Health promotion for adolescents in primary care: randomised controlled trial

Abstract

Objectives To evaluate the effectiveness of inviting teenagers to general practice consultations to discuss health behaviour concerns and appropriate follow up care. Design Randomised controlled trial, with participants randomised to a consultation (intervention) or usual care (control). Questionnaires completed at baseline, 3 months, and 12 months. Setting Eight general practices in Hertfordshire, England. Participants 1516 teenagers aged 14-15 years. Intervention Consultations with practice nurses to discuss health concerns and develop plans for healthier lifestyles. Main outcome measures Mental and physical health, "stage of change" for health related behaviour, and use of health services. Results At baseline 970 teenagers completed questionnaires; 23% smoked, 35% had been drunk in the previous three months, 64% considered they ate unhealthily, 39% took little exercise, and 36% had possible depression. 41% (304) of teenagers invited attended for a consultation; over one third (112) were offered follow up care. More intervention group teenagers reported positive movement in stage of change for diet and exercise and in at least one of four behaviours (diet, exercise, smoking, drinking alcohol) at 3 months (41% v 31%, P < 0.01), but this did not persist at 12 months. There was marginally more positive change in actual behaviour by intervention teenagers at 3 months (16% v 12%, P=0.06). Recognition of possible depression resulted in improved mental health outcomes at 3 and 12 months. 97% of attenders said they would recommend the intervention to a friend. Conclusions Change in behaviour was slight but encouraging, and the intervention was well received and relatively cheap.

Health Care Experiences and Needs of Adolescents in Urban Greece: Implications for Planning Appropriate Health Care

“…Furthermore, 80% of adolescents reported that they visit a doctor at least once in every six months (Table 2). This is consistent with research findings in other developed countries, which indicate that 70-90% of adolescents contact primary health services at least once a year [2,31]. Therefore, present practice provides opportunities for consultations with adolescents, which, if appropriately oriented, can address critical problems of this stage of development.…”

“…It has been shown that health professionals have credibility among adolescents and the advice they give may have a positive impact on health behavior [31]. Furthermore, studies have reported that a familiar trusted person can improve communication and adolescents are more willing to discuss topics that have been previously discussed [31]. Time available for consultation is an important parameter of increased quality in health care of adolescents, as has been consistently shown [23,24,27,32,33].…”

“…Teaching of consultation and communication skills has been shown to be an effective means of improving doctors' skills in consulting, and specific training in consultation skills for pediatric encounters has been advocated [29,30]. It has been shown that health professionals have credibility among adolescents and the advice they give may have a positive impact on health behavior [31]. Furthermore, studies have reported that a familiar trusted person can improve communication and adolescents are more willing to discuss topics that have been previously discussed [31].…”

Sensitization and its impact on Reproductive and sexual health issues of adolescents in clinics and schools - a comparative study.

“…[6][7][8] One of these studies 6 , in which young people were invited to attend a nurse-led general-practice visit reported only minor changes in participants' health-risk behaviours. The other studies, which focused on reductions in sexual-risk behaviours, reported a positive effect of the intervention.…”

Early Identification of Cardiovascular Risk Factors in Adolescents and Follow-Up Intervention Strategies

“…Lule et al (2006) suggest that efforts to improve the health of young people may be even more complex and challenging than for other age groups because many of their health issues are behaviourbased and actual symptoms of CVD may not be evident, or seen as serious yet. Walker et al (2002) found few published reports of screening and health promotion in family practice settings and Walker and Townsend (1998) reported that according to 200 health care providers in 200 U. S. cities, youth are at a point when health intervention could make a difference, but that preventive, primary reproductive, and behavioural health care is not well matched to adolescent needs and preferences. The Canadian Task Force on Preventive Health care (2000) suggested that an adolescent friendly atmosphere is needed and teens reported that issues of confidentiality and access to telephone and good written information is needed.…”