Randomized Trial of Enhanced Anticipatory Guidance for Injury Prevention | Pediatrics | JAMA Pediatrics | JAMA Network
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January 2001

Randomized Trial of Enhanced Anticipatory Guidance for Injury Prevention

Author Affiliations

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.

Arch Pediatr Adolesc Med. 2001;155(1):42-49. doi:10.1001/archpedi.155.1.42

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.