Caregiver OM Risk Factor Knoledge
Caregiver OM Risk Factor Knoledge
Caregiver OM Risk Factor Knoledge
www.elsevier.com/locate/ijporl
a
Children’s Hospital of Wisconsin, Department of Otolaryngology and Communication Sciences,
Medical College of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
b
Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA
c
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
Received 28 April 2004; received in revised form 4 August 2004; accepted 6 August 2004
KEYWORDS Summary
Otitis media;
Risk factors; Objective: There are many risk factors for otitis media. Some of these, such as
Caregiver knowledge passive tobacco smoke exposure and childcare arrangements; have the potential to be
modified. The purpose of this study is to assess caregiver knowledge deficits about risk
factors associated with otitis media and their willingness to modify behaviors
associated with those risks.
Research design and methods: This study is a prospective survey study investigating
knowledge deficits of parents or guardians of children ages 6—36 months about the risk
factors of otitis media. The patients were consecutively drawn from a suburban and an
urban pediatric practice. Any difference in survey results between these two groups
was also assessed. Participants completed a survey of 21 questions with content
including demographic and OM risk factor data.
Results: A total of 401 caregivers completed surveys, with 213 from an urban
pediatric practice and 188 from a suburban practice. There was a significant differ-
ence in the ethnic distributions of the two populations. The suburban population had a
significantly greater family history of ear infections, number of ear infections in the
past 12 months, and number of previous ventilation tubes placed. The urban popula-
tion had a significantly greater number of smokers in the household and decreased
knowledge about day care as a risk for OM. The urban population’s question responses
$
Portions of this manuscript were presented at the Society for Ear, Nose and Throat Advances in Children (SENTAC) Annual Meeting,
New Orleans, LA, 31 October 2003.
* Corresponding author. Tel.: +1 414 266 6476; fax: +1 414 266 6989.
E-mail address: kersch@mcw.edu (J.E. Kerschner).
0165-5876/$ — see front matter # 2004 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijporl.2004.08.004
50 J.E. Kerschner et al.
suggested a greater willingness to change day care arrangements to reduce the risk of
otitis media.
Conclusions: Both populations demonstrated knowledge deficits regarding risk fac-
tors associated with OM and both populations exhibited willingness to modify beha-
viors to reduce risk. These findings demonstrate that there are opportunities for
improving education regarding OM risk factors and that this education could poten-
tially reduce risk for OM and in turn reduce the incidence of OM in children.
# 2004 Elsevier Ireland Ltd. All rights reserved.
related to OM or a history of OM to enroll. Any cian’s office. There were no significant differences
difference in survey results between these two between the suburban and urban groups regarding
groups was also assessed. Participants completed day care use and previous discussion of RF at their
a survey of 21 questions with content including pediatrician’s office.
demographic data of the caregiver’s child and OM In comparing the two cohorts in regard to the RF,
RF questions. Demographic data corresponding to the urban population had a significantly greater
the caregivers completing the survey was not col- number of smokers in the household (p < 0.0001).
lected. The suburban population had a significantly greater
family history of ear infections (p < 0.0001), number
2.3. Data analysis of ear infections in the past 12 months (p = 0.004),
and number of previous tympanostomy tubes placed
Statistical analysis of survey results included (p = 0.0003) (Table 2).
descriptive statistics, Levene’s test for equality of
variances, t-test for equality of means and Mann— 3.3. Knowledge of risk factors
Whitney testing. Survey design and statistical ana-
lysis was done in consultation with the National There was no significant difference between cohorts
Outcomes Research Center at Children’s Hospital for knowledge about tobacco exposure, breast-
of Wisconsin. feeding or family history of OM as OM RF.
However, the urban population responses sug-
gested less knowledge about day care as a risk factor
3. Results for OM (p < 0.004), but greater knowledge about the
possibility of a vaccine to limit OM risk (p = 0.05).
