The Effect of Physician—Parent Discussions and a Brief Intervention on Caregivers’ Plan to Discipline: Is it Time for a New Approach?

Abstract

Consecutive English- or Spanish-speaking caregivers of 1- to 5-year-old children were randomized to view a multimedia program (approximately 5-10 minutes) in a pediatric primary care clinic. After the clinic visit, 258/259 caregivers participated in a brief personal interview. In the multivariate logistic model, caregivers were more likely to have been assisted in their plans to discipline if they had had a discussion about discipline with their physician (odds ratio [OR] = 4.93; 95% confidence interval [CI] = 1.08-22.46), viewed the multimedia program (OR = 259.29; 95% CI = 56.56-1188.61), or viewed the multimedia program and had had a discussion with their physician (OR = 507.05; 95% CI = 86.81-2961.45) than if they had had no discussion and had not viewed the multimedia program. In addition to face-to-face discussions, routinely viewed educational material may help teach caregivers about discipline. The results have implications for improving primary care services, child abuse prevention, and violence prevention.

Why Parents Value a Brief Required Primary Care Intervention That Teaches Discipline Strategies

“…With a new approach in which parents had discussions and were asked to view the multimedia intervention, 89% of parents revised their plans to discipline their child. 12 The ethnically diverse population in this study is important because discipline strategies vary between cultures, 32 and both parents and physicians have reported cultural challenges related to discussions about discipline. 33,34 We found that parents of different sociodemographic backgrounds uniformly valued the intervention, albeit for somewhat different reasons.…”

Brief Approaches to Developmental-Behavioral Promotion in Primary Care: Updates on Methods and Technology

“…Parents gained knowledge of normal child development, insight into why children misbehave, and learned alternative behavior management strategies. [96][97][98][99] It is important to note that videos, including public service announcements on television, work best when the speaker is a peer (eg, an African American teenage mother speaking to other African American teenage mothers about the virtues of breastfeeding). 1 Mendelsohn et al 100 showed that replaying videotapes in which parents served as their own role models and when aided by live professional commentary is an effective way to increase positive parent-child interactions.…”

“…The intervention required no additional physician time and automatically printed a summary report for the medical record. Parents who completed the intervention showed superior knowledge of child development, behavior, and safety issues than did Scholer et al 95,96,98,99 conducted numerous studies on "Play Nicely," an interactive DVD approach to managing children' s aggression. Parents viewing the program (within which they can select specific topics of interest) were significantly more likely than controls to report better management of children' s problematic behavior.…”

“…Overall, the use of multimedia educational material along with clinician guidance appears to be a more effective means of affecting parents'skills than are physician-parent discussions alone, although clinicians' guidance and affirmation remain essential. [95][96][97][98][99] Telephony, Telemedicine, E-mail, and Cell Phone Messages Automated phone calls, or telephone support services, and e-mails can be used not only for appointment reminders but also for reinforcing important health and safety messages, behavior intervention issues, and follow-up dates. Cell phone messaging (eg, Text4Baby, Baby Center) is another approach that sends texts on health, safety, and developmental promotion based on the child' s age.…”

Dissemination of Evidence-Based Behavioral Advice via Video in Pediatric Primary Care

“…For clinicians, multimedia educational materials provide an effective 19 and resource-efficient tool for enhancing existing behavioral care. In accordance to previous findings, the results of this study strengthen the conclusion that a strong majority of parents, particularly those who have concerns about their child's behavior, will receive multimedia-based behavioral interventions positively.…”