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Development of Conversation Cards for Adolescents©: A patient-centered communication and behavior change tool for adolescents with obesity and health care providers
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- Author / Creator
- Kebbe, Maryam
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Background. Given adolescents’ increasing desire for independence and autonomy, there is a need for research to examine their lived experiences, including concerns, preferences, and priorities. In the context of lifestyle modification for weight management, most adolescents with obesity exhibit suboptimal lifestyle habits and adherence to treatment. To promote tailored interventions for this population, health care providers (HCPs) can benefit from effective patient-centered communication and behavior change tools to support their consultations.
Objectives. To (i) explore barriers, enablers, and recommendations for adopting healthy lifestyle behaviors among adolescents with obesity, (ii) gain insight into the delivery of health services for adolescent obesity management, and (iii) develop Conversation Cards for Adolescents© (CCAs), an adolescent-specific, patient-centered clinical and bilingual (English and French) tool designed to facilitate communication between adolescents with obesity and HCPs as well as lifestyle modifications.
Methods. This doctoral thesis was completed from 2016 to 2019 and applies a multiphase mixed-methods, cross-language, and patient-oriented research design to three studies. Study 1 was a scoping review and stakeholder consultation on barriers and enablers for adopting healthy nutrition, physical activity, sedentary behavior, and sleep habits in adolescents with obesity (objective 1). Study 2 consisted of qualitative, one-on-one interviews and focus groups with Anglophone and Francophone adolescents with obesity and HCPs (objectives 1 and 2). Study 3 involved adolescents from the second study in co-designing CCAs via a quantitative data prioritization activity and qualitative unstructured telephone interviews (objective 3).
Results. Perspectives of 571 adolescents and 31 HCPs were included across all three studies. Study 1 (n=17 articles, including 546 unique participants; n=20 stakeholders) showed that barriers to healthy nutrition and physical activity were more consistently related to individual- and interpersonal-level factors, compared with interpersonal-level factors for enablers. Knowledge gaps included information on sedentary behavior and sleep as well as environmental and policy levels of influence. Study 2 included adolescents (n=19) and HCPs (n=16) in one-on-one interviews and focus groups, respectively. Adolescents reported barriers and enablers for change, which included the degree of controllability, the impact of mental health, and social pressures related to weight management. These barriers and enablers spanned physiological mechanisms and physical health status, self-regulation for behavior change, controllability and competence beliefs, social relationships and interactions, and accessibility to and availability of opportunities for lifestyle enhancement. To facilitate healthy changes, they recommended establishing parental support, but with limits, improving accessibility and availability of ‘healthy foods’, limiting deceptive practices in food advertisements, improving accessibility and availability of varied physical activity opportunities, and adopting later school start times. Adolescents and HCPs also shared their perspectives on decision-making for weight management, noting conditions and preferences for adolescent and parental involvement. HCPs further identified strategies that they undertook to effectively deliver health services to adolescents with obesity, including discussing realistic expectations regarding weight management, personalizing weight management, and exhibiting non-biased attitudes and practices. In study 3, adolescents (n=18) rank-ordered 153 individual barriers, enablers, and potential enablers (categories) related to nutrition, physical activity, sedentariness, sleep, mental well-being, relationships, and clinical factors (suits); these factors were identified from Studies 1 and 2. A subset of adolescents (n=5) and HCPs (n=3) then completed telephone interviews to help co-design CCAs, which represent a hard-copy deck of cards composed of the 45 top-rated factors distributed across the 3 categories and 7 suits.
Conclusions. This research adds to the literature on adolescent lifestyle behaviors and engagement in weight management services and highlights the importance of multi-level, multi-component, interventions and tailored health services delivery for lifestyle management in adolescents with obesity. CCAs were developed as a practical, evidence-based tool to facilitate communication and lifestyle behavior change during clinical encounters between adolescents with obesity and HCPs. The feasibility, user experiences, and effectiveness of using CCAs in a clinical setting for improved communication and lifestyle habits remain to be examined empirically.
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- Graduation date
- Fall 2019
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- Type of Item
- Thesis
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- Degree
- Doctor of Philosophy
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- License
- Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.