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Randomized Trial of Enhanced Anticipatory Guidance for Injury Prevention
Andrea Carlson Gielen, ScD, ScM;
Modena E. H. Wilson, MD, MPH;
Eileen M. McDonald, MS;
Janet R. Serwint, MD;
John S. Andrews, MD;
Wei-Ting Hwang, BS;
Mei-Cheng Wang, PhD
Arch Pediatr Adolesc Med. 2001;155:42-49.
Objective To develop and evaluate an injury prevention anticipatory guidance training
program for pediatric residents.
Design Thirty-one residents were randomly assigned to an intervention or control
group. Both groups attended a 1-hour seminar about injury prevention and the
American Academy of Pediatrics TIPP (The Injury Prevention Program) materials.
The intervention group also received 5 hours of experiential instruction on
injury prevention content and counseling skills (SAFE Counseling Framework).
Families with infants from birth to age 6 months were enrolled in the study
(N = 196); they were followed up until the child was aged 12 to 18 months.
Data were collected by means of baseline and follow-up interviews, audiotapes
of medical visits, parent exit surveys, and home observations.
Setting A hospital-based continuity clinic that serves families living in low-income,
inner-city neighborhoods.
Outcomes Physician counseling and parent satisfaction, knowledge, beliefs, and
behaviors.
Results Parents seen by physicians in the intervention group received significantly
more injury prevention counseling for 5 of the 6 safety practices, and they
were significantly more satisfied with the help their physicians provided
on safety topics. They were no less satisfied with their physicians' counseling
on other anticipatory guidance topics. Parents' knowledge, beliefs, and home
safety behaviors did not differ between the 2 groups.
Conclusions The frequency and impact of pediatric counseling can be enhanced by
experiential training that targets specific injury hazards. Because low-income
families face many barriers to carrying out the recommended safety practices,
supplemental strategies are needed to ensure safer homes.
From the Department of Health Policy and Management and the Center
for Injury Research and Policy (Dr Gielen and Ms McDonald) and the Department
of Biostatistics (Ms Hwang and Dr Wang), Johns Hopkins University, School
of Public Health, and the Department of Pediatrics, Johns Hopkins University
School of Medicine (Drs Wilson, Serwint, and Andrews), Baltimore, Md. Dr Wilson
is now with the American Academy of Pediatrics, Elk Grove Village, Ill. Dr
Andrews is now with Starship Children's Health, Auckland, New Zealand.
Corresponding author: Andrea Carlson Gielen, ScD, ScM, Center for
Injury Research and Policy, Johns Hopkins University, School of Public Health,
624 N Broadway, Baltimore, MD 21205 (e-mail: agielen{at}jhsph.edu).
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