In-person delivery of a clinic-based brief intervention by nurse practitioners
Component overview
An in-person format was used for a brief intervention (BI) designed to address substance use and sexual risk behaviors for adolescents. Its curriculum included motivational and educational content targeting marijuana, alcohol, and risky sexual behaviors. The in-person format involved training licensed nurse practitioners on motivational interviewing techniques and providing them with booster sessions to reinforce training content. Nurse practitioners delivered the intervention to participants in a school-based health center (SBHC). In-person delivery was designed to be completed in a single session, but participants were encouraged to continue engaging with the SBHC about health behaviors covered in the BI. On average, in-person delivery of the intervention took 17 minutes.
Evaluation findings: The in-person format was evaluated by comparing outcomes for youth assigned to get the BI in-person against a comparison group that was assigned to receive the same BI through a computer-based format. Participants assigned to receive program content in-person were significantly more likely than those assigned to the computer-based format to have been tested for sexually transmitted infections within six months of receiving the intervention (effect size = 0.49).
The BI addresses substance use and sexual risk behaviors among adolescents. It is delivered in-person by nurse practitioners to youth enrolled in urban high schools, ages 14 to 18, who have self-reported risky substance (alcohol and/or marijuana) use. Nurse practitioners are trained to tailor BI content to youth through motivational interviewing techniques. The program is delivered to individual youth in a single session.
The Stages of Change model informs the BI. Its curriculum includes motivational and educational content targeting marijuana, alcohol, and risky sexual behaviors. Nurse practitioners deliver content by using motivational interviewing techniques to develop individualized plans for risk reduction based on the participant’s degree of substance use, readiness to change, level of self-efficacy, capacity for decisional balance, life goals, and risk behaviors. Nurse practitioners deliver health education content to all participants and encourage them to consult providers at the SBHC for sexual health care, including testing for sexually transmitted infections.
Motivational interviewing and lecture delivered during a SBHC visit.
Single-session, about 17 minutes.
In the evaluation, the program developer trained presenters in BI techniques based upon a standard curriculum for a statewide initiative to train health care staff with a goal of expanding screening, BI, and referral to treatment (SBIRT) services in health care settings. The training was modified for the SBHC context. Techniques covered in the training included asking open-ended questions, providing affirming responses, reflective listening, and summary reflections. The principal investigator no longer offers training.
Program content is delivered in-person individually. The in-person format was evaluated against a comparison group that received the same program content through a computer-based format.
The in-person format was evaluated at SBHCs in two urban, public high schools.
The in-person format was evaluated with primarily Black/African American young women ages 14 to 17.
Jan Gryczynski, Ph.D.; Shannon Gwin Mitchell, Ph.D.; Robert P. Schwartz, M.D.; Kristi Dusek, M.Div., Carlo C. DiClemente, Ph.D.
Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, Email: jgryczynski@friendsresearch.org
Materials for the in-person format of the BI, including resource binders with key information (for example, readiness rulers, normative data on adolescent substance use), are available. Individuals who are interested in resources and support should contact the principal investigator at jgryczynski@friendsresearch.org.
In the evaluation, the SBHCs occupied large suites with private offices and an examination room to deliver the BI.
| Citation | High-Quality Randomized Trial | Moderate-Quality Randomized Trial | Moderate-Quality Quasi-Experiment | Low Study Rating | Did Not Meet Eligibility Criteria |
|---|---|---|---|---|---|
| Gryczynski et al. 2021 |
| Citation | Setting | Majority Age Group | Majority Racial/Ethnic Group | Gender | Sample Size |
|---|---|---|---|---|---|
Gryczynski et al. 2021 |
School-based health clinic | 14 to 17 | African American or Black | Male and female youth | 300 |
Evidence by Outcome Domain and Study
| Citation | Sexual Activity | Number of Sexual Partners | Contraceptive Use | STIs or HIV | Pregnancy |
|---|---|---|---|---|---|
Gryczynski et al. 2021 |
|
n.a. | n.a. |
|
n.a. |
| Citation | Details |
|---|---|
Gryczynski et al. 2021 |
The study is a randomized controlled trial that recruited youth from school-based health centers (SBHC) in two urban public high schools. Three hundred youth were randomly assigned via block-random assignment within site and sex. Half of the adolescents in each block were assigned to the computer delivery of a clinic-based brief intervention (CBI) group and half to the In-person delivery of a clinic-based brief intervention by nurse practitioners (NBI) group. Each of the two types of brief intervention (BI) was delivered in a single session, with CBI taking 19.7 minutes to complete, on average, and NBI taking 17.0 minutes. Three months after receiving a BI, the study found no statistically significant effects of the delivery format on the number of days of unprotected sex in the last 30 days. The study also examined a subgroup of 254 participants who reported being sexually active at baseline. Six months after receiving a BI, the study found that the adolescents who were sexually active at baseline and were assigned to NBI format were significantly more likely than their counterparts in the CBI group to have been tested for an STI (effect size = 0.49). The study also examined impacts on the number of days of marijuana use, days of alcohol use, days of binge drinking, days of sex while intoxicated, marijuana-specific problems, and alcohol-specific problems. Findings for these outcomes were not considered for the review because they fell outside the scope of the review. |