Teaching primary care physicians the 5 A's for discussing weight with overweight and obese adolescents

PATIENT EDUCATION AND COUNSELING

卷:99

Article

Pollak, Kathryn I.^1,2  Tulsky, James A.³  Bravender, Terrill⁴  Ostbye, Truls^1,2  Lyna, Pauline¹  Dolor, Rowena J.⁵  Coffman, Cynthia J.^6,7  Bilheimer, Alicia¹  Lin, Pao-Hwa⁵  Farrell, David⁸  Bodner, Michael E.⁹  Alexander, Stewart C.¹⁰ 

[1] Duke Canc Inst, Canc Control & Populat Sci, Durham, NC 27710 USA

[2] Duke Sch Med, Dept Community & Family Med, Durham, NC USA

[3] Dana Farber Canc Inst, Dept Psychosocial Oncol & Palliat Care, Boston, MA 02115 USA

[4] Univ Michigan, Dept Pediat, Ann Arbor, MI 48109 USA

[5] Duke Univ Med, Dept Med, Durham, NC USA

[6] Durham VA Med Ctr, Hlth Serv Res & Dev Serv, Durham, NC USA

[7] Duke Sch Med, Dept Biostat & Bioinformat, Durham, NC USA

[8] People Designs Inc, Durham, NC USA

[9] Trinity Western Univ, Sch Human Kinet, Langley, BC, Canada

[10] Purdue Univ, Dept Consumer Sci, Lafayette, IN USA

关键词: Physicians;    Motivational interviewing;    Adolescents;    Obesity;   

DOI  :  10.1016/j.pec.2016.05.007

来源: Elsevier

【 摘 要 】

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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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