Adolescent health promotion interventions using health care visits and a cognitive behavioral therapy smartphone app: a randomized controlled trial

This article was originally published here

JMIR Mhealth Uhealth. 2022 May 23;10(5):e34154. doi: 10.2196/34154.

ABSTRACT

BACKGROUND: Promoting adolescent health is important for preventing risky behaviors and improving mental health. Health promotion during adolescence has been shown to help prevent late onset mental illness. However, scalable interventions have yet to be established.

OBJECTIVE: This study was designed to test the effectiveness of two adolescent health promotion interventions: a health care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a cognitive-behavioral therapy (CBT) application for smartphone. Our hypothesis was that participants who received both WCV and the CBT app would perform better than those who received only WCV or those who received no intervention. We conducted a multi-institutional prospective randomized controlled trial.

METHODS: Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV group with CBT application) and a non-intervention group. WCV included a standardized physical examination as well as a structured interview and counseling for youth risk assessment, which was designed with reference to the Bright Futures Guidelines for Adolescent Health Supervision. A smartphone CBT program has been developed based on the CBT approach. The CBT application included a week-long psychoeducation component and a week-long self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary endpoint was change in depressive symptom scores. Secondary outcomes included changes in self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale scores. These results were assessed at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. The effects of the intervention were estimated using mixed-effects models.

RESULTS: A total of 94% (204/217) of participants completed the 4-month assessment. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The effect of the intervention was significantly more predominant in those whose score was above the threshold for depressive symptoms. There were significantly fewer suicidal thoughts in the intervention groups. Regarding secondary outcomes, there was a significant increase in Health Promotion Scale scores at 4-month follow-up among junior high school students in the WCV group. Additionally, the CBT app was significantly effective in terms of gaining self-monitoring skills and reducing depressive symptoms.

CONCLUSIONS: Although adolescent health promotion interventions may have short-term benefits, WCV frequency and subsequent review of CBT application should be considered to assess long-term effectiveness.

TRIAL REGISTRATION: UMIN University Hospital Medical Information Network Clinical Trials Registry 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246.

PMID:35604760 | DOI: 10.2196/34154

Comments are closed.