3.1. Demographics The urban population responses to the question
regarding antibiotic efficacy also suggested less
A total of 401 caregivers completed surveys with 213 knowledge regarding antibiotic resistance (p <
from an urban pediatric practice and 188 from a 0.0001) (Table 3).
suburban practice. There was a significant differ- An overall assessment of caregiver knowledge of
ence in the ethnic distributions of the two patient risk factors suggested that the urban cohort had
populations (Table 1). The suburban population was significantly less knowledge of OM risk factors com-
overwhelmingly Caucasian, whereas the urban prac- pared with the suburban cohort (p = 0.0003).
tice was primarily African American. The gender The overall knowledge about OM RF were also
distribution was similar for each location. assessed within each cohort separately. Knowledge
about individual, modifiable risk factors was great-
3.2. Risk factor exposure
The overall data for RF exposure revealed that Table 2 Risk factors
28.6% of caregivers noted smokers in the household. Urban Suburban
Caregivers (38.7%) utilize day care for their chil- (%) (%)
dren. Patients (56.1%) indicated that they had been Siblings with OM 18.5a 47.6a
educated regarding the RF for OM at their pediatri- Parent with OM history 7.2a 37.8a
Patient with history of 4.7a 15.5a
ventilation tubes
Table 1 Demographics Siblings with history of 14.1 10.2
ventilation tubes
Urban (%) Suburban (%) Smokers in household 43.4a 11.8a
Gender Patient in daycare 41.8 35.1
Female patients 52.7 45.7 Discussion of OM risk factors 53.4 59.0
Male patients 47.3 54.3 with doctor
Ethnicity/race OM episodes in past 12 months
African American 79.5a 0.0a 0 45.6 32.4
Caucasian 6.9a 95.9a 1—2 35.0 40.1
Hispanic 9.6 2.5 3—4 15.5 18.1
Native American 2.7 0.8 5—6 1.5 5.0
Asian 1.4 0.8 7 or more 2.4 4.4
a a
Indicates statistically significant difference between Indicates statistically significant difference between
populations. populations.
52 J.E. Kerschner et al.
significantly associated with increased caregiver there was about the potential to decrease OM with a
knowledge regarding RF for OM. vaccine. In addition, the urban population had a
In this current survey, caregivers reported more better understanding of the association of tobacco
widespread education about OM RF than the pre- and OM than daycare and OM. These findings would
vious report. However, approximately 44% of care- suggest that educational materials and strategies
givers reported that they had not been educated focused on these less well understood RF might
about OM RF by their primary care physician. This provide greater impact in RF modification.
represents an important segment of the population The differences in understanding regarding the
with the potential for knowledge deficits. The RF associated with OM between the two sites existed
increased percentage of caregivers whom reported despite caregivers reporting similar levels of educa-
receiving education regarding OM RF in this survey, tion provided by healthcare professionals regarding
compared with the previous study, might represent RF on their survey questions. There are several
of number of factors. These include that older possible explanations for the different level of
children were included in this survey giving more understanding regarding RF despite apparent equal
opportunity for education, or that more emphasis attempts at education. These include that neither
has been placed on OM and OM education in the participating site employs standardized materials
survey sites assessed. This study did not find a for education regarding OM RF and that the quality
difference between the suburban or urban practices and scope of education might therefore vary
regarding caregiver’s perceptions of OM risk factor between patients. The increased incidence of OM
education being done by the primary care physician. in the suburban cohort might also suggest that more
frequent or more in-depth discussions regarding OM
4.1. Demographics might have taken place with this group of patients.
Additional factors that could be important in leading
Gender distribution of patients of caregivers was to these differences are the potential impact of
similar for both cohorts in this study. The ethnic educational background, access to healthcare and
background in the different cohorts revealed a sig- continuity of care provided to patients. These areas
nificant difference with more African American of interest deserve further study.
patients in the urban practice and more Caucasian
patients in the suburban practice. Previous reports 4.3. Behavior modification
have documented a difference in rates of OM based
on race and socioeconomic situation [3]. This survey Perhaps the most salient finding in this study is that
supports previous studies with a reported increased as a raw score on a five-point scale, the willingness
incidence of OM and previous ear tube placement in to change behaviors regarding tobacco exposure and
our suburban, primarily Caucasian, population. childcare arrangements was very affirmative in both
Despite these differences in race and OM incidence the suburban and urban populations (Table 4). In all
there was not a reported difference in education cases, the willingness to modify behavior was even
regarding OM RF at these two sites. more affirmative if this modification could be linked
to avoidance of surgery with placement of ventila-
4.2. Risk factor incidence and knowledge tion tubes to treat the OM. This indicates a signifi-
cant willingness on the part of caregivers to modify
Exposure to modifiable RF differed between urban behaviors to lessen the risk of OM for their children.
