Kepper Maura, Walsh-Bailey Callie, Miller Zoe M, Zhao Min, Zucker Kianna, Gacad Angeline, Herrick Cynthia, White Neil H, Brownson Ross C, Foraker Randi E
Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States.
Institute for Informatics, Washington University School of Medicine, St. Louis, MO, United States.
JMIR Form Res. 2024 May 17;8:e55731. doi: 10.2196/55731.
Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients.
The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data.
A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children's hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data.
PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05).
Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes.
ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193.
青少年超重和肥胖是一场公共卫生危机，会增加心血管健康状况不佳（CVH）和患慢性病的风险。医疗保健提供者在体重管理中起着关键作用，但几乎没有工具可支持提供者为患者提供量身定制的循证行为改变干预措施。
这项试点随机可行性研究的目的是确定在临床环境中实施以患者为中心的实时干预（PREVENT）工具的可行性，生成实施数据以为扩大规模提供信息，并收集初步有效性数据。
进行了一项试点随机临床试验，以检验PREVENT对患者知识、动机、行为和CVH结果的可行性、实施情况和初步影响。该研究在一所学术医疗中心的儿童医院的多学科肥胖管理诊所进行。共有36名12至18岁的患者被随机分配在常规就诊期间使用PREVENT（n = 18，50%）或接受常规护理对照（n = 18，50%）。PREVENT是一种数字健康工具，供提供者用于促使患者参与行为改变教育和目标设定，并提供支持改变的资源。在基线和干预后3个月收集患者电子健康记录和自我报告行为数据。通过PREVENT、直接观察、调查和访谈收集实施数据。我们进行了定量、定性和混合方法分析，以评估患者干预前后的变化和实施数据。
PREVENT是可行的、可接受的、易于理解的，并且对患者有帮助。虽然没有统计学意义，但只有使用PREVENT的患者增加了改变行为的动机以及对改善心脏健康方法和资源的了解。与对照组相比，使用PREVENT的患者在整体CVH和血压方面有显著改善（P <.05）。
数字工具可以支持在临床环境中提供行为改变咨询，以增加知识并促使患者改变行为。需要进行一项有足够效力的试验来确定PREVENT对CVH行为和结果的影响。
ClinicalTrials.gov NCT06121193；https://www.clinicaltrials.gov/study/NCT06121193。
