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Title: Primary care physicians' perceptions of adolescent pregnancy and STD prevention practices in a Nova Scotia county.
Author: Langille DB, Mann KV, Gailiunas PN.
Journal: Am J Prev Med; 1997; 13(4):324-30. PubMed ID: 9236972.
Abstract:
INTRODUCTION: This study was carried out to determine the predisposing, enabling, and reinforcing factors related to practice behaviors in the prevention of adolescent pregnancy and sexually transmitted diseases (STDs), and to assess physicians' "ideal" history taking and service provision versus their actual practice in this clinical area. METHODS: Twenty-six of 37 physicians in a single county in Nova Scotia took part in a face-to-face interview. RESULTS: Analysis of predisposing factors found that, for seven of 10 areas related to knowledge of the epidemiology of adolescent pregnancy and STDs, fewer than 50% of male physicians were able to give correct responses. All physicians believed this to be an important area for prevention, and 89% that prevention is possible, but only 62% believed that their own prevention efforts are effective. Respondents were about equally likely to view schools and physicians as having responsibility for prevention of adolescent pregnancy and STDs. Significant enabling factors included high levels of perceived personal comfort and skill, but time factors and opportunities to interact with adolescents sufficiently frequently to carry out prevention were seen as barriers. Most physicians (68%) agreed that the physician fee schedule was a negative reinforcing factor. Male physicians and those in rural practice were significantly more likely to have larger gaps between those preventive practices they saw as desirable and those they actually performed. In 1992, the reported Nova Scotia provincial rate for Chlamydia trachomatis genital infection was 15/1000 for girls and 2/1000 for boys, whereas rates for County A were 12/1000 for girls and 1/1000 for boys. The predisposing, enabling, and enforcing factors related to practice behaviors in the prevention of adolescent pregnancy and sexually transmitted diseases (STDs) were determined in face-to-face interviews to assess 26 physicians' ideal history taking and service provision versus their actual practice. Beliefs, attitudes, and enabling and reinforcing factors were assessed using a 5-point Likert scale. Interviews were completed between July 7 and August 31, 1994, with 26 doctors, of whom 20 were men (median age, 39 years) and 6 were women (median age, 35 years). The number of years in practice was 12. Fewer than 50% of male physicians were able to answer 7 of the 10 questions in relation to predisposing factors in prevention of adolescent pregnancy and STDs. 89% of the physicians believed that adolescent pregnancy and STDs are preventable, only 62% believed their own efforts to be effective in prevention. 85% of the physicians believed that schools had a responsibility to provide sex education, while 81% considered the role of parents in avoiding pregnancy and STDs crucial. 85% agreed that they were comfortable about talking with adolescents about sexuality, but only 36% felt that their medical school education had provided adequate preparation and 46% cited lack of time. While two-thirds agreed that female adolescents often made appointments for pregnancy prevention, only 23% said that girls did the same for STD prevention and 12% said that boys did. 68% of the physicians claimed that the current Medical Services Insurance fee schedule discouraged them from talking to adolescents about prevention. The lowest rate of agreement was with questions about sexual orientation (69%) and sexual practices (62%). The median score difference between believing that questions should be asked in the history and actually asking those questions was 0.0 for women and 2.0 for men (p = 0.04).

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