Determinants of counseling in primary care pediatric practice: Physician attitudes about time, money, and health issues

Tina L Cheng, Thomas G. DeWitt, Judith A. Savageau, Karen G. O'Connor

Research output: Contribution to journalArticle


Objectives: To assess pediatrician goals and practice in preventive counseling, and to use social learning theory to examine physician attitudes about preventive health issues, time, and reimbursement to explain physician counseling behavior. Design: Random sample survey of American Academy of Pediatrics fellows. Participants: A total of 1620 pediatricians were surveyed with a return rate of 72%. The 556 pediatricians who had finished training and who currently performed child health supervision were included. Methods: Pediatricians were asked about their goals in 6 areas of health supervision: biomedical issues, development, behavior, family functioning, safety education, and supportive interpersonal interaction. They were also asked about the prevalence of counseling, importance of specific topics, their self-efficacy, outcome expectation in these areas, and their concerns about time and reimbursement for preventive counseling. Results: Assurance of physical health and normal development were the most important goals of child health supervision among the pediatricians surveyed. Goals involving behavioral, family, and safety issues were less important and less likely to be addressed in practice. Most did not regularly discuss family stress, substance abuse, gun safety, and television. In these areas, physicians had less confidence they could provide guidance and lower expectation that they could prevent problems. Only 17% felt that they receive adequate reimbursement for preventive counseling. Most have adequate time (53%) and receive adequate respect (57%) for their preventive efforts. Physicians who were more concerned about time for preventive counseling reported less overall counseling (r =-0.28, P

Original languageEnglish (US)
Pages (from-to)629-635
Number of pages7
JournalArchives of Pediatrics and Adolescent Medicine
Issue number6
Publication statusPublished - Jun 1999
Externally publishedYes


ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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