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Key Predictors of Primary Care Providers’ Self-Efficacy in Caring for Children with Overweight or Obesity

Published:March 02, 2022DOI:https://doi.org/10.1016/j.acap.2022.02.017

      Abstract

      Objective

      Self-efficacy is a crucial factor in enabling pediatric primary care providers (PCPs) to deliver recommended care to children with overweight and obesity. This study, conducted with a large, national sample of PCPs, aimed to identify key factors, which may contribute to PCP self-efficacy for obesity-related care, from a list of previously reported barriers and facilitators.

      Methods

      A national random sample of American Academy of Pediatrics members was surveyed in 2017 (analytic n = 704). Factor analysis was used to identify self-efficacy variables from relevant indicators and assess fit. Multivariable linear regression analyses were conducted to identify key predictors of PCP self-efficacy from reported facilitators or barriers to care, including characteristics of the PCP, practice, community, and payment systems.

      Results

      Two PCP self-efficacy variables were identified: health risk assessment and patient-centered counseling. Both were positively predicted by relevant training, the belief that pediatricians play an important role in obesity, and awareness of barriers to payment for dietitians or weight management programs. Both were negatively predicted by a perceived lack of available PCP time for counseling and inadequacy of available referral resources to assist with treatment. Additional predictors of counseling self-efficacy included PCP beliefs that they are paid for treatment (+) and that patients/families lack time for healthy behaviors (-). Electronic health record clinical decision supports or registries and patient social disadvantage were not predictive.

      Conclusions

      Results suggest multiple potential roles and strategies for local and national organizations seeking to facilitate improvements to PCP self-efficacy in caring for children with overweight and obesity.

      Keywords

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      References

        • Barlow S
        • Expert Committee
        Expert committee recommendations regarding prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.
        Pediatrics. 2007; 120: S164-S192
        • Skinner AC
        • Ravanbakht SN
        • Skelton JA
        • et al.
        Prevalence of obesity and severe obesity in US children,1999–2016.
        Pediatrics. 2018; 141e20173459
      1. Centers for Disease Control and Prevention. Childhood obesity facts Available at:https://www.cdc.gov/obesity/data/childhood.html. Accessed February 16, 2022.

