Original article
Provider self-efficacy and the screening of adolescents for risky health behaviors

Presented in part at the annual meeting of the Society for Adolescent Medicine, 2000, Washington, DC.
https://doi.org/10.1016/j.jadohealth.2003.09.016Get rights and content

Abstract

Purpose

To examine the extent to which providers' perceived self-efficacy to deliver adolescent preventive services relates to their screening practices.

Methods

Screening rates were determined by both provider self-reported screening practices and the independent report of the adolescent patient. First, 66 pediatric providers (pediatricians and nurse-practitioners), working in three pediatric clinics within a managed care organization, completed surveys assessing: (a) self-efficacy for screening adolescent patients in the areas of tobacco use, alcohol use, sexual behavior, seat belt use, and helmet use; and (b) self-reported screening of adolescents during well-visits over the past month. Second, a sample of patients, aged 14 years to 16 years, reported on whether their clinicians screened them for these behaviors during a well-visit. Adolescents completed reports (N = 323) immediately following the well visit. Data were analyzed using Pearson product-moment correlation coefficients.

Results

Provider self-efficacy to deliver preventive services was correlated with self-reported screening in each of the five content areas, ranging from r = .24 (p < .05) for seat belt use to r = .51 (p < .001) for helmet use. Provider self-efficacy was significantly related to adolescent reports of screening in three of the five content areas; r = .25 (p < .05) for sexual behavior and tobacco use; and r = .23 (p = .06) for alcohol use.

Conclusions

Providers' self-efficacy to screen adolescents for risky behaviors was significantly related to both clinician self-report and independent adolescent reports of screening during well-visits. These findings point to the importance of enhancing clinicians' sense of competence to deliver adolescent preventive services.

Section snippets

Methods

The present study examines the relationship between pediatric providers' self-efficacy to deliver preventive services to adolescents and rates of delivery of preventive screening to adolescents during well-visits in pediatric outpatient clinics. These visits occurred as part of the baseline phase of a longitudinal study of preventive services for adolescents in three general outpatient pediatric clinics within a large managed care organization in Northern California. We utilized two independent

Sample

Pediatric providers from three outpatient pediatric clinics participated in the present evaluation in 1998. The clinics were selected on the basis of their provision of care to large numbers of adolescents (e.g., ≥ 3000 annual visits of 14-year-old patients) and their agreement to participate in a longitudinal study related to adolescent clinical preventive services. None of the general pediatric clinics had a specialized adolescent clinic. Providers completed the following two questionnaires

Provider self-efficacy

Providers completed the Provider Efficacy Questionnaire, an assessment of confidence in one's ability to deliver preventive services to adolescent patients. This measure was developed for use in this study. Five separate efficacy scales were constructed, one for each of the five risk areas: tobacco use; alcohol use; sexual behavior; seat belt use; and helmet use. All efficacy scales inquired about providers' perceived self-efficacy to screen for a risky behavior and provide brief counseling

Descriptive analyses of study variables

The means and standard deviations for the study variables are presented in Table 1.

Discussion

This study examined the relationship between provider self-efficacy to deliver preventive services and rates of screening adolescents for risky health behaviors. Screening rates were determined by both provider self-reported screening practices and the independent report of the adolescent patient.

First, greater provider self-efficacy was associated with higher self-reported rates of screening across five separate risk areas: tobacco use, alcohol use, sexual behavior, and wearing a seat belt and

Acknowledgements

We thank Julie Lustig and Susan Millstein for their contribution to the development of the assessment materials and Michael Berlin and Omar Ahsanuddin for their help in the preparation of the manuscript. We are grateful to the chiefs, clinicians, and adolescents in three Kaiser Permanente Northern California clinics who participated in this study and demonstrated an interest in improving preventive health care for adolescents.

This research was supported by The California Wellness Foundation

References (37)

  • N. Brener et al.

    Co-occurrence of health-risk behaviors among adolescents in the United States

    J Adolesc Health

    (1998)
  • J.M. Ellen et al.

    Primary care physicians' screening of adolescent patientsA survey of California physicians

    J Adolesc Health

    (1998)
  • E.M. Ozer et al.

    America's AdolescentsAre They Healthy?

    (2003)
  • J.A. Grunbaum et al.

    Youth Risk Behavior Surveillance–United States, 2001

    MMWR CDC Surveill Summ

    (2002)
  • L. Kann et al.

    Youth Risk Behavior Surveillance–United States, 1999

    MMWR CDC Surveill Summ

    (2000)
  • C.E. Irwin et al.

    Risk-taking behavior in adolescentsThe paradigm

    Ann N Y Acad Sci

    (1997)
  • L.D. Lindberg et al.

    Teen Risk Taking: A Statistical Report

    (2000)
  • E.M. Ozer et al.

    Adolescent health care in the United States: Implications and projections for the new millennium

  • A.B. Elster et al.

    American Medical Association. AMA Guidelines for Adolescent Preventive Services (GAPS)Recommendations and Rationale

    (1994)
  • M.E. Green et al.

    Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents

    (2000)
  • M.E. Stein

    Health Supervision Guidelines

    (1997)
  • U.S. Public Health Service. Clinician's Handbook of Preventive Services: Put Prevention Into Practice. 2nd edition....
  • M.J. Park et al.

    Investing in Clinical Preventive Health Services for Adolescents

    (2001)
  • R.W. Blum et al.

    Don't ask, they won't tellThe quality of adolescent health screening in five practice settings

    Am J Public Health

    (1996)
  • M. Franzgrote et al.

    Screening for adolescent smoking among primary care physicians in California

    Am J Public Health

    (1997)
  • V. Igra et al.

    Current status and approaches to improving preventive services for adolescents

    JAMA

    (1993)
  • B.L. Halpern-Felsher et al.

    Preventive services in a health maintenance organizationHow well do pediatricians screen and educate adolescent patients?

    Arch Pediatr Adolesc Med

    (2000)
  • M.D. Cabana et al.

    Why don't physicians follow clinical practice guidelines? A framework for improvement

    JAMA

    (1999)
  • Cited by (89)

    • Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network

      2020, Journal of Substance Abuse Treatment
      Citation Excerpt :

      Co-occurring medical and psychiatric conditions are common and may compete for clinical attention during primary care visits. Providers often lack training and confidence in assessing and treating substance use (Elwy, Horton, & Saitz, 2013; Ozer et al., 2004), and may subsequently avoid addressing these conditions with patients. Inconsistent practices in screening, assessment, and treatment across settings may further decrease diagnosis and treatment rates (Williams et al., 2015), explaining some variability across clinics.

    • Factors associated with physician self-efficacy in mental illness management and team-based care

      2018, General Hospital Psychiatry
      Citation Excerpt :

      Self-efficacy is associated with physician behavior- specifically following guideline-concordant care [33,46]. Clinician self-efficacy in the provision of mental health care has been positively linked to care quality [33,34,47–49]. Its association with behavior and modifiability make self-efficacy the best measure for physician confidence to effectively care for patients with mental illness within a healthcare team.

    • Adolescent medicine training in postgraduate family medicine education: a scoping review

      2023, International Journal of Adolescent Medicine and Health
    View all citing articles on Scopus
    View full text