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PRB Research - Health Behavior Change in Medical Settings
Tailored Health Communications for Pediatric Injury Prevention
Unintentional injuries are the leading cause of preventable death and a major cause of mortality and morbidity among children ages one to five years in the United States. Parent-directed interventions within the clinical setting offer a potentially efficacious route for the promotion of safety behaviors. Children are routinely seen for well-child care, and health care providers are viewed by parents as a salient and valued source of information on health practices. While the provision of guidance in the clinical setting on the prevention of injuries has been recommended by the American Academy of Pediatrics, the American Medical Association, and national task forces, injury prevention receives insufficient attention during the course of routine visits due to time constraints and other competing demands. The integration of individually tailored health communications in the pediatric primary care setting may offer an innovative and efficacious way to reduce injury in young children. This program of research addresses the utility of individually-tailored pediatric injury prevention health communications provided in the pediatric primary care setting. Parents complete a brief assessment at a computer kiosk in the waiting room and receive individually-tailored injury prevention information.
A preliminary study was conducted testing tailored versus generic communications with 174 parents of children ages six to 20 months. The sample was primarily African American (85 percent), with 55 percent reporting an annual income under $25,000. Participants were recruited when visiting a medical center based pediatric clinic in Washington, D.C., for a well-child visit. They completed a baseline assessment of injury risk and prevention behaviors using a computer kiosk located in the waiting room, and were randomized to receive either tailored or generic injury prevention handouts following completion of the assessment. Follow-up assessments were completed by telephone one month following the visit. Findings supported the efficacy of the program in promoting parent adoption of injury prevention behaviors.
Building on findings from the preliminary study, a second study was conducted comparing three intervention groups: 1) generic communications; 2) tailored communications; and 3) tailored communications plus tailored physician feedback. The software program was expanded to include assessment and information applicable to parents of a broader age range of children. Parents of children ages birth to four years were recruited from three Midwestern pediatric clinics during routine well-child visits and randomized to one of the three intervention conditions. The sample was 59-percent African American and 34-percent Caucasian, with 74 percent reporting an annual income under $25,000. A baseline assessment was completed by computer kiosk in the waiting room, and parents were provided with the tailored or generic injury prevention handouts following completion of the assessment. Follow-up assessments were completed by telephone one month following the visit. Findings indicated program efficacy for promoting parent adoption of injury prevention behaviors, particularly among participants with lower education levels.
Research was then conducted to assess the uptake and utility of this individually-tailored injury prevention computer program designed for use during well child visits to enhance the provision of anticipatory guidance regarding safety behaviors. A sample of five pediatric clinics in North Carolina implemented the Safe N' Sound injury prevention program. Provider use of the program and documentation of injury prevention anticipatory guidance was assessed prior to and following program implementation.
Tonja Nansel, Ph.D.
- Williams J, Nansel TR, Weaver NL, Tse J. Safe N’ Sound: an evidenced based tool to prioritize injury messages for pediatric healthcare. Family and Community Health 2012; 35(3): 212-224. PMID: 22617412
- Weaver NL, Nansel TR, Williams J, Tse J, Botello-Harbaum M, Willson K. Reach of a kiosk based pediatric injury prevention program. Translational Behavioral Medicine 2011; 1(4), 515-522.
- Weaver NL, Williams J, Jacobson HA, Glasheen C, Botello-Harbaum M, Nansel TR. Translation of an evidence-based tailored childhood injury prevention program. Journal of Public Health Management and Practice 2008; 14(2): 177-184. PMCID: PMC2441924 PMID: 18287925
- Nansel TR, Weaver NJ, Jacobson HA, Glasheen C, Kreuter MW. Preventing unintentional pediatric injuries: a tailored intervention for parents and providers. Health Education Research 2008; 23(4); 656-669. PMCID: PMC2562892 PMID: 17906313
- Vladutiu CJ, Nansel TR, Kreuter MW, Weaver NJ, Jacobson HA. Differential strength of association of child injury prevention attitudes and beliefs on practices: a case for audience segmentation. Injury Prevention 2006; 12: 35-40. PMCID: PMC2563488 PMID: 16461418
- Nansel TR, Weaver N, Donlin M, Jacobsen H, Kreuter MW, Simons-Morton B. Baby, Be Safe: The effect of tailored communications for pediatric injury prevention provided in a primary care setting. Patient Education and Counseling 2002; 46(3): 175-190. PMCID: PMC2387242 PMID: 11932115