and suburban caregivers. Patients from an urban These findings are important in that they suggest
population were more likely to be exposed to that programs targeted at OM risk factor education
tobacco smoke despite the fact that there was no and linked with risk factor modification strategies
difference in the knowledge of tobacco as a risk such as smoking cessation programs will find willing
factor for OM. Day care usage was no different for participants and could have the potential to posi-
the two cohorts, but knowledge of day care usage as tively affect risk factor exposure of young children
a risk factor for OM was significantly greater in the and reduce OM incidence. The questions regarding
suburban cohort. Awareness of antibiotic resistance risk factor modification were only directed towards
as a potential contributing factor in OM was also caregivers whose children were exposed to the risk
greater in the suburban cohort. The urban popula- in question, smokers and users of daycare, and
tion demonstrated increased knowledge about a therefore this willingness to change behavior exists
vaccine to potentially protect against OM. in the populations at risk. It was beyond the scope of
For each separate, modifiable RF, in both popula- this project to examine which type of educational
tions there was a greater knowledge about the efforts might have the most impact on changing
association of tobacco exposure as a RF for OM than behavior, but multiple avenues should be explored
54 J.E. Kerschner et al.
in addition to education by physicians including viors that might reduce the risk of OM to their child.
media campaigns and community efforts. Standardized teaching materials could be made
Caregivers from the urban cohort were signifi- available to assist with education of caregivers
cantly more willing to consider changing childcare and could be a first step in behavior modification
arrangements to reduce OM risk for their children. in an attempt to reduce the incidence of OM. This
This difference from the suburban cohort existed survey study certainly has some limitations, how-
despite a greater understanding of the suburban ever, the data obtained from this investigation
population regarding the association of daycare demonstrates a number of important points and
and OM. As daycare is often considered the most suggests some clear avenues of future investigation
important risk factor associated with OM these find- in an area that has been scientifically neglected.
ings warrant further investigation. Further study is needed to assess if education alone
can be effective in risk factor modification or if more
4.4. Potential study weaknesses intensive programs are needed to assist with risk
reduction. Further study is also needed to assess if
This study also did not attempt to standardize different strategies are required to erase knowledge
patient populations in terms of OM incidence, deficits in different types of practice locations.
patient age or other medical conditions. As with Some of this work has already been initiated. Given
all survey instruments this study relied on caregiver the high prevalence of OM and its potential for
perceptions rather than more objective measure- morbidity, the significant health care expenditures
ments. This survey also had a focus on past events involved in treating this disease and the more recent
rather than prospective measurements which per- declining efficacy of antimicrobial therapy due to
mits recall bias. The survey used for this study did antibiotic resistance, increased study of risk reduc-
not undergo validation in other settings, did not tion with implementation of strategies to reduce
assess a broad cross-section of the population and this risk should be pursued.
was not assessed for possible cultural and educa-
tional biases. In addition, this survey did not
attempt to correlate caregiver knowledge about Acknowledgements
OM RF, or willingness to change behaviors, to their
own child’s particular incidence of OM and these Special thanks to all of the physicians, residents,
would be areas of interest in future investigations. medical students and staff at the Downtown Health
Clinic, Milwaukee, WI, who assisted in collecting
data for this project and to Dr. Rohloff’s colleagues
5. Conclusions (Drs. Gutzeit, Jeruc, Richter and Young) as well as
their staff at Southwest Pediatrics, New Berlin, WI.
There is a knowledge deficit regarding the RF for OM Also, special thanks to Stephanie Frisbee and Evelyn
by caregivers in both urban and suburban pediatric Kuhn from the National Outcomes Research Center
practices. However, the caregivers of these children at Children’s Hospital of Wisconsin for their assis-
do exhibit a significant willingness to modify beha- tance with survey design and data analysis.
Caregiver otitis media risk factor knowledge 55