Shafii Taraneh, Benson Samantha K, Morrison Diane M
Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.
Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, United States.
J Med Internet Res. 2019 Jul 10;21(7):e13220. doi: 10.2196/13220.
Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits.
The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer.
At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice.
The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves.
In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents.
临床医生需要对青少年患者越来越多的健康行为进行筛查,并在发现危险行为时进行干预,然而,分配给筛查、干预和提供资源的门诊时间不足。简短动机性访谈(MI)提供简洁的行为改变咨询;然而,为了实施,临床医生需要培训、技能和时间。计算机化筛查和咨询辅助工具可能有助于临床医生扩大行为筛查范围,尤其是对于性健康等敏感话题,并在就诊期间不占用医生时间的情况下提供降低风险的干预措施。
本研究的目的是(1)了解医疗保健提供者在与青少年患者进行性健康讨论时使用简短MI的程度,以及(2)评估将基于简短MI的干预措施纳入其临床实践(由他们自己或计算机实施)以减少性风险行为的可接受性。
在一次全国性医学会议上,对为青少年提供性健康护理的临床医生进行了调查。询问他们目前在性风险行为讨论中使用MI的情况,以及他们将计算机化性健康筛查和计算机化性风险行为干预措施纳入其临床实践的意愿。
绝大多数(87.6%,170/194)临床医生已经在与患者的交流中使用MI,不到一半(72/148,48.6%)的医生报告他们接受过MI的正规培训。尽管所有(195/195,100.0%)临床医生都觉得与患者讨论性风险行为非常或完全自在,但绝大多数(160/195,82.1%)报告说,对于一个计算机化程序来完成所有事情:筛查患者、生成风险概况并提供降低风险的咨询,而不是他们自己来做,这将是有用的、非常有用的或极其有用的。
在本研究中,大多数临床医生在与青少年讨论性风险行为时使用了某种形式的简短MI或以患者为中心的咨询,并且对此非常自在。然而,绝大多数人更愿意在对青少年的临床护理中实施计算机化性健康筛查、风险评估和性风险行为干预措施。