1
|
Grabert BK, McRee AL, Henrikson NB, Heisler-MacKinnon J, Blasi PR, Norris CM, Nguyen MB, Dunn J, McKeithen MC, Gilkey MB. Feasibility of using an app-based coaching intervention to improve provider communication about HPV vaccination. Transl Behav Med 2023; 13:581-588. [PMID: 36999806 PMCID: PMC10415729 DOI: 10.1093/tbm/ibad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Provider communication training is effective for increasing HPV vaccination rates among U.S. adolescents. However, such trainings often rely on in-person meetings, which can be burdensome for providers and costly to implement. To evaluate the feasibility of Checkup Coach, an app-based coaching intervention, to improve provider communication about HPV vaccination. In 2021, we offered Checkup Coach to providers in 7 primary care clinics in a large integrated delivery system. Participating providers (n = 19) attended a 1-h interactive virtual workshop that taught 5 high-quality practices for recommending HPV vaccination. Providers then had 3 months of access to our mobile app, which offered ongoing communication assessments, tailored tips for addressing parents' concerns, and a dashboard of their clinic's HPV vaccination coverage. Online surveys assessed pre-/post-intervention changes in providers' perceptions and communication behaviors. Compared to baseline, more providers reported high-quality HPV vaccine recommendation practices at 3-month follow-up (47% vs. 74%, p < .05). Providers' knowledge, self-efficacy, and shared commitment to improving HPV vaccination also improved (all p < .05). Although we found improvements in several other cognitions after the workshop, these changes did not retain statistical significance at 3 months. About three-quarters (78%) of providers used the mobile app, logging 2.3 sessions on average. Most providers agreed the app was easy to use (mean = 4.7/5.0), a convenient way to get vaccination data (mean = 4.6/5.0), and a tool they would recommend (mean = 4.3/5.0). Our app-based coaching intervention demonstrated feasibility and warrants additional evaluation as a novel mode for training providers to improve their HPV vaccine communication.
Collapse
Affiliation(s)
- Brigid K Grabert
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| | - Annie-Laurie McRee
- University of Minnesota Medical School, Minneapolis, MNUSA
- Center for Scientific Review, National Institutes of Health, Bethesda, MDUSA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer Heisler-MacKinnon
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| | - Paula R Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Consuelo M Norris
- Office of Performance, Strategy and Budget, King County, Seattle, WA, USA
| | - Matthew B Nguyen
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Dunn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Washington, Seattle, WA, USA
| | - Mary Catharine McKeithen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| | - Melissa B Gilkey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NCUSA
| |
Collapse
|
2
|
Engster SA, Molina BSG, Bogen DL. Adolescent and Parent Knowledge, Attitudes, and Perceptions of Harm of Household Controlled Medications. Subst Use Misuse 2020; 55:734-742. [PMID: 31847677 DOI: 10.1080/10826084.2019.1701034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Adolescents learn knowledge, attitudes, and behaviors from their parents, yet little is known about how these attributes are associated with management of household controlled prescription medications. We aimed to assess adolescent and parent: 1) knowledge and attitudes regarding household controlled medications, including previous healthcare counseling; 2) perceptions of harm of medication misuse and diversion; and 3) potential associations of these attributes with household management. Methods: This was a cross-sectional study with paired data using brief, online, confidential surveys of adolescents and parents via an adolescent medicine clinic associated with a large academic center. Eligible adolescents were aged 12-18 years old with at least one controlled prescription medication in the home. Data collection and analysis occured in 2017-2018. Results: Of the 243 adolescent-parent dyads, many adolescents and parents had: low knowledge (15%; 6%), risky attitudes (31%; 32%), received healthcare counseling on safe management of controlled medications (30%; 96%), and low perceived harm of adolescent diversion (39%; 49%). Parents practicing unsafe household management were 2.4 (95% CI = 1.3, 4.3) times as likely to have risky attitudes. Adolescents with families practicing unsafe medication management were 3.7 (95% CI = 1.1, 10.4) times as likely to have low perceptions of harm from diversion. Conclusions: Many adolescents and parents have low knowledge, risky attitudes, and low perceptions of harm of adolescent diversion, some of which are associated with unsafe household medication management. Providers should aim to utilize interventions to improve these attributes for adolescents and parents to enhance safe household medication management.
