Miller Melissa K, Champassak Sofie, Goggin Kathy, Kelly Patricia, Dowd M Denise, Mollen Cynthia J, Humiston Sharon G, Linebarger Jennifer, Apodaca Timothy
From the *Department of Pediatrics, Children's Mercy Hospitals and Clinics; †Department of Psychology and ‡School of Nursing, University of Missouri-Kansas City, Kansas City, MO; §Division of Emergency Medicine, Children's Hospital of Philadelphia; and ∥Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Pediatr Emerg Care. 2016 Jan;32(1):17-9. doi: 10.1097/PEC.0000000000000285.
Although emergency department (ED) visits offer an opportunity to deliver brief behavioral interventions to improve health, provision of ED-based interventions targeting adolescent sexual health is uncommon. The objectives for this study were to evaluate the feasibility and preliminary effects of a novel sexual health service intervention for adolescents.
In this cross-sectional feasibility study, sexually active patients aged 14 to 19 years presenting to a Midwestern pediatric ED were recruited to receive an intervention to improve sexual health. The intervention, based on motivational interviewing (MI), included agenda setting, exploration of behaviors, a decisional balance exercise, tailored feedback, and provision of personalized health services (including condoms, prescription for emergency contraception, urine testing for Chlamydia trachomatis and Neisseria gonorrheae, and referral to the hospital-affiliated adolescent clinic). Data were collected before and after intervention administration and at a 3-month follow-up telephone interview. Surveys assessed sexual risk behaviors, satisfaction with the intervention, health care use, and demographics. Feasibility criteria were (1) subject-rated interventionist fidelity to MI principles (Likert scale 1 [strongly agree] to 4 [strongly disagree]), (2) subject satisfaction (Likert scale 1 [not at all] to 5 [very]), and (3) session duration (minutes, recorded by the interventionist). A secondary outcome was the proportion of subjects who completed at least 1 health service. Services provided at the adolescent clinic were determined by an electronic medical record review. Comparisons of responses between sex subgroups were analyzed using Χ test.
From August to November 2012, 69 adolescents were approached, 66 (96%) completed the screening survey, and 24 (37%) reported previous sexual activity. Of those, 20 (83%) agreed to participate. The mean (SD) age was 16.2 (1.4) years; 60% were female. Most (78%) reported that the interventionist maintained high fidelity to MI principles and most (80%) were very satisfied with the intervention. Mean (SD) intervention length was 15.7 (2.2) minutes. Most subjects (65%) accepted 1 or more health services, including 42% who completed clinic follow-up. In the ED or the referral clinic, the following services were provided to the subjects: condoms (n = 11), emergency contraception prescription (n = 5), C. trachomatis/N. gonorrheae testing (n = 4), hormonal birth control provision (n = 2), and human immunodeficiency virus testing (n = 3). Fifteen subjects (75%) were reached for the 3-month follow-up, and condom use was maintained by 67% of those reporting sexual activity.
This study demonstrated the feasibility and potential utility of an MI-based service navigation intervention to connect youth with point-of-care services as well as resources for ongoing sexual health needs.
尽管急诊科就诊为提供简短行为干预以改善健康状况提供了契机，但针对青少年性健康的基于急诊科的干预措施并不常见。本研究的目的是评估一种针对青少年的新型性健康服务干预措施的可行性和初步效果。
在这项横断面可行性研究中，招募了到中西部一家儿科急诊科就诊的14至19岁性活跃患者，以接受改善性健康的干预措施。该干预措施基于动机性访谈（MI），包括设定议程、行为探索、决策平衡练习、个性化反馈以及提供个性化健康服务（包括避孕套、紧急避孕处方、沙眼衣原体和淋病奈瑟菌尿液检测以及转介至医院附属青少年诊所）。在干预措施实施前后以及3个月的随访电话访谈中收集数据。调查评估性风险行为、对干预措施的满意度、医疗保健利用情况和人口统计学特征。可行性标准为：（1）受试者对干预者遵循MI原则的评分（李克特量表1[强烈同意]至4[强烈不同意]）；（2）受试者满意度（李克特量表1[一点也不]至5[非常]）；（3）会话时长（分钟，由干预者记录）。次要结果是至少完成1项健康服务的受试者比例。通过电子病历审查确定在青少年诊所提供的服务。使用卡方检验分析性别亚组之间反应的比较。
2012年8月至11月，接触了69名青少年，66名（96%）完成了筛查调查，24名（37%）报告有过性活动。其中，20名（83%）同意参与。平均（标准差）年龄为16.2（1.4）岁；60%为女性。大多数（78%）报告称干预者高度遵循MI原则，大多数（80%）对干预措施非常满意。平均（标准差）干预时长为15.7（2.2）分钟。大多数受试者（65%）接受了1项或更多健康服务，包括42%完成了诊所随访的受试者。在急诊科或转诊诊所，为受试者提供了以下服务：避孕套（n = 11）、紧急避孕处方（n = 5）、沙眼衣原体/淋病奈瑟菌检测（n = 4）、激素避孕措施（n = 2）以及人类免疫缺陷病毒检测（n = 3）。15名受试者（75%）接受了3个月的随访，报告有性活动的受试者中67%维持了避孕套使用。
本研究证明了基于MI的服务导航干预措施将青少年与即时医疗服务以及满足持续性性健康需求的资源相连接的可行性和潜在效用。
