atv safety summit: consumer awareness: getting the message out - anticipatory guidance provided by...
DESCRIPTION
Dr. Charles Jennissen, of the University of Iowa Department of Emergency Medicine presented this at CPSC's ATV Safety Summit Oct. 12, 2012. The study objective was to determine the ATV anticipatory guidance practices of primary care providers, as well as their attitudes, knowledge, and the barriers faced in educating families about the risk of ATV use. Methods: An electronic survey was administered to primary care providers belonging to Iowa state medical societies. Results: More than 60% of respondents (N=218) believed that providing ATV anticipatory guidance was important. However, 78% gave ATV safety counseling less than 10% of the time during regular pediatric exams, and only 12% did so greater than 25% of the time. Families rarely ask providers for advice on ATV safety issues; 84% of providers were asked once a year or less. ATV knowledge scores were low (median score 2 of 12); however, those with previous ATV exposure had significantly higher scores. Many respondents affirmed insufficient knowledge (47%) and inadequate resources (63%), but the most commonly identified barrier was that it was not a routine part of their practice.TRANSCRIPT
1
The Anticipatory Guidance Provided by Primary
Healthcare Providers With Regards to ATV Safety and
Injury Prevention
Gerene Denning, PhDCharles Jennissen, MDKarisa Harland, PhD
2
Background
ATVs continue to be a significant cause of injury and deaths in children.
• Risk of ATV crash for children is over 12 times higher than for adults.
More children die each year from ATV crashes than from bicycle crashes.
Education of families regarding ATV safety is considered an important component in decreasing injuries.
Primary healthcare providers are the principal source of health and safety advice in most communities.
Can they play an important role?
3
Objectives of the Study
To assess knowledge, attitudes, and practices related to ATV safety anticipatory guidance
among primary care providers in Iowa.
Funding for these studies was generously provided by:
4
ATV Anticipatory Guidance Survey
Distributed a solicitation letter with a link to an on-line survey through health professional organizations in Iowa:
• Iowa Chapter of the American Academy of Pediatrics (AAP)
• Iowa Academy of Family Physicians (IAAFP)
• Iowa Physician Assistant Society (IPAS)
• Iowa Association of Nurse Practitioners (IANP)
• Iowa Nurse Practitioner Society (INPS)
Determined:
(1) Knowledge of ATV safety and laws
(2) Attitudes toward ATV injury prevention counseling in the office
(3) Current ATV safety anticipatory guidance being provided to children and their families.
1
IANP
5
Survey Results: Demographics and ATV Exposure
218 usable surveys 52% Male; Median age 48, Range 26 to >70 96% White, non-HispanicBoard certification:
Pediatrics 21% Family Med. 56%
ATV user status N Percent
No exposureRidden but do not Ridden and now own
1048629
47%40%13%
40%
47%
13%56%
8%
13%
23%
6
Survey Results: Provider Practices
I ask patients/families if they own/use an ATV during well checks and physical exams about:
%R
esp
on
de
nts
%Time
78%
9.6%4.6% 2.8% 3.2% 2.8%
Care providers are not asking about ATV exposure.
• Almost 80% ask about ATVs less than 10% of the time.
• PAs were more likely ask. (p =0.06)
7
I provide ATV injury prevention anticipatory guidance to my pediatric patients/families during well checks or physical exam
about:
%R
esp
on
de
nts
%Time
81%
7%2.8% 3.7% 2.3% 2.8%
Care providers are not providing anticipatory guidance.
• Over 80% provide guidance less than 10% of the time.
• Only 8.8% reported providing ATV safety anticipatory guidance more than half the time.
Survey Results: Provider Practices
8
Resources used:
• Verbal information from provider (28.4%).
• Pamphlets and handouts (5%).
• Other resources were used by 2% or less.
Survey Results: Provider Practices
9
Survey Results: Families
Families are NOT recognizing healthcare providers as a resource for ATV safety.
Patients or their families ask me about ATV safety on average:
• Only 15.8% of providers were being asked by families about ATV safety issues more than once a year.
• Over half were never asked about ATV safety issues.
%R
esp
on
de
nts
54%
30%
14%
1.4% 0.5%
10
12 knowledge questions regarding ATV safety and state laws (“I don’t know” answers were regarded as incorrect).
Knowledge scores were very low.
Median score 2 out of 12.
No differences by age.
No differences by licensure.
Survey Results: Provider Knowledge
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Survey Results: Provider Knowledge
ATV User Status Mean Score P value
Never been on an ATV 1.9 <0.001
Operated or ridden on an ATV 3.7
Currently owned an ATV 6.2
There were significant differences in knowledge scores based on ATV experience.
There were significant differences in knowledge scores based gender.
Gender Mean Score P value
Male 3.5 <0.05
Female 2.5
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Knowledge Questions
#1-7 Multiple Choice, #8-12 True/False% Correct
(1) A traditional ATV is designed to carry how many people?
