Vanderbilt University, Department of Pediatrics, 8232 Doctor's Office Tower, Nashville, TN 37232, USA.
Pediatrics. 2010 Feb;125(2):e242-9. doi: 10.1542/peds.2009-0874. Epub 2010 Jan 18.
The objective was to determine if a primary care intervention can help caregivers develop appropriate methods of discipline.
A randomized, controlled trial was conducted in a pediatric primary care clinic. Consecutive English- or Spanish-speaking caregivers of 1- to 5-year-old children were randomly assigned (1:1 ratio) at triage. Members of the intervention group (n = 130) were instructed (ie, required) to view at least 4 strategies of their choosing for responding to childhood aggression in the Play Nicely educational program; Spanish-speaking caregivers viewed the Spanish edition. The intervention duration was 5 to 10 minutes. Those in the control group (n = 129) received standard care. At the end of the clinic visit, 258 of 259 caregivers (99.6%) consented to participate in a brief personal interview. The key measure was whether caregivers were helped in their plans to discipline, defined as a caregiver who could verbalize an appropriate change in how they would discipline their child in the future.
Overall, caregivers in the intervention group were 12 times more likely to have been helped in developing methods of discipline compared with caregivers in the control group (83% vs 7%; P < .001). Within this group, Spanish-speaking caregivers (n = 59) in the intervention group were 8 times more likely to have been helped compared with those in the control group (91% vs 12%; P < .001). Caregivers in the intervention group were more likely than caregivers in the control group to report that they planned to do less spanking (9% vs 0%; P < .001).
A brief, required, primary care intervention helps English- and Spanish-speaking caregivers develop appropriate methods of discipline. The findings have implications for violence prevention, child abuse prevention, and how to incorporate counseling about childhood aggression and discipline into the well-child care visit.
确定初级保健干预措施是否有助于照顾者制定适当的纪律处分方法。
在儿科初级保健诊所进行了一项随机对照试验。在分诊时，以 1:1 的比例随机分配连续的 1 至 5 岁儿童的英语或西班牙语照顾者。干预组（n=130）成员被指示（即，要求）至少观看 4 种选择策略，以应对儿童攻击行为，在“好好玩”教育计划中；西班牙语照顾者观看西班牙语版。干预持续时间为 5 至 10 分钟。对照组（n=129）接受标准护理。在就诊结束时，259 名照顾者中的 258 名（99.6%）同意参加简短的个人访谈。主要测量指标是照顾者在其纪律处分计划中是否得到帮助，定义为能够口头表达出他们将来如何管教孩子的适当变化的照顾者。
总体而言，与对照组相比，干预组的照顾者在制定纪律处分方法方面的帮助可能性要高出 12 倍（83%对 7%；P<0.001）。在这个组中，干预组的西班牙语照顾者（n=59）比对照组更有可能得到帮助（91%对 12%；P<0.001）。干预组的照顾者比对照组的照顾者更有可能报告他们计划减少打屁股的次数（9%对 0%；P<0.001）。
简短、强制性的初级保健干预措施有助于英语和西班牙语照顾者制定适当的纪律处分方法。这些发现对暴力预防、儿童虐待预防以及如何将儿童攻击和纪律处分咨询纳入儿童保健访问具有重要意义。
