The design and implementation of a health and lifestyle screening app to improve the care of young people in general practice
AuthorWebb, Marianne Julie
Document TypePhD thesis
Access StatusOpen Access
© 2019 Dr. Marianne Julie Webb
Adolescence and young adulthood are periods of major transition in physical, cognitive, social, and emotional development along the journey from childhood to adulthood. However, despite experiencing a high prevalence and co-occurrence of mental health disorders and lifestyle issues, young people do not usually seek professional help for these concerns. Yet, young people do regularly attend general practice, usually to address physiological concerns, making General Practitioners (GPs) ideally situated to opportunistically discuss a range of health and lifestyle issues and to provide health promotion and early intervention as needed. Technology-based screening provides an acceptable and systematic format for identifying health issues before the consultation. However, this screening technology is not being utilised by GPs. The aim of my research was to investigate the design, implementation, and effectiveness of a preventive screening technology intervention for supporting conversations about young people’s health and lifestyle risks in general practice. To address this aim I conducted three studies using a mixed methods multiphase design. The first study was a systematic review of the literature, which provided an understanding of the need and rationale for developing a health and lifestyle technology-based screening tool in primary care. The second study was a series of co-design workshops with 16 young people, 8 GPs, and 8 parents of young people, and interviews conducted with 11 practice support staff, to identify and explore user and stakeholder design and implementation requirements of a technologybased screening tool. The final study was an effectiveness-implementation study in one general practice clinic in Melbourne, Australia. For the effectiveness component of the final study, I compared the exit surveys of 30 young people in a one-month pre-intervention, treatment-as-usual phase with 85 young people using a health and lifestyle screening app in a two-month intervention phase, when the app was integrated into young people’s routine care. I also conducted semi-structured interviews with 14 young people from the intervention group. The implementation component of the final study was an in-depth implementation case study, with methodology informed by action research. Semi-structured interviews and focus groups were conducted with four GPs and seven support staff at the end of the implementation period. In addition, I analysed the number of times staff were supported by researchers, the location where young people completed the app, whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of making their appointment. I present the findings of my studies in this thesis in four published peer reviewed articles. The results indicated that integrating a health and lifestyle screening app into face-to-face regular care of young people improved patient-centred care, and created scope to identify and address unmet health needs. However, the implementation of the app in the dynamic and time-poor general practice setting presented a range of technical and administrative challenges. My research shows that an effective way to engage young people in their health and wellbeing may be to resource preventive screening implementation into routine general practice care. My research also provides evidence that to drive and support sustainable technology innovation and implementation in general practice settings more resources, external to existing practice staff, are needed.
Keywordsscreening; health; adolescent; implementation; health technology
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