Silverstein Michael, Grossman David C, Koepsell Thomas D, Rivara Frederick P
Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle 98195, USA.
Pediatrics. 2003 Jun;111(6 Pt 1):1351-7. doi: 10.1542/peds.111.6.1351.
Early learning programs have proven benefits for impoverished children; Head Start is the most widespread of such programs. The current involvement of pediatricians in the Head Start enrollment process is unknown.
Mail survey to stratified random sample of pediatricians practicing in poor and non-poor US zip codes. Prevalence estimates and logistic regression models were estimated using weighted data.
Of 1000 surveys distributed, 472 of 772 presumed-eligible subjects completed surveys for a response rate of 61%. Respondents and nonrespondents were similar with regard to age, gender, years in practice, and urban/rural practice setting. Eighty percent of pediatricians reported discussing child care arrangements with a majority of their preschool-aged patients' families, while only 14% reported actually assisting these families in applying to Head Start. Lack of time (77% of pediatricians) and nonphysician office staff (71%) were listed as the most significant barriers to helping families apply to Head Start. Unfamiliarity with early childhood education (10%) was generally not seen as a barrier to this practice. Head Start knowledge (adjusted odds ratio [aOR]: 1.43; 95% confidence interval [CI]: 1.01, 2.02), self-efficacy in advising families how to access local Head Start programs (aOR: 3.49; 95% CI: 1.46, 8.38), and the belief that it is the pediatrician's responsibility to do so (aOR: 9.98; 95% CI: 3.91, 25.48) were significantly associated with assisting families with Head Start enrollment. The majority of respondents (77%) reported a willingness to participate in a proposed computer-based intervention to aid eligible families in applying to Head Start. Having access to a social worker (aOR: 2.48; 95% CI: 1.17, 5.21) and respondent age (aOR: 0.96 for each year; 95% CI: 0.93, 0.99) were significantly associated with likely participation in the intervention.
Although pediatricians report commonly discussing child care issues, few actively assist patients in the application process for Head Start. An intervention to facilitate Head Start referral from the physician's office must address time and staff limitations; education of pediatricians is a secondary need.
早期学习项目已被证明对贫困儿童有益；“启智计划”是此类项目中最为普及的一个。目前尚不清楚儿科医生在“启智计划”招生过程中的参与情况。
1）评估儿科医生在将家庭转介至“启智计划”方面的知识、态度及所报告的行为；2）评估儿科医生对一项基于实践的潜在干预措施的接受程度，该干预措施旨在增强他们进行“启智计划”转介的能力。
对在美国贫困和非贫困邮政编码地区执业的儿科医生进行分层随机抽样邮件调查。使用加权数据估计患病率及逻辑回归模型。
在分发的1000份调查问卷中，772名假定符合条件的受试者中有472人完成了调查，回复率为61%。在年龄、性别、执业年限及城乡执业环境方面，回复者与未回复者相似。80%的儿科医生报告称，他们与大多数学龄前患者的家庭讨论过儿童保育安排，而只有14%的医生报告实际协助这些家庭申请“启智计划”。缺乏时间（77%的儿科医生）和非医生办公室工作人员（71%）被列为帮助家庭申请“启智计划”的最主要障碍。对幼儿教育不熟悉（10%）通常不被视为这一行为的障碍。对“启智计划”的了解（调整优势比[aOR]：1.43；95%置信区间[CI]：1.01，2.02）、就如何获取当地“启智计划”项目向家庭提供建议的自我效能感（aOR：3.49；95%CI：1.46，8.38）以及认为这样做是儿科医生的责任（aOR：9.98；95%CI：3.91，25.48）与协助家庭进行“启智计划”招生显著相关。大多数受访者（77%）报告愿意参与一项提议的基于计算机的干预措施，以帮助符合条件的家庭申请“启智计划”。有机会接触社会工作者（aOR：2.48；95%CI：1.17，5.21）和受访者年龄（每年aOR：0.96；95%CI：0.93，0.99）与可能参与干预显著相关。
尽管儿科医生报告称经常讨论儿童保育问题，但很少有人积极协助患者进行“启智计划”的申请过程。一项旨在促进从医生办公室进行“启智计划”转介的干预措施必须解决时间和人员限制问题；对儿科医生的教育是次要需求。