        • Freemark MS.
        Childhood obesity in the modern age: global trends, determinants, complications, and costs.
        in: Freemark MS Pediatric Obesity: Etiology, Pathogenesis and Treatment. 2nd ed. Springer, 2018: 3-24
        • Daniels SR
        • Hassink SG.
        The role of the pediatrician in primary prevention of obesity.
        Pediatrics. 2015; 136: e275-e292
        • Wilfley DE
        • Staiano AE
        • Altman M
        • et al.
        Improving access and systems of care for evidence-based childhood obesity treatment: conference key findings and next steps.
        Obesity. 2017; 25: 16-29
        • Bandura A.
        Self-efficacy mechanism in human agency.
        Am Psychol. 1982; 37: 122
        • McAlister A
        • Perry C
        • Parcel G.
        How individuals, environments, and health behaviors interact.
        in: Glanz K Rimer BK Viswanath K Health Behavior and Health Education: Theory, Research, and Practice. John Wiley & Sons, San Francisco, CA2008: 169-188
        • Lavoie KL
        • Rash JA
        • Campbell TS.
        Changing provider behavior in the context of chronic disease management: focus on clinical inertia.
        Annu Rev Pharmacol Toxicol. 2017; 57: 263-283
        • Lowenstein LM
        • Perrin EM
        • Campbell MK
        • et al.
        Primary care providers' self-efficacy and outcome expectations for childhood obesity counseling.
        Childhood Obes. 2013; 9: 208-215
        • Steeves JA
        • Liu B
        • Willis G
        • et al.
        Physicians’ personal beliefs about weight-related care and their associations with care delivery: the US National Survey of Energy Balance Related Care among primary care physicians.
        Obes Res Clin Pract. 2015; 9: 243-255
        • Guo H
        • Pavek M
        • Loth K.
        Management of childhood obesity and overweight in primary care visits: gaps between recommended care and typical practice.
        Curr Nutr Rep. 2017; 6: 307-314
        • Barlow SE
        • Salahuddin M
        • Butte NF
        • et al.
        Improvement in primary care provider self-efficacy and use of patient-centered counseling to address child overweight and obesity after practice-based changes: Texas Childhood Obesity Research Demonstration study.
        Childhood Obes. 2018; 14: 518-527
        • Rhee KE
        • Kessl S
        • Lindback S
        • et al.
        Provider views on childhood obesity management in primary care settings: a mixed methods analysis.
        BMC Health Ser Res. 2018; 18: 55
        • Belay B
        • Frintner MP
        • Liebhart JL
        • et al.
        US pediatrician practices and attitudes concerning childhood obesity: 2006 and 2017.
        J Pediatr. 2019; 211: 78-84
        • Imoisili OE
        • Goodman AB
        • Dooyema CA
        • et al.
        Referrals and management strategies for pediatric obesity–DocStyles Survey 2017.
        Front Pediatr. 2018; 6: 367
        • Imoisili OE
        • Goodman AB
        • Dooyema CA
        • et al.
        Screening and referral for childhood obesity: adherence to the US Preventive Services Task Force recommendation.
        Am J Prev Med. 2019; 56: 179-186
        • Brown CL
        • Perrin EM.
        Obesity prevention and treatment in primary care.
        Acad Pediatr. 2018; 18: 736-745
        • Perrin EM
        • Flower KB
        • Garrett J
        • et al.
        Preventing and treating obesity: pediatricians' self-efficacy, barriers, resources, and advocacy.
        Ambul Pediatr. 2005; 5: 150-156
        • Grossman DC
        • Bibbins-Domingo K
        • Curry SJ
        • et al.
        Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.
        JAMA. 2017; 317: 2417-2426
        • Eva KW
        • Regehr G.
        Self-assessment in the health professions: a reformulation and research agenda.
        Acad Med. 2005; 80: S46-S54
        • Turchi RM
        • Antonelli RC
        • Norwood KW
        • et al.
        Patient-and family-centered care coordination: a framework for integrating care for children and youth across multiple systems.
        Pediatrics. 2014; 133: e1451-e1460
        • Bodenheimer T
        • Wagner EH
        • Grumbach K.
        Improving primary care for patients with chronic illness: the chronic care model, Part 2.
        JAMA. 2002; 288: 1909-1914
        • Story M
        • Neumark-Stzainer D
        • Sherwood N
        • et al.
        Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals.
        Pediatrics. 2002; 110: 210
        • Boundy EON
        • Boyd AF
        • Hamner HC
        • et al.
        US pediatrician practices on early nutrition, feeding, and growth.
        J Nutr Educ Behav. 2020; 52: 31-38
        • Zientek LR
        • Thompson B.
        Applying the bootstrap to the multivariate case: bootstrap component/factor analysis.
        Behav Res Meth. 2007; 39: 318-325
        • Shi D
        • Maydeu-Olivares A.
        The effect of estimation methods on SEM fit indices.
        Edu Psychol Measure. 2020; 80: 421-445
        • Williams DM.
        Outcome expectancy and self-efficacy: Theoretical implications of an unresolved contradiction.
        Pers Soc Psychol Rev. 2010; 14: 417-425
        • Polacsek M
        • Orr J
        • Letourneau L
        • et al.
        Impact of a primary care intervention on physician practice and patient and family behavior: Keep ME Healthy—the Maine Youth Overweight Collaborative.
        Pediatrics. 2009; 123: S258-S266
        • Frintner MP
        • Liebhart JL
        • Lindros J
        • et al.
        Are graduating pediatric residents prepared to engage in obesity prevention and treatment?.
        Acad Pediatr. 2016; 16: 394-400
        • Resnicow K
        • Davis R
        • Rollnick S.
        Motivational interviewing for pediatric obesity: conceptual issues and evidence review.
        J Am Diet Assoc. 2006; 106: 2024-2033
        • Shaffer LA
        • Brothers KB
        • Burkhead TA
        • et al.
        Factors associated with attendance after referral to a pediatric weight management program.
        J Pediatr. 2016; 172: 35-39
        • Evans JSB
        • Stanovich KE.
        Dual-process theories of higher cognition: advancing the debate.
        Perspec Psychol Sci. 2013; 8: 223-241
        • Williams A
        • Turer C
        • Smith J
        • et al.
        Adoption of an electronic medical record tool for childhood obesity by primary care providers.
        Appl Clin Inform. 2020; 11: 210-217
        • Keyworth C
        • Hart J
        • Armitage C
        • et al.
        What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review.
        BMC Med Inf Decis Making. 2018; 18: 93
        • Dryden EM
        • Hardin J
        • McDonald J
        • et al.
        Provider perspectives on electronic decision supports for obesity prevention.
        Clin Pediatr (Phila). 2012; 51: 490-497
      2. Children's Hospital Association. 2013 Survey findings of children's hospitals obesity services. 2014. Available at:https://downloads.aap.org/dochw/2013SurveyFindingsofChildrensHospitalsObesityServices--CHA.pdf. Accessed April 4, 2022.

        • Block JP
        • Oken E.
        Practical considerations for the US Preventive Services Task Force recommendations on obesity in children and adolescents.
        JAMA Intern. Med. 2017; 177: 1077-1079