Collapse
Affiliation(s)
- Stacey A Engster
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | - Brooke S G Molina
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
3
|
Suryadevara M, Bonville CA, Cibula DA, Domachowske JB. Cancer Prevention Education for Providers, Staff, Parents, and Teens Improves Adolescent Human Papillomavirus Immunization Rates. J Pediatr 2019; 205:145-152.e2. [PMID: 30314663 DOI: 10.1016/j.jpeds.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop a program to educate providers, office staff, patients, and parents on life-long cancer prevention strategies, including the use of human papillomavirus (HPV) vaccine to improve adolescent HPV vaccination rates. STUDY DESIGN A 2-phase program was implemented at 6 pediatric practices across upstate New York. Phase 1 included provider and staff education regarding practice-specific vaccination challenges and discussion of the contents of a study-specific cancer-prevention booklet, which included HPV vaccine information. Throughout phase 2, the booklets were distributed to all adolescents and their parents during office visits over a 12-month period. Practice-specific, countywide, and statewide HPV vaccination rates were assessed before phase 1, and 6 and 12 months after the launch of phase 2. RESULTS One year after implementing phase 2 in 6 practices, adolescent HPV vaccine series initiation increased by at least 10% in 3 practices, and at least 5% in 5 practices. Similarly, adolescent vaccine series completion rates increased by more than 10% in 3 practices. The percent change in vaccine series completion rates across all study sites postintervention ranged from 12% to 20% for 11- to 12-year-olds, and from 7% to 23% for 13- to 18-year-olds. CONCLUSIONS Cancer prevention education targeting providers, office staff, patients, and parents was modestly effective for improving adolescent HPV vaccination rates.
Collapse
Affiliation(s)
- Manika Suryadevara
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY.
| | | | - Donald A Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
| | | |
Collapse
|
4
|
Gersh E, Richardson LP, Katzman K, Spielvogle H, Arghira AC, Zhou C, McCarty CA. Adolescent Health Risk Behaviors: Parental Concern and Concordance Between Parent and Adolescent Reports. Acad Pediatr 2018; 18:66-72. [PMID: 28870652 DOI: 10.1016/j.acap.2017.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We investigated which adolescent health risk behaviors are of concern to parents generally, according to adolescent age, gender, and in the context of perceived risk. We compared adolescent and parent reports of the presence of health-risk behaviors and factors predicting agreement. METHODS Three hundred adolescents aged 13 to 18 years (mean, 14.5 years; 52% female) who presenting for well care completed an electronic screening tool used to assess health-risk behaviors. Parents completed parallel measures of their child's behavior and parental concern. Adolescent and parent reports were compared using McNemar test. Hierarchical linear regression was used to examine predictors of agreement. RESULTS High parental concern was most commonly reported for screen time and diet. When parents identified their adolescent as at-risk, high parental concern was near universal for mental health but less commonly reported for substance use. There were no differences in parental concern according to adolescent gender. Parents of older adolescents expressed more concern regarding physical activity and alcohol. Compared with adolescents, parents were more likely to report risk regarding anxiety, fruit and vegetable consumption, and physical activity, and less likely to report risk regarding screen time, sleep, and marijuana use. Younger adolescent age and higher family relationship quality were predictive of stronger parent-adolescent agreement. CONCLUSIONS Parents in well-care visits commonly have concerns about adolescent lifestyle behaviors. Although parents are more likely to report concern when they know about a behavior, parental concern is not always aligned with parental awareness of risk, particularly for substance use. Parent report of higher prevalence of some risk behaviors suggests their input might assist in risk identification.
