Kathryn I Pollak1, James A Tulsky2, Terrill Bravender3, Truls Østbye4, Pauline Lyna5, Rowena J Dolor6, Cynthia J Coffman7, Alicia Bilheimer5, Pao-Hwa Lin6, David Farrell8, Michael E Bodner9, Stewart C Alexander10. 1. Cancer Control and Populations Sciences, Duke Cancer Institute, United States; Department of Community and Family Medicine, Duke School of Medicine, United States. Electronic address: kathryn.pollak@duke.edu. 2. Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States. 3. Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States. 4. Cancer Control and Populations Sciences, Duke Cancer Institute, United States; Department of Community and Family Medicine, Duke School of Medicine, United States. 5. Cancer Control and Populations Sciences, Duke Cancer Institute, United States. 6. Department of Medicine, Duke University Medical, United States. 7. Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, United States; Department of Biostatistics and Bioinformatics, Duke School of Medicine, United States. 8. People Designs, Inc., Durham, NC, United States. 9. School of Human Kinetics, Trinity Western University, Langley, BC, Canada. 10. Department of Consumer Science, Purdue University, Lafayette, IN, United States.
Abstract
OBJECTIVE: We developed an online intervention to teach physicians both MI (addressed in outcomes paper) and the 5 A's (Ask, Advise, Assess, Assist, and Arrange) when discussing weight with overweight/obese adolescents. METHODS: We audio recorded 527 encounters between adolescents and physicians and coded the 5 A's during weight/BMI discussions. Half of physicians were randomized to receive a tailored, intervention that included their own audio-recorded clips. To examine arm differences, we used multilevel linear mixed-effects models for sum of 5 A's and generalized estimating equations (GEE) models with a logit link for each of the A's separately. RESULTS: Intervention arm physicians used more A's than control physicians (estimated difference=0.6; 95%CI(0.2,1.0);p=0.001). Intervention physicians used Assess (p=0.004), Assist (p=0.001) and Arrange (p=0.02) more when compared to control arm physicians. CONCLUSION: An online intervention increased physicians' use of the 5 A's when discussing weight with overweight adolescents. These results are promising as the online intervention improved performance for the three A's that are infrequently used (Assess, Assist, and Arrange) yet have the most impact. PRACTICE IMPLICATIONS: A tailored online program can increase physicians' use of the 5 A's behavioral counseling approach in clinical practice with adolescents.
RCT Entities:
OBJECTIVE: We developed an online intervention to teach physicians both MI (addressed in outcomes paper) and the 5 A's (Ask, Advise, Assess, Assist, and Arrange) when discussing weight with overweight/obese adolescents. METHODS: We audio recorded 527 encounters between adolescents and physicians and coded the 5 A's during weight/BMI discussions. Half of physicians were randomized to receive a tailored, intervention that included their own audio-recorded clips. To examine arm differences, we used multilevel linear mixed-effects models for sum of 5 A's and generalized estimating equations (GEE) models with a logit link for each of the A's separately. RESULTS: Intervention arm physicians used more A's than control physicians (estimated difference=0.6; 95%CI(0.2,1.0);p=0.001). Intervention physicians used Assess (p=0.004), Assist (p=0.001) and Arrange (p=0.02) more when compared to control arm physicians. CONCLUSION: An online intervention increased physicians' use of the 5 A's when discussing weight with overweight adolescents. These results are promising as the online intervention improved performance for the three A's that are infrequently used (Assess, Assist, and Arrange) yet have the most impact. PRACTICE IMPLICATIONS: A tailored online program can increase physicians' use of the 5 A's behavioral counseling approach in clinical practice with adolescents.
Authors: Kathryn I Pollak; Cynthia J Coffman; James A Tulsky; Stewart C Alexander; Truls Østbye; David Farrell; Pauline Lyna; Rowena J Dolor; Alicia Bilheimer; Pao-Hwa Lin; Michael E Bodner; Terrill D Bravender Journal: J Adolesc Health Date: 2016-05-05 Impact factor: 5.012
Authors: Tammy K Stump; June K Robinson; Betina Yanez; Frank Penedo; Adaeze Ezeofor; Sheetal Kircher; Bonnie Spring Journal: Cancer Date: 2019-08-26 Impact factor: 6.860
Authors: Nancy E Sherwood; Rona L Levy; Elisabeth M Seburg; A Lauren Crain; Shelby L Langer; Meghan M JaKa; Alicia Kunin-Batson; Robert W Jeffery Journal: Pediatr Obes Date: 2019-03-14 Impact factor: 4.000
Authors: Serena Brusamento; Bhone Myint Kyaw; Penny Whiting; Li Li; Lorainne Tudor Car Journal: J Med Internet Res Date: 2019-09-25 Impact factor: 5.428