The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study

Background: Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH)and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers indelivering tailored evidence-based behavior change interventions to patients. Objective: The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-CenteredReal-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. Methods: A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impactof PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinaryobesity management clinic at a children's hospital within an academic medical center. A total of 36 patients aged 12 to 18 yearswere randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is adigital health tool designed for use by providers to engage patients in behavior change education and goal setting and providesresources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 monthsafter the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. Results: PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Conclusions: Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledgeand motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENTon CVH behaviors and outcomes.