Impact of pediatricians' perceived self-efficacy and confidence on violence prevention counseling: a national study.
ABSTRACT To measure impact of pediatricians' perceived self-efficacy and confidence on current practices and attitudes regarding four violence prevention (VP) topics (gun storage, gun removal, limiting exposure to media violence, discipline techniques) during health supervision for children ages 2-11.
Random sample survey of American Academy of Pediatrics Fellows (n = 486; 53% response rate) providing health supervision for children ages 2-11. Participants surveyed about VP issues regarding: (1) current counseling practices for 2-5 and 6-11 year olds; (2) amount of time spent addressing; (3) confidence in addressing; and (4) perceived self-efficacy at changing patients' behaviors. Multivariate analyses explored relationships between pediatricians' perceived self-efficacy and confidence versus VP counseling frequency.
VP topics were not routinely discussed during health supervision. Most pediatricians (64%) reported spending too little time addressing these topics. Although most pediatricians felt confident discussing and effective at changing behaviors regarding limiting exposure to media violence (89% vs. 50%) and discipline techniques (91% vs. 76%), they were less so for safe gun storage (54% vs. 35%) and gun removal (51% vs. 17%). Perceived self-efficacy was the mediating factor on self-reported VP counseling frequencies for all topics.
Pediatricians reported spending insufficient time on VP counseling. Confidence and perceived self-efficacy levels varied by VP topic, but for all topics pediatricians felt more confident discussing than effective at changing behaviors. Since pediatricians' self-efficacy was related to counseling practices, boosting self-efficacy could ultimately improve counseling frequencies. Further research is needed to identify methods to build providers' perceived self-efficacy regarding these VP areas.
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ABSTRACT: Consecutive English and Spanish speaking caregivers of 6–24 month old children were randomly assigned to either a control or intervention group. Parents in the intervention group were instructed to view at least 4 options to discipline a child in an interactive multimedia program. The control group participants received routine primary care with their resident physician. After the clinic visit, all parents were invited to participate in a research study; the participation rate was 98% (258/263). The key measure was the Attitudes Toward Spanking (ATS) scale. The ATS is correlated with parents’ actual use of physical punishment. Parents with higher scores are more likely to use physical punishment to discipline their children. Parents in the intervention group had an ATS score that was significantly lower than the ATS score of parents in the control group (median = 24.0, vs. median = 30; p = 0.043). Parents in the control group were 2 times more likely to report that they would spank a child who was misbehaving compared with parents in the intervention group (16.9% vs. 7.0%, p = 0.015). In the short-term, a brief intervention, integrated into the primary care visit, can affect parents’ attitudes toward using less physical punishment. It may be feasible to teach parents to not use physical punishment using a population-based approach. The findings have implications for how to improve primary care services and the prevention of violence.Child Abuse & Neglect 12/2013; 37(12):1192–1201. DOI:10.1016/j.chiabu.2013.06.003 · 2.47 Impact Factor
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