physicians discussing the six health risk behaviors and adolescent changes in nutrition, physical activity, and weight three months after the visit. We hypothesize that, compared to physicians in the control arm, physicians in the intervention arm will provide more effective (MI adherent) nutrition and physical activity counseling. Results of this study will expand the field of patient- physician communication by testing a low intensity, self-directed communication intervention for physicians to improve counseling, which over time and multiple visits, will improve adolescent patients'nutrition and physical activity.

Public Health Relevance

Adolescent obesity is at an all time high. Physicians can play a role in helping adolescents attain a healthy weight. This study will test an intervention to help physicians counsel adolescents about nutrition and physical activity more effectively. This intervention should improve physician communication, which then in turn, should improve adolescents9 nutrition and physical activity behaviors.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL092403-05
Application #
8485635
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Pratt, Charlotte
Project Start
2009-09-15
Project End
2014-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
5
Fiscal Year
2013
Total Cost
$688,804
Indirect Cost
$237,234
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Pollak, Kathryn I; Coffman, Cynthia J; Tulsky, James A et al. (2016) Teaching Physicians Motivational Interviewing for Discussing Weight With Overweight Adolescents. J Adolesc Health 59:96-103
Østbye, Truls; Lyna, Pauline; Bodner, Michael E et al. (2015) The Effect of Parental Presence on Weight-Related Discussions Between Physicians and Their Overweight Adolescent Patients. Clin Pediatr (Phila) 54:1218-20
Alexander, Stewart C; Fortenberry, J Dennis; Pollak, Kathryn I et al. (2015) Disclosure of Sexual Intercourse by Teenagers: Agreement Between Telephone Survey Responses and Annual Visit Disclosures. Clin Pediatr (Phila) 54:529-33
Pollak, Kathryn I; Coffman, Cynthia J; Alexander, Stewart C et al. (2014) Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents. Patient Educ Couns 96:327-32
Alexander, Stewart C; Fortenberry, J Dennis; Pollak, Kathryn I et al. (2014) Sexuality talk during adolescent health maintenance visits. JAMA Pediatr 168:163-9
Bodner, Michael E; Dolor, Rowena J; Ostbye, Truls et al. (2014) Accuracy and congruence of patient and physician weight-related discussions: from project CHAT (Communicating Health: Analyzing Talk). J Am Board Fam Med 27:70-7
Bravender, Terrill; Tulsky, James A; Farrell, David et al. (2013) Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight. Patient Educ Couns 93:525-31
Pollak, Kathryn I; Coffman, Cynthia J; Alexander, Stewart C et al. (2012) Can physicians accurately predict which patients will lose weight, improve nutrition and increase physical activity? Fam Pract 29:553-60
Pollak, Kathryn I; Alexander, Stewart C; Tulsky, James A et al. (2011) Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med 24:665-72
Pollak, Kathryn I; Coffman, Cynthia J; Alexander, Stewart C et al. (2011) Predictors of weight loss communication in primary care encounters. Patient Educ Couns 85:e175-82

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