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Taking well-child care into the 21st century: a novel, effective method for improving parent knowledge using computerized tutorials.

BACKGROUND
Despite expert panel recommendations, few pediatric providers administer sufficient anticipatory guidance and educational counseling during well-child visits, largely owing to lack of time.


OBJECTIVES
To design a waiting room educational kiosk that uses interactive, self-guided, computerized tutorials to give anticipatory guidance to parents at the 6-week and 4-month well-child visits, and assess impact on parent knowledge. The intervention required no additional provider time, and automatically printed a summary for the medical record.


SETTING
A government-funded hospital serving Navajo patients in New Mexico.


METHODS
After a well-child visit, knowledge regarding issues such as fever management, dental care, sleep position, nutrition, and car seat use was tested in a group of parents receiving standard care (control), and a group using the computerized tutorials in addition to standard care (intervention).


RESULTS
Fifty-two parents in the control group and 49 parents in the intervention group completed the knowledge assessment. Ninety-five percent of intervention subjects completed the computerized tutorial without clinic staff involvement. Compared with the control group, the intervention group had superior knowledge in all tested areas. The percentage of correct responses to all questions was higher for the intervention group in the following categories: car seat use (49% vs 31%, P<.01), dental care (80% vs 27%, P<.001), and nutrition (43% vs 21%, P<.001). Among parents of 6-week-old infants, a greater number of parents in the intervention group identified fever as 100.4 degrees F or higher (86% vs 50%, P<.001), and fewer replied that they would give antipyretics to a febrile child younger than 3 months old without consulting a provider (52% vs 100%, P<.001). The percentage of parents with a perfect score or only one question wrong on the 21-item test was 17-fold higher in the intervention group (P<.001).


CONCLUSION
Computerized anticipatory guidance at well-child visits increases knowledge over printed materials alone and is usable by the majority of parents.