Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: Mar 20, 2023
Open Peer Review Period: Mar 16, 2023 - May 11, 2023
Date Accepted: Nov 19, 2023
(closed for review but you can still tweet)
An electronic teen questionnaire, the eTeenQ, for risk behavior screening during adolescent well visits in an integrated health system: Development and pilot implementation
ABSTRACT
Background:
Screening for risk behaviors is a routine and essential component of adolescent preventive health visits. Early identification of risks can inform targeted counseling and care. If stored in discrete fields in the electronic health record (EHR), adolescent screening data can also be used to understand risk behaviors across a clinic or health system, or to support quality improvement projects.
Objective:
Goals of this pilot study were to adapt and implement an existing paper adolescent risk behavior screening tool for use as an electronic data capture tool, the eTeenQ, to evaluate acceptance of the eTeenQ and to describe the prevalence of the selected risk behaviors reported through the eTeenQ.
Methods:
The multidisciplinary project team applied an iterative process to develop the 29-item eTeenQ. Two unique data entry forms were created with attention to a) user interface and user experience; b) the need to maintain patient privacy; and c) the potential to transmit and store data for future use in clinical care and research. Three primary care clinics within a large health system piloted the eTeenQ from August 17, 2020 to August 27, 2021. During preventive health visits for adolescents 12-18 years, the eTeenQ was completed on tablets and responses were converted to a provider-display for teens and providers to review together. eTeenQ responses were stored in a REDCap database, and for patients who agreed, transferred to an EHR flowsheet. Responses to selected eTeenQ questions are reported among those consenting to research. At the conclusion of the pilot, the study team conducted semi-structured interviews with providers and staff regarding their experience using the eTeenQ.
Results:
Among 2816 adolescents with well visits, 2098 (74.5%) completed the eTeenQ. Of these 1811 (86.3%) agreed to store responses in the EHR. Of 1632 (77.8% of those completing the eTeenQ) who consented for research and remained eligible, 1472 (90.2%) reported having an adult they can really talk to, 1510 (92.5%) reported feeling safe in their community, yet 401 (24.6%) reported someone they lived with had a gun and 172 (10.5%) reported having had a stressful or scary event that still bothered them. In addition, 157 (9.6%) reported they were or wondered if they were gay, lesbian, bisexual, pansexual, asexual, or other, 43 (2.6%) reported they were or wondered if they were transgender or gender diverse. Of 11 staff and 7 providers completing interviews, all felt that the eTeenQ improved confidentiality and willingness among adolescents to answer sensitive questions. All 7 providers preferred the eTeenQ over the paper screening tool.
Conclusions:
Electronic capture of adolescent risk behaviors is feasible in a busy clinic setting and well accepted among staff and clinicians. Most adolescents agreed for their responses to risk behavior screening to be stored in the EHR. Clinical Trial: Not applicable
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