Answer: One
67.4 %
(9) Adults are required by Iowa law to wear an approved helmet while operating an ATV.
Answer: False
46.8%
Survey Results: Provider Knowledge
Highest percent correct = 67%
2 questions = Around half or more correct
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Knowledge Questions
#1-7 Multiple Choice, #8-12 True/False% Correct
(7) At what age are ATV operators subject to prosecution for violation of Iowa ATV laws? Answer: Any ATV operator regardless of age
26.1%
(8) Children are required by Iowa law to wear an approved helmet while operating an ATV. Answer: False
22.0%
(10)According to Iowa law, children 12-17 years of age must have a valid safety certificate to operate an ATV on private land.
Answer: False
26.1%
(11)According to Iowa law, children 12-17 years of age must be supervised by an adult to operate an ATV on private land.
Answer: False
21.1%
(12)According to Iowa law, failure to report an ATV accident resulting in injury or death to the proper authorities is a misdemeanor.
Answer: True
26.1%
Survey Results: Provider Knowledge
5 questions = 21-26% correct
14
Knowledge Questions
#1-7 Multiple Choice, #8-12 True/False% Correct
(2) According to manufacturer guidelines, what is the largest ATV engine size recommended for use by children 6-11 years of age?
Answer: Under 70 cc
15.1%
(3) According to manufacturer guidelines, what is the largest ATV engine size recommended for use by children 12-15 years of age?
Answer: 90 cc
11.0%
(5) According to Iowa law, children 12 to 17 years of age may operate an ATV on public land…
Answer: If they have a valid safety certificate.
14.7%
(6) According to Iowa law, under which circumstances can a private citizen operate an ATV on public roads?
Answer: Agricultural purposes
13.8%
Survey Results: Provider Knowledge
4 questions = 15% or less correct
15
School Survey Results: Knowledge
1. According to guidelines, what is the largest ATV engine size recommended for use by 12-15 year olds?
Correct Answer: 90 cc
2. According to Iowa law, when can someone ride an ATV on a public road?
Correct Answer: For farming purposes
3. ATVs are designed to carry how many people? Correct Answer: 1 Person
Primary Care Providers11% Correct
School Age Children26% Correct
Primary Care Providers68% Correct
School Age Children52% Correct
School Age Children46% Correct
Primary Care Providers14% Correct
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Survey Results: Attitudes About Knowledge
I have adequate knowledge to provide ATV injury prevention anticipatory guidance to my pediatric patients and their families.
%R
esp
on
de
nts
21%
26%23%
22%
9%
1%
Mean #Correct 1.5 2.3 3.3 4.2 6.6
•47% Disagreed or Somewhat Disagreed.
•31% Agreed or Somewhat Agreed.
•ATV owners > Non-owners
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Survey Results: Attitudes About Resources
A variety of educational resources were requested.
I have adequate resources to provide ATV injury prevention anticipatory guidance to my pediatric patients and their families.
%R
esp
on
de
nts
32% 31%
21%
11%
4%2%
• 63% Disagreed or somewhat disagreed.
• Only 15% agreed or somewhat agreed.
18
Survey Results: Barriers
The major barriers to providing ATV injury prevention anticipatory guidance to my pediatric patients and their families are:
Barriers encountered providing ATV injury prevention anticipatory guidance at well checks/physical exams
N Percent
I do not have enough time. 88 18%
I lack specific knowledge concerning ATV safety. 81 16%
I do not have the necessary ATV injury prevention resources. 80 16%
It is not a routine part of my well checks/physical exams. 105 21%
I am unaware of my patients' use of ATVs. 80 16%
I am not familiar with the use of ATVs. 31 6.2%
I do not believe any barriers exist. 15 3.0%
Other 19 3.8%
Total Responses 499
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Survey Results: Attitudes About Importance
ATV injury prevention anticipatory guidance is important to provide to my pediatric patients and their families.
%R
esp
on
de
nts
5% 6%
27%28%
33%
2%
Approximately 60% of providers think it is important.
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Conclusions
Primary providers in Iowa have limited knowledge of
ATV safety and laws, and most provide little or no
anticipatory guidance on ATV injury prevention.
Families do not recognize primary providers as
sources of ATV safety advice.
However, providers indicated an importance and
interest in providing more guidance.
The major barrier was “not part of their regular
practice”.
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Conclusions
Healthcare providers could play a more central role in promoting ATV safety if armed with increased knowledge and appropriate resources.
Educational methods that help overcome perceived barriers are likely to be most effective
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Deaths And Injuries From ATV Crashes Are Preventable!
To prevent deaths and injuries and their accompanying financial costs, we need:
• EDUCATION and Public Awareness
• ENGINEERING Safer Vehicles
• ENFORCEMENT of Evidence-Based Public Health and Safety Laws
It takes all stakeholders working together.
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THANK YOU
When we have the power to save lives and health, we have the responsibility to do so.