Abstract
Adolescent mental health and cardiometabolic concerns are at an all-time high, necessitating the development of acceptable, feasible, and effective interventions. Investigations of behavioral health interventions with teenagers must incorporate a means of understanding how adolescents perceive and engage with an intervention, and the relevance and meaning they ascribe to its therapeutic goals, as these potentially modifiable factors may ultimately influence future uptake, sustainability, and effectiveness of the interventions. Qualitative research methods provide well-established, rigorous frameworks for addressing these questions, but are underutilized in pediatric research. This qualitative study is part of a multisite, pilot, and feasibility randomized controlled trial of three 6-week behavioral group intervention arms: an experimental mindfulness-based intervention (MBI), standard-of-care cognitive-behavioral therapy (CBT), a didactic health education control group (HealthEd), for adolescents ages 12-17 years with elevated depression symptoms and body mass index. Data were collected through 24 semi-structured, 6-week/post-intervention focus groups with adolescents (N=77) and three post-enrollment study staff focus groups (n=12). A two-pronged team-based approach to analysis involved an ongoing rapid qualitative analysis and a summative practical thematic analysis. Three overarching themes were identified: (a) group activities and peer-to-peer dynamics shape adolescent acceptability and perceived impact, (b) interventionist skills and qualities differentially influence adolescent acceptability across interventions, and (c) barriers unique to each intervention modality hinder group acceptability. Results highlight the distinct value of including qualitative methods within adolescent behavioral health intervention research, especially at the pilot and feasibility phase, as it provides a rich opportunity to optimize intervention delivery within future efficacy testing.
Author Bio(s)
Talia Thompson is an Assistant Professor for the University of Denver. She is a Licensed psychologist and a faculty member. Please direct correspondence to [email protected].
Dr. Thompson is a research scientist in the Military Cardiovascular Outcomes Research (MiCOR) Program and an Assistant Professor in the Department of Medicine at the Uniformed Services University of the Health Sciences. She completed her Ph.D. in clinical psychology and her clinical residency in women's mental health at the University of North Carolina at Chapel Hill.
Sarah Perzow is a child clinical psychologist with dual appointments as a Research Scientist I in the Department of Human Development and Family Studies at Colorado State University and as a Clinical Instructor in Pediatric Endocrinology at Children’s Hospital Colorado. Her research centers on the intersection of stress and health, applying integrative efforts to increase access to evidence-based healthcare within under-resourced communities and aiming to understand individual differences in responses to stress and behavioral intervention. Her clinical work aims to reduce depression and promote wellness among youth at-risk for cardiometabolic illness and their families.
Holly Spinner is a Graduate of The Pennsylvania State University with a B.S. in Psychology (Quantitative Skills option) and a minor in Sociology. Comes from the Greater Chicago Area. Currently a graduate student in the clinical psychology Ph.D. program at Florida State University.
Bentley Porterfield-Finn received her MA in Communication Studies from Colorado State University in 2021, and BA in Communication Studies from University of San Diego in 2018. Her research has focused on the intersections of health communication and social support, particularly as it pertains to maternal health, reproductive justice, and birth equity. Bentley's master's thesis investigated how identity impacts the communication of and perception of social support between doulas and birthing persons in birthing contexts. Bentley joined ACCORDS in 2023 as a Qualitative Analyst in the Qualitative and Mixed Methods Core.
Lauren D. Gulley is a pediatric psychologist who joined the Pediatric Division of the Barbara Davis Center for Diabetes in 2024 to provide mental health services to youth with type 1 diabetes and their families. She is especially passionate about helping youth build their relationship and communication skills so that they can navigate the transition to greater interdependence in diabetes management with their caregivers, peers, and healthcare providers. Dr. Gulley also conducts research around youth depression and anxiety, healthy lifestyle, and cardiometabolic disease in type 1 diabetes, type 2 diabetes, and polycystic ovary syndrome. Her research has been funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the American Diabetes Association, and the American Psychological Association, to investigate mental health interventions – especially interpersonal psychotherapy approaches – that are tailored to meet the unique needs of youth with type 1 diabetes, type 2 diabetes, and polycystic ovary syndrome.
Rachel G. Lucas-Thompson is a developmental psychologist with primary interests in (a) studying ways to reduce regulation and health problems in adolescents experiencing environmental stressors, and (b) mediators and moderators of the association of a particularly potent environmental characteristics, family relationships, with child/adolescent health and self-regulation.
