title: Teaching primary care physicians the 5 A's for discussing weight with overweight and obese adolescents.
abstract: We developed an online intervention to teach physicians both MI (addressed in outcomes paper) and the 5 A's (Ask, Advise, Assess, Assist, and Arrange) when discussing weight with overweight/obese adolescents.
  
  
  
  We audio recorded 527 encounters between adolescents and physicians and coded the 5 A's during weight/BMI discussions. Half of physicians were randomized to receive a tailored, intervention that included their own audio-recorded clips. To examine arm differences, we used multilevel linear mixed-effects models for sum of 5 A's and generalized estimating equations (GEE) models with a logit link for each of the A's separately.
  
  
  
  Intervention arm physicians used more A's than control physicians (estimated difference=0.6; 95%CI(0.2,1.0);p=0.001). Intervention physicians used Assess (p=0.004), Assist (p=0.001) and Arrange (p=0.02) more when compared to control arm physicians.
  
  
  
  An online intervention increased physicians' use of the 5 A's when discussing weight with overweight adolescents. These results are promising as the online intervention improved performance for the three A's that are infrequently used (Assess, Assist, and Arrange) yet have the most impact.
  
  
  
  A tailored online program can increase physicians' use of the 5 A's behavioral counseling approach in clinical practice with adolescents.
authors.affiliation: Cancer Control and Populations Sciences, Duke Cancer Institute, United States; Department of Community and Family Medicine, Duke School of Medicine, United States. Electronic address: kathryn.pollak@duke.edu.
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States.
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.affiliation: Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Terrill
authors.initials: T
authors.lastname: Bravender
authors.affiliation: Cancer Control and Populations Sciences, Duke Cancer Institute, United States; Department of Community and Family Medicine, Duke School of Medicine, United States.
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.affiliation: Cancer Control and Populations Sciences, Duke Cancer Institute, United States.
authors.forename: Pauline
authors.initials: P
authors.lastname: Lyna
authors.affiliation: Department of Medicine, Duke University Medical, United States.
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, United States; Department of Biostatistics and Bioinformatics, Duke School of Medicine, United States.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.affiliation: Cancer Control and Populations Sciences, Duke Cancer Institute, United States.
authors.forename: Alicia
authors.initials: A
authors.lastname: Bilheimer
authors.affiliation: Department of Medicine, Duke University Medical, United States.
authors.forename: Pao-Hwa
authors.initials: PH
authors.lastname: Lin
authors.affiliation: People Designs, Inc., Durham, NC, United States.
authors.forename: David
authors.initials: D
authors.lastname: Farrell
authors.affiliation: School of Human Kinetics, Trinity Western University, Langley, BC, Canada.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bodner
authors.affiliation: Department of Consumer Science, Purdue University, Lafayette, IN, United States.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D009765:Obesity / Q000523:psychology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D050177:Overweight / Q000523:psychology* / Q000628:therapy*; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care; D013637:Tape Recording; D015431:Weight Loss
keywords: Adolescents; Motivational interviewing; Obesity; Physicians