Physician Self-efficacy Research Articles

Family Physician Self-Efficacy With Screening for Inherited Cancer Risk

Recent evidence has shown low and inconsistent rates of family history screening among generalist physicians. Little has been done to investigate the physician factors likely to mediate this behavior. We investigated family physicians' beliefs about screening their patients for inherited cancer risk, measuring their perceptions of self-efficacy and the importance of screening. We mailed a cross-sectional, 1-page questionnaire to all active members (691) of the Massachusetts Academy of Family Physicians, measuring their attitudes about predictive genetic cancer screening. We received responses from 300 of the 691 members (43%). Although 87% believed screening to be important, less than two thirds believed they were effective in screening. Many family physicians lack confidence in their ability to screen patients for a family history of cancer despite recognizing its importance to their practice.

Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking.

Although environmental tobacco smoke is a common trigger for asthma exacerbations in children, pediatricians infrequently counsel parents who smoke to quit. High physician self-efficacy, or self-confidence, in the ability to counsel parents about smoking cessation is associated with increased physician screening and counseling on this topic. However, it is not clear which factors are associated with high physician self-efficacy for counseling, such as previous training in smoking-cessation counseling or number of years in pediatric practice. To identify factors associated with high levels of physician self-efficacy for 4 skills associated with smoking-cessation counseling. Cross-sectional survey. A national random sample of 829 primary care pediatricians. The response rate was 55% (457 of 829). The percentage of physicians with high levels of self-efficacy for screening parents and screening patients to identify smokers was 87% and 84%, respectively. The percentage of physicians with high levels of self-efficacy for counseling parents and patients was 59% for both groups. The presence of previous training in smoking-cessation counseling was associated with high levels of self-efficacy for all 4 skills including inquiring about an asthma patient's smoking status (odds ratio [OR]: 3.91; 95% confidence interval [CI]: 1.63, 9.37); inquiring about a parent's smoking status (OR: 2.51; 95% CI: 1.09, 5.75); counseling a patient to quit smoking (OR: 5.30; 95% CI: 3.02, 9.31); and counseling a parent to quit (OR: 4.96; 95% CI: 2.85, 8.61). Years since completion of residency were not associated with high self-efficacy. These findings suggest that formal training in smoking cessation has a significant impact on physician self-efficacy related to smoking cessation throughout a physician's career.

Behavioral change in preventive medicine. An efficacy assessment of a physician education module.

We designed and evaluated a program to teach internal medicine residents behavioral counseling skills for multiple risk factor modification. Integrating physician-patient communication, negotiation skills, and the transtheoretical model of behavior change, we used small group discussion and standardized patients. The 18 participating residents increased their ability to modify patient behavior during videotaped interviews, mean pretest/posttest score: 33.1/40.1 (Student's paired t test, p < .0001). Physician self-efficacy in screening for risk factors and effecting behavioral change in patients was increased (p < .0001), as were positive attitudes toward psychosocial factors (p < .003). Our teaching effectively increased the residents' self-efficacy and performance of behavioral counseling.

Acceptance and Use of Put Prevention into Practice Materials at an Inner-city Hospital

Many studies indicate that physicians' prevention practices frequently differ from published guidelines. Put Prevention into Practice (PPIP) consists of a variety of paper-based materials for providers, patients, and the office setting designed to enhance the delivery of clinical preventive services. Prototype PPIP materials were distributed to physicians and patients at the Harlem Hospital medical clinic in conjunction with a series of prevention lectures for physicians. Acceptance and use of these materials were assessed through self-administered questionnaires for physicians and structured interviews for patients. A regression analysis was conducted to assess correlates of physician use of PPIP materials. Physicians reported a high degree of use of and satisfaction with PPIP materials. Multiple regression analysis indicated that the physicians' perceived self-efficacy in their ability to provide preventive counseling to patients at baseline was significantly associated with increased use of PPIP materials. When controlling for baseline physician self-efficacy, physicians whose self-efficacy increased during the study period were more likely to have used the materials. A majority of patients (53%) reported that the main patient-based component of the program-a pocket-sized booklet providing health education information and record-keeping of preventive tests and procedures-was very useful. Results from this study indicate a high degree of acceptance of prototype PPIP materials by physicians and patients at an inner-city hospital. Educational programs for physicians that enhance physician self-efficacy may be more effective in helping practitioners to adopt office-based prevention resources. Medical Subject Headings (MeSH): prevention, primary care, preventive health services, clinical practice patterns.

Counselling patients to make lifestyle changes: the role of physician self-efficacy, training and beliefs about causes.

Three factors that might help explain the extent to which physicians counsel patients to quit smoking and lose weight were examined: counselling self-efficacy, training in behaviour change and beliefs about causes of smoking and being overweight. More aggressive counselling was defined as counselling more patients per month and following up on counselling recommendations. Questionnaires were returned by 85 health maintenance organization physicians. As predicted, physicians with a stronger sense of counselling self-efficacy, and those who had received education in health behaviour change techniques were more aggressive counsellors. Motivational strategies were also explored. Physicians' beliefs about the causes of smoking and being overweight were related to the use of some types of strategies. Implications for increasing physician counselling patients to make behaviour changes are discussed.