Collapse
Affiliation(s)
- Elon Gersh
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Heather Spielvogle
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Adriana Cristina Arghira
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash.
| |
Collapse
|
5
|
McRee AL, Mays D, Kornides ML, Gilkey MB. Counseling About Skin Cancer Prevention Among Adolescents: What Do Parents Receive From Health Care Providers? J Adolesc Health 2017; 61:533-536. [PMID: 28732717 PMCID: PMC5722459 DOI: 10.1016/j.jadohealth.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Adolescence is a high-risk period for ultraviolet radiation exposure, a primary cause of skin cancer later in life. We sought to characterize receipt of health care provider-delivered counseling about skin cancer prevention (SCP) among parents of adolescents. METHODS In 2016, we conducted an online survey with a national sample of parents of adolescents aged 11-17 years (n = 1,253). Multivariable logistic regression assessed correlates of receiving counseling from a health care provider about any of the six skin cancer prevention (SCP) topics. RESULTS Only half (49%) of parents recalled discussing any SCP topic with their child's provider; the prevalence was highest for sunscreen (39%) and lowest for indoor tanning (3%). Parents had greater odds of receiving counseling if they had a child with more sun-reactive skin (odds ratio [OR] = 1.53); a family history of skin cancer (OR = 1.38); or a higher quality relationship with the provider (OR = 1.47; all p < .05). CONCLUSIONS Greater attention to SCP counseling is needed, especially for exposures such as indoor tanning that remain prevalent among adolescents but are rarely addressed in clinical encounters.
Collapse
Affiliation(s)
- Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Melanie L Kornides
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Melissa B Gilkey
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC
| |
Collapse
|
6
|
Provider Attitudes and Practices toward Sexual and Reproductive Health Care for Young Women with Cystic Fibrosis. J Pediatr Adolesc Gynecol 2017; 30:546-552. [PMID: 28163120 DOI: 10.1016/j.jpag.2017.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To investigate the attitudes and practices of cystic fibrosis (CF) providers toward sexual and reproductive health (SRH) care in young women with CF. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS Adult and pediatric US CF providers were sent an online survey exploring their attitudes toward SRH importance, SRH care practices, and barriers/facilitators to SRH care in adolescent and/or young adult women. Descriptive statistics and logistic regression were used to analyze results. MAIN OUTCOME MEASURES Attitudes toward the importance of SRH care in patients with CF and self-report of practice patterns of SRH discussion. RESULTS Respondents (n = 196) were 57% pediatric (111/196) and 24% adult physicians (48/196) and 19% nurse practitioners (NPs)/physician assistants (PAs) (37/196). Ninety-four percent of respondents believed SRH was important for female patients with CF (184/196). More than 75% believed SRH care should be standardized within the CF care model (147/196) and 41% believed the CF team should have the primary role in SRH discussion and care (80/196). For many CF-specific SRH topics, discrepancies emerged between how important respondents believed these were to address and how often they reported discussing these topics in practice. Significant differences in SRH attitudes and practices were present between adult and pediatric physicians. The most significant barriers to SRH care identified were lack of time (70%, 137/196) and the presence of family in clinic room (54%, 106/196). Potential facilitators included training materials for providers (68%, 133/196) and written (71%, 139/196) or online (76%, 149/196) educational resources for patients. CONCLUSION CF providers perceive SRH topics as important to discuss, but identify barriers to routine discussion in current practice. Providers endorsed provider training and patient educational resources as means to improve SRH delivery.
