Understanding academic clinicians’ intent to treat pediatric obesity

Table 1 Psychometric properties of the theory of planned behavior subscales

Subscales	No. of items	Cronbach’s α
Attitudes	6	0.93
Subjective norms	6	0.76
Perceived behavioral control	10	0.87
Barriers	7	0.60
Intent	9	0.85

Table 2 Agreement level for subscale items (n = 198)

	Percentage (%)
	Strongly disagree	Disagree	Neither agree or disagree	Agree	Strongly agree
Attitudes/benefits
When obesity is managed or treated, children and adolescents will be less likely to develop:
Diabetes	1.5	0.5	2.0	39.4	56.6
Cardiovascular disease	1.5	0.0	4.0	43.4	51.0
High blood pressure	1.5	0.5	3.0	44.9	50.0
Musculoskeletal problems	1.5	1.5	3.5	49.5	43.9
Elevated LDL cholesterol levels	2.0	1.5	9.1	52.0	35.4
Mental health problems	1.5	3.5	15.7	54.0	25.3
Subjective norms
What would encourage you to manage or treat pediatric obesity?
Patients requesting treatment	0.0	4.5	12.1	38.4	44.9
Parents requesting that a child or adolescent be treated	0.0	5.6	21.2	49.5	23.7
Clinical practice guidelines	0.0	3.5	15.2	58.1	23.2
Colleagues who found treatment was successful	0.0	3.5	24.7	55.6	16.2
Policies in your organization	0.5	10.1	36.4	42.4	10.6
Meta-analyses showing treatment was successful	0.0	2.5	8.1	52.5	36.9
Self-efficacy/barriers
What would make it difficult for you to manage or treat pediatric obesity?
Families do not support pediatric obesity treatment	2.0	16.7	19.7	40.4	21.2
Patients do not adhere to pediatric obesity treatments	0.0	7.6	18.2	53.5	20.7
I don't have enough expertise in the treatment of pediatric obesity	5.6	18.7	22.7	37.4	15.7
It would be hard to find the time	5.6	23.2	29.8	27.8	13.6
I don't have access to consultation regarding the treatment of pediatric obesity	8.6	32.8	22.7	30.8	5.1
Difficulty billing for pediatric obesity treatment	9.1	36.4	36.9	14.1	3.5
My colleagues would not support pediatric obesity treatment	15.2	42.4	27.3	13.1	2.0
Perceived behavioral control
With respect to pediatric obesity, I have the skills to:
Conduct an assessment	4.5	16.2	15.2	47.0	17.2
Estimate the risks associated with pediatric obesity	4.5	18.2	19.7	48.0	9.6
Counsel patients and families regarding treatment options	6.1	22.2	19.7	43.4	8.6
Deal with children and adolescents who do not adhere to treatment	10.1	36.4	18.7	29.3	5.6
Deal with families who do not support treatment	12.1	35.4	21.7	27.8	3.0
Provide psychosocial treatment	17.7	44.4	19.2	16.2	2.5
Provide long term treatment follow-up	16.2	24.2	18.7	35.4	5.6
Evaluate the usefulness of different approaches to treatment	7.6	26.3	22.7	38.9	4.5
Treat or manage obesity with medication	25.3	48.0	12.6	12.1	2.0
Provide surgical treatment	66.7	22.2	4.0	4.0	3.0
Intent
I would be willing to:
Refer a pediatric patient for obesity treatment	2.5	2.0	3.0	41.9	50.5
Assess obesity in children	7.1	10.6	8.1	50.5	23.7
Assess obesity in adolescents	6.1	9.6	11.1	48.5	24.7
Counsel families regarding obesity treatment options	7.1	11.6	13.6	52.5	15.2
Accept referrals of children and adolescents who have difficulty with obesity	23.2	25.3	14.1	25.3	12.1
Provide psychosocial treatments for obesity in adolescents	19.7	37.4	15.2	22.7	5.1
Provide psychosocial treatments for obesity in children	22.2	35.4	16.2	22.7	3.5
Treat obesity with medication	19.2	38.9	18.2	21.7	2.0
Provide surgical treatments for obesity	56.1	23.2	9.1	9.1	2.5

The order of questions within subscales was randomized in each survey. LDL: Low-density lipoprotein.

Table 3 Demographic and practice characteristics of participants (n = 198)

Variable	n (%)
Sample Size	198 (100)
Gender
Male	73 (37)
Female	125 (63)
Age
26-35	38 (19)
36-55	127 (64)
≥ 56	33 (17)
Years of experience treating pediatric obesity
0-5	119 (60)
6-15	48 (24)
≥ 16	31 (16)
Birth country
Canada	131 (66)
Other country	67 (34)
First language
English	158 (80)
French	23 (12)
Other	17 (9)
Educational background
Allied health	11 (6)
Physician	149 (75)
Surgeon	38 (19)
Setting
Walk-in/individual practice/community hospital	14 (7)
Group practice	19 (10)
University teaching hospital	165 (83)
Professional experience
0-5 yr	43 (22)
6-15 yr	81 (41)
≥ 16 yr	74 (37)
Province
West	52 (26)
Ontario	98 (50)
Quebec	19 (10)
East	29 (15)

Table 4 Pearson inter-correlation matrix between intent to treat pediatric obesity and demographic variables/theory of planned behavior subscales

Variable	Item mean	SD	Correlation coefficients
			1	2	3	4	5	6	7
Sex	-	-
Birth country	-	-	-0.1
Experience	2.6	1.7	-0.05	-0.05
Attitudes	4.3	0.7	-0.02	0.01	-0.05
Subjective norms	4	0.5	0.23b	-0.14	0.02	0.27c
Perceived behavioral control	2.8	0.7	-0.04	-0.01	0.36c	0.02	0.08
Barriers	3.2	0.6	0.08	-0.1	-0.19b	0.02	0	-0.29c
Intent	3.1	0.8	0.11	-0.12	0.26c	0.07	0.27c	0.72c	-0.27c

Item mean is based on the average scores per question within each subscale (each question was anchored on a scale of 1 to 5). ^aP < 0.05,

^bP < 0.01,

^cP < 0.001. 1 = Less than 1 year, 2 = 1 to 5 years, 3 = 6 to 10 years, 4 = 11 to 15 years, 5 = 16 to 20 years, 6 = 21 to 25 years, 7 = More than 25 years. SD: Standard deviation.

Table 5 Step two of the hierarchical linear regression analysis for demographic factors and theory of planned behavior subscales on intent to treat (n = 198)

Independent variable	B	SE	β	P value
Sex	1.3	0.69	0.09	0.061
Birth country	-1.23	0.69	-0.09	0.077
Years of experience treating pediatric obesity	-0.04	0.21	-0.01	0.86
Attitudes	0.02	0.09	0.01	0.83
Subjective norms	0.38	0.11	0.17	0.001
Perceived behavioral control	0.65	0.05	0.69	< 0.001
Barriers	-0.15	0.09	-0.08	0.097

The P-value is based on the unstandardized regression coefficient. B: Unstandardized regression coefficient; β: Standardized regression coefficient. SE: Standard error.