Olson Ardis L, Gaffney Cecelia A, Lee Pamela W, Starr Pamela
Department of Pediatrics, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.
Am J Prev Med. 2008 Nov;35(5 Suppl):S359-64. doi: 10.1016/j.amepre.2008.08.014.
Brief motivational interventions that have been provided in addition to routine primary care have changed adolescent health behaviors. Whether health screening and motivational-interviewing-based counseling provided by clinicians during routine care can change behaviors is unknown.
Healthy Teens was a primary care, office-system intervention to support efficient, patient-centered counseling at well visits. Healthy Teens utilized a personal digital assistant (PDA)-based screener that provided the clinician with information about a teen's health risks and motivation to change. Changes in adolescent self-report of diet and activity health behaviors 6 months later were assessed in two cross-sectional samples of teens from five rural practices in 2005 and 2006. Usual-care subjects (N=148) were recruited at well visits prior to the intervention, and the Healthy Teens subjects (N=136) were recruited at well visits after the Healthy Teens system was well established.
At 6-month follow-up, the Healthy Teens group had significantly increased self-reported exercise levels and milk-product intake. In the models exploring covariates, the only significant predictors for improvement in exercise levels were intervention-group status (p=0.009) and post-visit interest in making a change (p=0.015). Interest in changing predicted increased milk intake (p=0.028) in both groups. When teens planned an action related to nutrition, physical activity, or both after a well visit, Healthy Teens participants were more likely to report multiple planned actions (68% Healthy Teens vs 32% usual care, p<0.05).
Changes in office systems using low-cost technology to screen adolescents and promote patient-centered counseling appear to influence teens to increase exercise and milk intake.
除常规初级保健外提供的简短动机干预已改变了青少年的健康行为。临床医生在常规护理期间提供的健康筛查和基于动机访谈的咨询是否能改变行为尚不清楚。
“健康青少年”是一项初级保健办公室系统干预措施，旨在支持在健康检查时进行高效、以患者为中心的咨询。“健康青少年”利用基于个人数字助理（PDA）的筛查工具，为临床医生提供有关青少年健康风险和改变动机的信息。在2005年和2006年，对来自五个农村医疗机构的两组青少年横断面样本进行了评估，以了解6个月后青少年饮食和活动健康行为自我报告的变化。在干预前的健康检查中招募了常规护理对象（N = 148），在“健康青少年”系统建立完善后的健康检查中招募了“健康青少年”对象（N = 136）。
在6个月的随访中，“健康青少年”组自我报告的运动水平和奶制品摄入量显著增加。在探索协变量的模型中，运动水平改善的唯一显著预测因素是干预组状态（p = 0.009）和就诊后改变的兴趣（p = 0.015）。改变的兴趣预测两组的牛奶摄入量均会增加（p = 0.028）。当青少年在健康检查后计划采取与营养、体育活动或两者相关的行动时，“健康青少年”参与者更有可能报告多项计划行动（“健康青少年”组为68%，常规护理组为32%，p < 0.05）。
使用低成本技术筛查青少年并促进以患者为中心的咨询的办公室系统变化似乎会影响青少年增加运动和牛奶摄入量。
