PEDIATRICIANS? PERCEPTIONS OF THEIR LEVEL OF CONFIDENCE AND EFFECTIVENESS IN VIOLENCE PREVENTION COUNSELING: A NATIONAL SURVEY

Stacia A Finch¹, Alison B Bocian¹, Victoria Weiley¹, Shari Barkin². ¹Pediatric Research in Office Settings (PROS), Dept of Practice & Research; Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL; and ²Dept of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC. 

 

BACKGROUND:  The majority of pediatricians indicate that violence prevention (VP) topics should be included as part of health supervision (HS), yet studies indicate this doesn't occur regularly.

 

OBJECTIVE:  Measure pediatricians' current practices and attitudes regarding VP topics during HS for children ages 2-11. 

 

DESIGN/METHODS:  In 2003, a Periodic Survey was mailed to a random sample of 1,603 AAP members (response rate=53%). Analyses were limited to pediatricians (excluding residents) who provided HS for children ages 2-11 (n=486); mean age was 43 years and 60% were female. Differences in current practice, confidence in addressing topics, and self-perceived effectiveness at changing behaviors were assessed by gender, practice location, and age (<45 and ≥45) using Chi-square analyses.

 

RESULTS:  Most pediatricians (64%) reported spending too little time addressing VP issues during HS, with younger pediatricians more likely to report this sentiment (p<.01). Most pediatricians do not routinely discuss VP topics during HS:

	Gun storage	Gun removal	Discipline techniques	Exposure to media violence
% discussed with 75-100% of patients:
2-5 yrs	23%	16%	41%	27%
6-11 yrs	24%	17%	33%	34%

 

Females were more likely than males to discuss: 1) limiting exposure to media violence with both age groups (p<.05) and 2) discipline techniques during visits for ages 2-5 (p=.05); no differences were found by age or location. While most pediatricians felt confident in discussing discipline techniques (91%) and limiting exposure to violent media (89%), they were less so for safe firearm storage (54%) and removal of guns from home (51%). Pediatricians' self-perceived effectiveness at changing patients' VP-related behaviors also varied: discipline techniques (76%), limiting exposure to violent media (50%), safe firearm storage (35%), and removal of guns from home (17%). Suburban pediatricians felt more effective at changing patients' behaviors regarding discipline techniques (p<.01) and limiting exposure to violent media (p=.01). There were no differences in confidence or self-perceived effectiveness by gender or age.

 

CONCLUSIONS:  Pediatricians report spending insufficient time addressing VP and varying levels of confidence and self-perceived effectiveness by VP topic. Increasing pediatricians? skills in VP-related counseling must be made a priority if HS visits are to be used to address VP.