Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 4, 2020
Date Accepted: Jan 16, 2021
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Randomized Controlled Trial of Electronic Health Risk Behavior Screening with Integrated Feedback among Adolescents in Primary Care
ABSTRACT
Background:
Health risk behaviors are the most common sources of morbidity among adolescents. Guidelines recommend screening and counseling but implementation is inconsistent.
Objective:
To test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time.
Methods:
Randomized controlled trial comparing the electronic tool with usual care. Outcomes assessed via online survey at 1-day and 3- and 6-months post visit. 300 13-18 year olds attending a well-care visit between September 30, 2016 and January 12, 2018. Adolescents were randomized after consent employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Of the original sample, 282 (94%), 283 (94%), and 284 (95%) completed follow-up surveys at 1-day, 3-months, and 6-months respectively with similar levels of attrition across study arms. Intervention adolescents received electronic screening and feedback and clinicians received a summary report of results. Control adolescents received usual care.
Results:
The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (Score potential range: 0 to 20) After adjusting for age, gender, and random effect of clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (aRR-1.36, 95% CI: 1.04,1.78) at 1-day post well-care visit. Both the intervention group and the control group reported decreased risk behaviors at 3- and 6-month follow-up assessments with no significant group differences in risk behavior scores at either time point.
Conclusions:
While electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different than usual care. More research is needed to identify effective strategies to reduce risk in the context of well care. Clinical Trial: clinicaltrials.gov Identifier: NCT02882919
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