Pediatricians interested in what their colleagues think and do on an array of topics can turn to the storehouse of data compiled by the AAP Periodic Survey of Fellows, now marking its 20th anniversary.
Sixty-six surveys, on topics from circumcision to counseling about firearm safety, have been completed over the past two decades and helped illuminate opinions and experiences of U.S. pediatricians. The results document the issues of the day and provide information the Academy uses to evaluate and enhance programs as well as shape policy.
Two decades of data
Each Periodic Survey measures how a nationally representative sample of pediatricians renders treatment, how they operate their practices or what they think about current child health issues.
Respondents have expressed their views on issues from formula advertising to adolescent access to abortion. Some topics, such as immunization practices or experience with medical liability, are highlighted regularly and their results compared over time. The Academy tries not to replicate main topics within five years.
Survey results have been published on at least 20 occasions in peer-reviewed journals (including Pediatrics, Injury Prevention, Ambulatory Pediatrics and Health Services Research) and have formed the basis of more than 40 presentations at conferences and policy forums worldwide.
“The Academy's commitment to obtain continual feedback from members on emergent topics in practice helps provide an evidence-based approach to our decision-making and program planning, “said John S. Curran, M.D., FAAP, chair of AAP District X and the advisory committee to the AAP Board on Research. “And we are most grateful to our members for their time in completing these surveys.”
Some of the projects resulting from the surveys include:
Bright Futures Health Promotion/Prevention Education Center;
Pediatrics Collaborative Care (PedsCare) Program;
The Injury Prevention Program (TIPP); and
The National Center for Medical Home Initiatives for Children with Special Needs.
Ongoing programs that benefit from Periodic Surveys address immunization, obesity prevention and mental health.
With the Periodic Survey in existence for 20 years, pediatrics also has“ unique data to track trends in how the profession evolves,” Dr. Curran said. There has been substantial growth in part-time employment, for example, and an increase in the number of pediatricians who are salaried employees.
Survey data are used by AAP members, child health researchers and other pediatric leaders. In 1997, Susan S. Aronson, M.D., FAAP, a former AAP board member (1994-'00) and an authority on child care, used results from the Periodic Survey to show early childhood educators that 73% of pediatrician-respondents reported that they routinely used child care and preschool reports as a screening tool to help identify children with a developmental disability.
Genesis of a Periodic Survey
Potential topics for new surveys generally emanate from AAP committees or sections, which are required to submit a detailed form outlining the proposed topic, questions, how the data will be used, other collaborating groups within the Academy and additional background.
Once a survey topic is approved, state-of-the-art methods are used to ensure reliability and accuracy. Each self-administered questionnaire of eight pages or less goes out to a random sample of about 1,600 members. Up to five follow-up contacts are made, and response rates range from 55% to 64%, consistent within the industry.
The timeline for a typical survey is 12 to 13 months from approval to analysis. Each year, about three surveys are conducted, with up to two additional surveys supported by some outside funding (agencies have included the Centers for Disease Control and Prevention and the Maternal and Child Health Bureau, as well as university research groups).
Over the years, the layout of the surveys has changed slightly. Open-ended questions are kept to a minimum because many respondents don't complete them or, if they do, the writing often is not legible. Still, many of the questions include an “other—specify” question to allow for comments.
A logo debuted with Periodic Survey #41, and the Web page was added in recent years.
Results create attention
Occasionally, survey results can be surprising. A 1996 survey (#31) about opinions on legalization of drugs showed members were divided on legal status of marijuana, and 74% of respondents said legal prohibitions on possession or use of marijuana by adults should be less restrictive. When responses were analyzed by age and gender, pediatricians who were older (and male) tended to favor more decriminalization or legalization.
A survey on breastfeeding practices conducted in 1995 and published in 1999 (#30) revealed that while a majority of respondents recommended breastfeeding, a distinct proportion did not do so along AAP guidelines. Most pediatricians responding at that time said breastfeeding and formula-feeding were equally acceptable methods of feeding infants. Further, the reasons indicated for not recommending breastfeeding included medical conditions that generally do not preclude breastfeeding.
The survey found that the vast majority of respondents wanted more instructional opportunities; the results may have helped to confirm the need for a breastfeeding entity within the Academy. A work group on breastfeeding organized in 1996 was followed by a task force; a section was established in 2000.
Find results online
The Periodic Survey Web page (www.aap.org/research/periodicsurvey/psof.htm) is a repository of these survey topics and findings. Enter a key-word to search “bicycle helmets,” for example, and view all the results; or scroll to browse all surveys, with the most recent ones at the top.
Identified by the Periodic Survey (PS) number, each entry on the Web page provides title, years when the survey was conducted or “fielded,” executive summary and a link to publications (including AAP News). Topics also are cross-referenced for comparison.
Demographic data on personal and practice characteristics are updated annually and also can be found on the page (click on View Practice Characteristics).
Additional surveys in the works address attitudes and practices regarding patient communication and health literacy, pediatric subspecialty referral patterns, and oral health assessment.
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