Health counseling in adolescent preventive visits: effectiveness, current practices, and quality measurement

Health counseling in adolescent preventive visits: effectiveness, current practices, and quality measurement

Hedberg VA; Klein JD; Andresen E

The Journal Of Adolescent Health : Official Publication Of The Society For Adolescent Medicine

1998

Delivery of Health Care; Female; Humans; Male; Attitude to Health; Outcome Assessment (Health Care); Adolescent Health Services; Adolescent Behavior; Counseling; Primary Health Care; adolescent; Adolescent Transitions; Preventive Medicine

Most morbidity and mortality among adolescents results from their participation in health-compromising behaviors. Recent guidelines for clinical adolescent preventive services recommend that primary care clinicians routinely screen for and counsel adolescents about these behaviors, identify and address related social, psychological, and biologic factors. Office-based counseling can influence adult health behaviors, but little is known about the effectiveness of office-based counseling for adolescents. In this review we: (a) evaluate available information about the effectiveness of office-based health counseling to improve outcomes; (b) report what is known about the health counseling adolescents receive from primary care clinicians; and (c) critically review different approaches that have been, or might be, used to measure the content and quality of health counseling provided during adolescent medical visits. With the emphasis on accountability in the current health care environment, evidence supporting the effectiveness of counseling is needed to justify investment in this aspect of clinical adolescent preventive services. Challenges to studying the effectiveness of health counseling include the lack of well-defined theory-based models for adolescent office-based counseling, the complexity of measuring counseling quality, and the many factors that influence adolescent outcomes. Reliable and valid measures of counseling quality are needed both to study and to ensure the quality of counseling received by adolescents. No single measure can be expected to fully capture counseling quality, although patient self-report deserves further development.

1998

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