Collapse
|
7
|
Ramos MM, Sebastian RA, Stumbo SP, McGrath J, Fairbrother G. Measuring Unmet Needs for Anticipatory Guidance Among Adolescents at School-Based Health Centers. J Adolesc Health 2017; 60:720-726. [PMID: 28254388 DOI: 10.1016/j.jadohealth.2016.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Our previously validated Youth Engagement with Health Services survey measures adolescent health care quality. The survey response format allows adolescents to indicate whether their needs for anticipatory guidance were met. Here, we describe the unmet needs for anticipatory guidance reported by adolescents and identify adolescent characteristics related to unmet needs for guidance. METHODS We administered the survey in 2013-2014 to 540 adolescents who used school-based health centers in Colorado and New Mexico. A participant was considered to have unmet needs for anticipatory guidance if they indicated that guidance was needed on a given topic but not received or guidance was received that did not meet their needs. We calculated proportions of students with unmet needs for guidance and examined associations between unmet needs for guidance and participant characteristics using the chi-square test and logistic regression. RESULTS Among participants, 47.4% reported at least one unmet need for guidance from a health care provider in the past year. Topics with the highest proportions of adolescents reporting unmet needs included healthy diet (19.5%), stress (18.0%), and body image (17.0%). In logistic regression modeling, adolescents at risk for depression and those with minority or immigrant status had increased unmet needs for guidance. Adolescents reporting receipt of patient-centered care were less likely to report unmet needs for guidance. CONCLUSIONS The Youth Engagement with Health Services survey provides needs-based measurement of anticipatory guidance received that may support targeted improvements in the delivery of adolescent preventive counseling. Interventions to improve patient-centered care and preventive counseling for vulnerable youth populations may be warranted.
Collapse
Affiliation(s)
- Mary M Ramos
- Department of Pediatrics, Envision New Mexico, University of New Mexico School of Medicine, Albuquerque, New Mexico.
| | - Rachel A Sebastian
- Child Policy and Population Health, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott P Stumbo
- Department of Population, Family, and Reproductive Health, Child and Adolescent Health Measurement Initiative, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jane McGrath
- Department of Pediatrics, Envision New Mexico, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | |
Collapse
|
8
|
Calabro KS, Marani SK, Le TA, Khalil GE, Tami-Maury IM, Prokhorov AV. A Pilot Study for Linking Adolescent Patients to an Interactive Tobacco Prevention Program. Health Serv Res Manag Epidemiol 2017; 4:2333392817703208. [PMID: 28516127 PMCID: PMC5415292 DOI: 10.1177/2333392817703208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 02/11/2017] [Indexed: 11/17/2022] Open
Abstract
CONTEXT The American Academy of Pediatrics and professional guidelines recommend intervening with adolescents about avoiding tobacco use in the health-care setting. Barriers in the clinical setting limit consistent provision of this critical service. OBJECTIVES This pilot study compared 2 approaches for referring adolescents to an evidence-based tobacco prevention and cessation program in the outpatient setting. Secondary aims assessed tobacco use, knowledge, and program evaluation. DESIGN SETTING AND PARTICIPANTS The study setting was a medical and dental clinic. Participants aged 13 to 18 received tobacco advice and instructions to work through "A Smoking Prevention Interactive Experience." The program addresses health concerns of adolescents about tobacco use and is founded on behavioral change theories. The link to access it is featured on the website of the National Cancer Institute's Research-Tested Interventions. Participants (N = 197) were randomized to 1 of 2 approaches (ie, a program link via e-mail or referral by a printed card). RESULTS The program was accessed by 57% (112 of 197) of participants. Both referral approaches were equally effective. Non-Hispanics were twice as likely to access the program as Hispanics (adjusted odds ratio = 2.1, 95% confidence interval = 1.2-3.8, P < .05). Over 95% of participants identified themselves as nonusers of tobacco and evaluated the program as beneficial in increasing knowledge and motivation to remain tobacco-free. CONCLUSION Linking adolescent patients to an evidence-based tobacco prevention/cessation program at a community health clinic was highly promising and feasible. We present conclusions for future research.
Collapse
Affiliation(s)
- Karen S. Calabro
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Salma K. Marani
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thuan A. Le
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Georges E. Khalil
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Irene M. Tami-Maury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander V. Prokhorov
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|