Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 455-463 (doi:10.1542/peds.2005-0377)
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Anticipatory Guidance and Violence Prevention: Results From Family and Pediatrician Focus Groups

Robert D. Sege, MD, PhDa, Elizabeth Hatmaker-Flanigan, MSb, Edward De Vos, EdDa, Rebecca Levin-Goodman, MPHb and Howard Spivak, MDa

a Pediatric and Adolescent Health Research Center, Floating Hospital for Children at Tufts-New England Medical Center, Boston Massachusetts
b American Academy of Pediatrics, Elk Grove Village, Illinois

OBJECTIVES. Anticipatory guidance is a cornerstone of modern pediatric practice. Recent American Academy of Pediatrics policies related to violence prevention, notably those that advocate firearms safety and the use of alternatives to corporal punishment, seem to be discrepant with common parenting practices. To develop more effective anticipatory guidance, we sought the opinions of parents and pediatricians on how best to communicate these messages.

DESIGN. Focus groups were conducted to elicit parent and provider opinions.

SUBJECTS. Forty-nine parents participated in a total of 9 90-minute focus groups that were held in 3 cities. Twenty-six pediatricians participated in 3 focus groups that were held at a single national meeting.

PROCEDURES. Participants were read summaries of current American Academy of Pediatrics policies and led through a systematic discussion of how these policies might best be communicated. The group discussions were audiotaped, transcribed, and analyzed. Common themes heard in multiple groups are reported.

RESULTS. Parents provided specific feedback about corporal punishment and firearms and also raised a number of general issues. Pediatricians reported that anticipatory guidance was important to them but cited cultural and reimbursement issues as barriers to practice. They also reported the need for additional training and support to make anticipatory guidance more effective.

DISCUSSION. Focus groups provide insight into doctor-patient communications and can inform efforts to improve primary prevention in the clinical setting. Anticipatory guidance that consists of authoritative useful information, offered in a supportive manner that communicates respect for parental decision-making, may be effective in improving parenting practices.

Key Words: community pediatrics • discipline • firearms • anticipatory guidance • physician-patient/parent communication

Abbreviations: AAP—American Academy of Pediatrics

Accepted Jun 1, 2005.




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