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

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.