A teenager’s annual visit with his or her doctor is short. But the list of health-related information a growing adolescent needs can be very long. From acne to alcohol to sexuality and driving safety, there is too much information for any primary care provider to adequately discuss within the space of a brief check-up. Parents, however, can partner with physicians to help teenage patients navigate health-related choices as they grow up. A body of research now underway in the Craig Dalsimer Division of Adolescent Medicine at The Children’s Hospital of Philadelphia is helping to make that vision a reality.
Asking What Teens and Parents Need and Want
The research team began with a patient-centered approach by asking adolescents and their parents what they need instead of simply providing adolescents the health information that physicians chose for them. At a location that is part of CHOP’s Pediatric Research Consortium (PeRC) network, 91 parent-teen pairs met separately with interviewers and discussed their preferences for receiving health information from the pediatrician.
The questions included a wide range of categories, including routine healthcare concerns, physical and mental health concerns, sexual health, injury prevention, and substance use. Interviewers also asked the teens what type of information they hoped their parents would receive from the pediatrician. This foundational study for the larger project is now published online and will appear in a forthcoming issue of the Journal of Adolescent Health.
“The standout results were that both teenagers and their parents expressed high level of interest in getting information from their pediatricians about a wide range of adolescent health topics,” said study leader and Division Chief Carol Ford, MD. “They want a lot of information from us and feel that it would be valuable to them. This did not vary too much by topic. The expressed interest was pretty wide.”
Parents had slightly higher levels of interest than teens in receiving health information, but teens’ interest was still moderate to high. The topics that parents preferred were more likely to correspond to their adolescent’s age — such as acne for parents of younger teens, and driving safety for parents of older teens. The adolescents’ interest in health topics did not vary with age. Broadly, when the team compared responses within individual parent-child pairs, there was little overall concordance between the information preferences of each teenager and his or her parent.
“One of our take-home messages about that was to be sure that we asked both teenagers and parents what they wanted because they may be very different,” said Dr. Ford, who is also a professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.
Luckily, parents and teens did agree on a shared interest in receiving information about improving parent-teen communication. This interest contributed to how Dr. Ford’s team built the next stages of the project.
Testing Feasible Ways to Meet Teens’ and Parents’ Health Information Needs
“We’re trying to understand how to meet the information needs of parents and teens in a feasible way, to deliver them very high quality information that we know is useful to parents and can impact teens’ health,” Dr. Ford said.
Her team developed written materials including both in-depth booklets and brief pamphlets, focused on guidance to improve parent-teen communication. To do this, they adapted with permission existing health communication materials that had been shown effective by decades of prior research, including information about sexuality and sexual health (developed by Vincent Guilamo-Ramos, PhD, James Jaccard, PhD, and Patricia Dittus, PhD), and information about alcohol use (developed by Dr. Jaccard). Additional materials about teen driving safety were developed by co-investigator Jessica Mirman, PhD, a scientist in the Craig Dalsimer Division of Adolescent Medicine and in the Center for Injury Research and Prevention at CHOP.
The project using these materials is a randomized controlled trial called Patients, Parents, & Professionals Partnering to Improve Adolescent Health (P4). Participating teens and parents in the experimental arms of the P4 trial receive two sets of informational materials, including both the parent-teen communication materials and one of the subject-specific materials, when they come to a primary care appointment in CHOP’s PeRC network. Teens and parents participating in the control arms of the trial receive usual care.
When giving the health information materials to parents and teens in the study, pediatricians endorse the materials and recommend their use. A health coach also briefly reviews the materials with the parent-teen pairs during their visit and then follows up with a phone call a few weeks later to check in on whether they were used and if so how any conversations proceeded.
“These are hard things to talk about, but if the doctor thinks it’s important and gives families tools to make it easier for parents and teens to talk about them, then we hope that those conversations will actually happen and help teens make healthier choices about sexuality or alcohol or teen driving,” Dr. Ford said. Her team’s study will follow up to determine which of those things happen.
The foundational study asking about parents’ and teens’ informational needs may yet spur additional projects and questions. For example, Dr. Ford noted one intriguing finding that both parents and teens highly rated their interest in learning about how to communicate about teens’ strengths. Dr. Ford and the P4 research team hope to pursue further research focused on supporting health by discovering and emphasizing teens’ strengths in the future.