Potential barriers to implementing a computer-based injury prevention project in a clinic setting

Background: In 2008, we implemented an injury prevention anticipatory guidance project through a research-based computer program in a community pediatric clinic in a predominately Hispanic neighborhood. Methods: Parents of children less than 4 years old completed a computer-based injury risk assessment in the clinic during a well-child visit. A personalized assessment was generated. The child's physician discussed the results with the parent and provided tips to increase safety behaviors. Follow-up phone calls with parents were conducted three weeks and two months following the initial visit. Data was collected and linked to determine reported behavior change following the anticipatory guidance. Results: Seventy-one percent of eligible parents were enrolled in the intervention; 61% completed the follow-up phone survey. Of parents who completed the assessment, 55% reported at least one behavior change that had been recommended at the well-child visit. Overall, 20% did not complete the assessment. Verbal refusal rates were higher for Spanish speaking parents. More Spanish speaking parents indicated illiteracy or computer illiteracy as a reason to not take the assessment. The average time for English-speaking parents to complete the assessment was 6 minutes, 29 seconds, compared to 8 minutes, 49 seconds for Spanish-speaking (P>0.001). Conclusions: The project was effective at increasing reported injury prevention behaviors. Language and computer literacy appeared to be a barrier to enrollment. Several areas of improvement were identified that would contribute to planning a more sustainable, tailored unintentional injury project.