Developing a parent-adolescent relationship abuse prevention intervention for pediatric primary care

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

Investigators

Abstract

ABSTRACT Adolescent relationship abuse (ARA), defined as physical, psychological, cyber, sexual abuse, or stalking in the context of a teen dating relationship, is pervasive and associated with myriad negative health outcomes for youth. Parental monitoring of adolescents’ interpersonal relationships and activities is a powerful and modifiable protective factor to prevent ARA. Promising parent-adolescent interventions have emerged; however, some implementation challenges may exist particularly with recruiting and retaining parents. A potentially important setting to engaging parents and adolescents in ARA prevention is pediatric primary care, as parents accompany adolescents to annual well-child visits. Our team conducted interviews with 60 adolescents, parents, and healthcare providers who stated ARA is not currently discussed during well-child visits and an intervention around this topic is needed for primary care settings. However, a recent systematic review of sexual health and ARA interventions in primary care identified only one effective program focused on ARA, which was designed for older adolescents in school-based health centers and has no content around parental monitoring. Our goal for this R21 proposal is to first develop a brief ARA prevention intervention for middle-school aged adolescents (11 to 15) and their parents for the pediatric primary care setting and then conduct a pilot trial with parent-adolescent dyads. We will use the Capability, Opportunity, and Motivation Model of Behavioral change (COM-B) to guide intervention development, which describes how capability (knowledge about dating/ARA, self-efficacy to prevent ARA), opportunity (opportunity to engage in dating/ARA parental monitoring, resource utilization), and motivation (interest/desire to engage in dating/ARA parental monitoring) drive behavioral change. In Aim 1, guided by a community collaborative, we will use an intervention mapping approach to develop a provider-delivered ARA prevention intervention to be implemented within pediatric primary care settings. Informed by Aim 1 results, we will conduct a pilot trial with 55 parent-adolescent dyads within 4 pediatric primary care clinic sites, with the primary outcomes of assessing trial feasibility and intervention acceptability. Secondary exploratory outcomes will be: 1) behavioral change objectives pre and post (1, 6 months) intervention through parent and adolescent surveys; and 2) implementation barriers and facilitators using Proctor’s implementation outcomes framework through parent, adolescent, and provider interviews. This proposal leverages a multidisciplinary team of violence prevention and family-based intervention experts, as well as violence prevention leaders from Futures Without Violence and the Centers for Disease Control and Prevention. Results from this study will inform a future R01 proposal to conduct a fully- powered hybrid type 1 trial to test the effectiveness of the intervention, as well as collect implementation data.