Chaffee T A, Bridges M, Boyer C B
Department of Pediatrics, Division of Adolescent Medicine, University of California, Box 0503, San Francisco, CA 94143, USA.
Arch Pediatr Adolesc Med. 2000 Oct;154(10):1034-41. doi: 10.1001/archpedi.154.10.1034.
To examine pediatricians' provision of violence prevention services to their adolescent patients and to identify factors associated with pediatricians' implementation of these services.
A cross-sectional sample of California pediatricians completed a self-report questionnaire. The "Precede/Proceed" theoretical model guided the questionnaire in identification of factors associated with pediatricians' screening and intervening practices in preventing adolescent violence.
Two hundred twenty pediatricians (54% female, 66% white, 24% Asian, 5% Latino, and 5% other) participated in the study. On average, participants screened their patients for violence-related risk factors 31% of the time for fighting, 39% of the time for violence in the home, and 29% of the time for weapon carrying. Participants provided their at-risk patients with violence-related interventions less than 50% of the time (on average) implementing the following interventions: written materials, follow-up appointments, discipline counseling, or referral to a community organization, Child Protective Services, or a specialized adolescent clinic. Factors associated with violence prevention screening practices included the following: positive attitudes and beliefs regarding screening for violence, familiarity with violence prevention guidelines, use of prompts in medical records, perceptions of greater skills, and positive reinforcement from patients and colleagues for providing violence prevention services (R(2)=0.44; P<.001). Factors associated with violence prevention intervention practices included: positive attitudes and beliefs in screening for violence, availability of resources, and positive reinforcement from patients and colleagues for providing violence prevention services (R(2)=0.37; P<.001).
California pediatricians are not widely screening their adolescent patients for risk factors associated with adolescent violence, nor are they providing interventions to their adolescent patients who may be at risk for violence. The factors associated with pediatricians' implementation of violence prevention services may assist in the development of effective interventions designed to enhance their delivery of these services to their adolescent patients.
研究儿科医生为青少年患者提供暴力预防服务的情况，并确定与儿科医生实施这些服务相关的因素。
对加利福尼亚州的儿科医生进行横断面抽样调查，让他们填写一份自我报告问卷。“Precede/Proceed”理论模型指导问卷设计，以确定与儿科医生在预防青少年暴力方面的筛查和干预措施相关的因素。
220名儿科医生（54%为女性，66%为白人，24%为亚洲人，5%为拉丁裔，5%为其他种族）参与了该研究。平均而言，参与者对患者进行暴力相关风险因素筛查的时间比例如下：打架为31%，家庭暴力为39%，携带武器为29%。参与者为有风险的患者提供暴力相关干预措施的时间平均不到50%，这些干预措施包括：提供书面材料、安排随访预约、进行纪律咨询或转介到社区组织、儿童保护服务机构或专门的青少年诊所。与暴力预防筛查措施相关的因素包括：对暴力筛查持积极态度和信念、熟悉暴力预防指南、在病历中使用提示、认为自己技能更强以及患者和同事对提供暴力预防服务给予积极强化（R² = 0.44；P <.001）。与暴力预防干预措施相关的因素包括：对暴力筛查持积极态度和信念、资源可用性以及患者和同事对提供暴力预防服务给予积极强化（R² = 0.37；P <.001）。
加利福尼亚州的儿科医生并未广泛地为青少年患者筛查与青少年暴力相关的风险因素，也未为可能有暴力风险的青少年患者提供干预措施。与儿科医生实施暴力预防服务相关的因素可能有助于制定有效的干预措施，以提高他们为青少年患者提供这些服务的水平。
