Elsevier

Ambulatory Pediatrics

Volume 5, Issue 3, May–June 2005, Pages 150-156
Ambulatory Pediatrics

Preventing and Treating Obesity: Pediatricians' Self-Efficacy, Barriers, Resources, and Advocacy

https://doi.org/10.1367/A04-104R.1Get rights and content

Objective.—With respect to obesity prevention and treatment, to determine pediatricians' 1) treatment self-efficacy; 2) perceived barriers and relationships to management self-efficacy; 3) desired resources; and 4) willingness to be involved in advocacy.

Methodology.—A cross-sectional, self-administered mail survey queried members of the North Carolina Pediatrics Society and the American Academy of Pediatrics who were practicing routine care.

Results.—The adjusted response rate was 71% (n = 356). Only 12% of respondents reported high self-efficacy in obesity management, yet 39% believed that physicians could potentially be effective. The most frequently encountered barriers to obesity management included availability of fast food (97%) and soft drinks (95%). However, some practice-based barriers were most strongly associated with self-efficacy. Odds of high self-efficacy were lower for respondents who reported lack of non-MD staff reimbursement (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.58, 0.92), lack of on-site dietitian (OR = 0.65; 95% CI = 0.50, 0.83), or lack of patient educational materials (OR = 0.67; 95% CI = 0.50, 0.89), compared with those who reported encountering these barriers infrequently. Respondents chose better counseling tools (96%) as the most helpful clinical resource for obesity management. Most (89%) were willing to take at least a small role in advocacy efforts.

Conclusions.—Most pediatricians reported feeling ineffective in their ability to treat obesity. Some practice-based barriers were specifically associated with low self-efficacy. However, pediatricians welcomed multiple clinical resources for obesity management and expressed willingness to advocate for policy change. Practice-based tool kits and efforts to engage willing participants in advocacy may help pediatricians combat this epidemic.

Section snippets

Participants

We surveyed members of the North Carolina Pediatric Society (NCPS) who were also Fellows of the American Academy of Pediatrics (AAP) and who provide pediatric primary care. Detailed information on methodology of the survey has been reported previously.21 Potential participants (n = 738) were mailed brief questionnaires in June 2002, using addresses provided by the NCPS. A reminder postcard was sent 1 month after the initial mailing, and a second questionnaire was sent to nonrespondents 6 weeks

Response Rate and Demographic Characteristics

Of 738 potential participants, 214 did not return surveys. Of the 524 physicians who did return surveys, 356 provided routine care for children and were therefore eligible, while 168 were ineligible based on the screening question. The unadjusted response rate was 62%. With 145 of the nonrespondents estimated to be eligible based on the percent of self-selected eligibility from the respondents, the Council of American Survey Research Organization–adjusted response rate was 71%.25 Eligible

DISCUSSION

Our study has 4 key findings. First, there is a difference between pediatricians' own perceived efficacy at treating obesity and their beliefs of how effective physicians can be in treating obesity. Pediatricians may believe others have greater abilities than they do in this area or that collectively pediatricians could be effective given optimal resources. Second, although environmental obstacles to obesity management are cited as the most frequently encountered obstacles, some practice-based

ACKNOWLEDGMENTS

We thank Robin Hamre, William Dietz, Bob Schwartz, Mort Wasserman, Kathleen Thoma, and Tom Robinson for expert help with survey construction; Steven Shore on behalf of the North Carolina Medical Society; and Harvey Hamrick, without whom this study would not have occurred. We also thank Julie Colvin and Halle Amick for tireless administrative support and data entry; Bob Hamer for statistical help; David Kleckner for data support; Bob Konrad for expert assistance in survey response rate analysis;

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