Semester

Spring

Date of Graduation

2007

Document Type

Thesis

Degree Type

MS

College

School of Pharmacy

Department

Pharmaceutical Systems and Policy

Committee Chair

Virginia (Ginger) Scott

Committee Co-Chair

Jan Kavookjian

Abstract

One health challenge receiving a lot of attention today is childhood obesity. Numerous public and professional organizations recommend that physicians periodically measure BMI in children and adolescents. In addition, guidelines recommend medical evaluation of overweight children and adolescents. However, studies have shown an inconsistent use of body mass index (BMI). This study uses the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB) to identify factors that explain physicians' intention to measure BMI in children and adolescents. Salient beliefs associated with intention were compared between intenders and nonintenders. The study also determines how physicians identify and evaluate overweight children and adolescents. A self-administered questionnaire was mailed to a random sample of 2,590 physicians (family physicians and pediatricians) practicing in four states. The theoretical variables assessed in the study were: intention to measure BMI, attitude, subjective norm, perceived behavioral control, attitudinal beliefs and evaluation, normative beliefs and motivation to comply, and control beliefs and evaluations. Physician practice-related and demographic information were also collected. The factors explaining intention were examined using correlation and multiple regression analysis. Salient beliefs between intenders and nonintenders were compared using ANOVA. Overall, 583 physicians returned the questionnaire (usable response rate of 22.8%). Only 44% of surveyed physicians strongly intended to measure BMI in children and adolescents. The theoretical models explained up to 51.2% of variance in intentions to measure BMI. There were significant behavioral and normative belief differences between physicians who intended and those who did not intended to measure BMI. A majority of physicians frequently used clinical impression, weight-for-age percentile, and weight-for-height percentile to identify overweight children and adolescents, with less than 57% actually using BMI percentiles. In terms of evaluating overweight children and adolescents, 15% followed all recommendations for family history assessment; however, 6% followed all recommendations for clinical evaluations and medical history and physical examination. Roughly one-third of physicians followed all recommendations for behavioral history assessment. The study also reflected variation in physicians practice across states. The TRA and the TPB provided a useful framework for studying physicians' intentions to measure BMI. Physicians' adherence to the recommended evaluation practices for overweight children and adolescents was low.

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