Injury prevention counseling in an urban pediatric clinic. Analysis of audiotaped visits
A. C. Gielen, E. M. McDonald, C. B. Forrest, J. D. Harvilchuck and L. Wissow
Center for Injury Research and Policy, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md., USA.
OBJECTIVE: To determine the content of injury prevention counseling (an
expected component of pediatric anticipatory guidance) and the
communication methods used with data from an urban pediatric clinic that
serves low-income families. DESIGN: Audiotapes of well-child visits with 52
pediatric residents were analyzed for 178 children aged 0 to 4 years. A
specific coding methodology was developed to analyze counseling by injury
topics, prevention strategies, and communication methods. RESULTS: Less
than half (ie, 47%) of the visits included injury prevention counseling.
During the 83 visits that included counseling, an average of 1.96 injury
topics were discussed. The average time spent on injury topics was 1.08
minutes per visit and 33 seconds per injury topic. An average of 2.68
prevention strategies were mentioned, although a statement specifically
recommending their use was made for only 35% of the prevention strategies.
The most frequently discussed injury topics were ingestion, falls, and
pedestrian safety, house fires and firearms were never discussed. The most
frequently mentioned prevention strategies were storing dangerous
substances and items out of reach, using cabinet locks, calling the
poison-control center, having outlet covers, using stair gates, and using
car seats. Information-giving by the resident was the most frequently used
communication method. Physician elicitation of information from parents was
associated with more parental participation in the discussion. CONCLUSIONS:
Pediatric residents in this sample spent little time discussing injury
prevention, and problems thought to be important to the specific population
being served were never mentioned. Communication methods to enhance
compliance other than eliciting and giving information (ie, soliciting
feedback, obtaining a commitment, and giving reinforcements) were rarely or
never used. Priorities need to be defined so that the most important injury
prevention topics and strategies are discussed effectively in the limited
time available. Further research about pediatric injury prevention
counseling is needed to examine the feasibility and effect of resident
training in communication methods that enhance compliance.
