Barriers to pediatric injury prevention counseling

Physicians cite numerous barriers to incorporating injury prevention counseling into routine care. Health behavior models suggest that beliefs about barriers are associated with physician characteristics. This study explores associations between physician characteristics and physician perceptions of barriers.

Self administered structured questionnaires were sent to all five North Carolina (United States) pediatric residency programs. A total of 160 (72%) physicians training in pediatrics or medicine-pediatrics in these programs replied. Associations between perceived barriers and knowledge, gender, training, experience, and correlation between perceived barriers and other physician beliefs about injury prevention counseling, were measured.

Although most residents believed that talking to parents about injury prevention during routine visits was important, they felt they lacked time, did not think to ask parents about injury prevention, or had more important things to do. The more importance residents placed on asking parents about hazards, the less the extent to which barriers were perceived (r = 0.32). Barriers were perceived to a greater extent by residents who thought their preceptors did not expect them to counsel about injury prevention (r = 0.28), lacked confidence that their counseling helped parents (r = 0.32), or felt uncomfortable counseling parents about injury prevention (r = 0.18). Knowledge, residency year, training, and previous experience with injury were not related to perceived barriers.

Residency programs should teach the importance of injury prevention; provide opportunities for residents to become comfortable talking with parents about this; and train residents in the appropriate use of counseling as one strategy for addressing injury prevention.