Isabel Thorstad is a Outpatient Clinical Intern at HopeLink Behavioral Health. She has experience in behavior research and behavioral health.
Laura Pyle is a Research Professor in the University of Washington’s School of Medicine, the Director of Biostatistics at the University of Washington Medicine Diabetes Institute (UWMDI) and the Director of Integrative Data Sciences and Multi-Center Coordination at the UWMDI. She obtained her Ph.D. in Biostatistics from the University of Colorado in 2012. She was previously a Research Scientist at The George Washington University Biostatistics Center, where she was co-investigator and lead biostatistician on multicenter clinical trials funded by NIDDK to compare pharmaceutical and lifestyle treatments for type 2 diabetes in youth and adults. Her research interests are the design and analysis of clinical trials, methods for longitudinal data analysis, and multi-omics integration.
Molly Basch was a pediatric psychologist at Children’s National Hospital and assistant professor of Psychiatry and Behavioral Sciences and Pediatrics at the George Washington University School of Medicine & Health Sciences. She worked in the Division of Adolescent and Young Adult Medicine at Children’s National, specifically the Youth Pride Clinic. Her role in this clinic was to provide a range of behavioral health services for transgender and nonbinary youth ages 12-21 and their families. In addition to this role, Dr. Basch also conducted behavioral research with primary interests surrounding understanding factors associated with health outcomes of youth holding marginalized identities and implementing clinical interventions to promote resilience.
Megan J. Moran is a Postdoctoral Research Fellow in the Mixed Methods Program. She is a prevention scientist who uses mixed methods and community-engaged research approaches. Her research focuses on supporting holistic health and wellbeing in adolescence, including through mindfulness-based intervention, whole-family health behavior and lifestyle intervention, and community-based participatory research. Her mixed methods dissertation examined the role of multidimensional engagement in the efficacy of mindfulness training for community adolescents. Dr. Moran completed her Ph.D. in Applied Developmental Science at Colorado State University.
Marian Tanofsky-Kraff is Professor in the Departments of Medical and Clinical Psychology and Medicine at the Uniformed Services University of the Health Sciences. She is Director of the Developmental Research Laboratory on Eating and Weight Behaviors and Research Director for the Military Cardiovascular Outcomes Research Program. She is also a Research Collaborator in the Section on Growth and Obesity at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH. Dr. Tanofsky-Kraff’s research program involves the intersection of obesity and eating disorders and addresses questions about the risks, protective factors, maintenance, consequences, and prevention of excess weight gain and eating disorders, with a particular focus on psychological factors that promote obesity. Her work has emphasized assessment with a goal of endophenotyping pediatric eating patterns that promote both conditions. She has carried out intervention trials aimed at preventing adult obesity and eating disorders. Dr. Tanofsky-Kraff has published over 220 peer-reviewed papers and chapters, has received research funding from the several NIH institutes, including serving as a mentor for over 15 training grants, and is the recipient of numerous awards. She is on the Executive Council and a Fellow of The Obesity Society, Fellow and Past Board Member of the Academy for Eating Disorders, and is Past President and Board Member of the Eating Disorders Research Society
Megan M. Kelsey’s research broadly focuses on prevention and treatment of type 2 diabetes in youth. As a Ludeman Family Center for Women's Health Research seed grantee, she studied whether the composition of the bacteria in the gut might change during puberty in girls with obesity, who are at the greatest risk for developing youth-onset type 2 diabetes, and how gut bacteria composition relates to how well the body’s insulin works in these girls. Developing a better understanding of contributors to pediatric type 2 diabetes will help us design more targeted prevention strategies, which will have the greatest impact on at-risk adolescent girls.
Eleanor R. Mackey is an associate professor of Psychology and Behavioral Health. She has an active research program in the areas of behavioral health in obesity and diabetes. She has expertise in child and adolescent weight management, eating and exercise behaviors, and self-management of type 1 diabetes. Outside of work, she enjoys spending time with her family, including her two daughters.
Lauren B. Shomaker is a child clinical psychologist whose research interests center on understanding the role of psychological functioning in the etiology, development, and prevention of cardiometabolic diseases such as type 2 diabetes and cardiovascular diseases. My research seeks to elucidate to what extent psychological factors, such as depression and stress, promote insulin resistance, a key precursor of type 2 diabetes, as well as related cardiometabolic health concerns. I have a particular interest in identifying the behavioral and physiological mechanisms by which depression and stress influence developmental trajectories of cardiometabolic health.
