b EteffldnaUon Assessment
C. Fsrt-Bamlnation Measures
3. Maternal Assessment Regarding Pediatric visit Questionnaire
As noted above, this questionnaire corresponds to the pre-exam
questionnaire •'Maternal Expectations Regarding Pediatric Visit'*. Mather' overall satisfaction with the health visit and pediatrician carminication
is assessed and can be directly oarpared to pre-examination expectations (see Appendix K for a copy of this measure).
Maternal Health Beliefs and Expectations Regarding Pediatric V isits Related to Maternal Satisfaction
Measures of mothers1 beliefs with regard to their children's health and expectations regarding their interaction with their child's pediatrician during the well-child examination were used to predict maternal
satisfaction with the examination. Stepwise regression analyses were conducted to explore the hypothesized relationships between: (1) the
parental health belief variables (internality, chance and powerful others) and maternal satisfaction with the pediatric visit and (2) maternal
expectations regarding the pediatric visit and actual satisfaction following the visit.
Stepwise regression analyses were performed in the following manner: the three parental health belief factors were entered, is well as the socioeconomic status and race of the mother (see Table 2).
Mothers1 internality with regard to their children's health emerged as a significant predictor of mothers' overall satisfaction with the well child visit, with higher levels of intemality predicting hicflier levels of satisfaction.
Mothers' expectations with respect to several pediatrician behaviors during the visit were predictive of mothers' overall satisfaction with the visit. Positive pediatric behaviors such as pediatrician laucfliter were predictive of mothers' overall satisfaction with the visit, with hi^ier
28 Table 2
Results of the Regressions Performed on the Mother' Health
Beliefs and Expectation Predictors and the M a t e m isfaction with the Well-Child Examination Criteria,
c^it^ riQn/Pr^ictors (step 4 s e j r2 f
Maternal Overall Satisfaction with the Well-Child Examination
Internal ity Health Bel ief Factor Socioeconomic Status
"Powerful Others” Health Belief Factor "Chanoe" Health Belief Factor
Mother’s Race Doctor1
Maternal Overall Satisfaction with the Well-Child Examination
Maternal Expectations that Doctor would Interrupt
Maternal Expectations that Doctor would Laugh Socioeconomic Status
Mother's Raoe Doctor
Maternal Overall Satisfaction with the Well-Child Examination
Maternal Expectations that Doctor would not be Irritated by her Questions
Maternal Expectations that Doctor would Provide Information without Having
.25 12.18** to Request it .43 8.63*** Socioeconomic Status • * * • • • Mother's Race • • • • * « Doctor » t * ♦ • « .27 14.10*** .40 12.11***
» i «
* * ♦
• • •
• • •
• • t
• •
1 .19 8 . 8 7 * * .29 7 . 6 8 * *• * •
* * *
• • •
1•
1* * *
• • •
♦ t •
* * •
*p<.05 **p<,01 ***p<.001 df»l/38lnpocbor" indictates which pediatrician performed the well-child examination.
levels of physician laughter related to higher levels of satisfaction. Negative physician behaviors were also related to mothers* overall
satisfaction with the visit, with higher levels of expected interrupting, irritation at being questioned, and providing information only on request predictive of lower levels of overall satisfaction with the visit.
It should be noted that which doctor performed the examination, the research site, sex of the child, ordinal position of the child, race of the mother, and age of tie mother were not significantly related to maternal health beliefs and expectations as related to maternal satisfaction.
Pediatrician-Parent Interaction Related to Maternal Health Beliefs and Regarding Pediatric Visits
Measures of mothers* beliefs with respect to their chi kiren*s health and expectations regarding their interaction with their children’s
pediatrician during the well-child examination were used to predict the interaction between the pediatricians and the mothers. Stepwise
regression analyses were conducted to explore the relationships
between: (1) the parent health belief variables (intemality, ch an ce and powerful others) and the pediatricians* interactive behavior during the well-child examination and (2) parental health belief variables
(intemality, chance and powerful otters) and the mothers' interactive behavior.
30
Stepwise regression analyses were performed in the following tranner: the three parental health belief factors were entered, as well as the
socioeconomic status and race of the mother (see Table 3).
Two parental belief factors: "internality" and "powerful others"
emerged as significant predictors of the doctors' interaction, with higher levels of internality and belief in powerful others as controlling factors in their child's health predictive of the pediatrician requesting hitter levels of descriptive information from the mother.
Mothers' chanoe beliefs with respect to their children's health emerged as a significant predictor of interruptions by the pediatricians, with higher levels of mothers' belief in chanoe as a controlling factor in their children's health predicting greater frequency of interruptions by the doctor.
Mothers' socioeconomic status was a significant predictor of several types of doctor interactive behavior, with higher socioeconomic status being predictive of: (l)the pediatricians' questions regarding
behavior/personality characteristics of the child, (2)the pediatricians' offering of behavior/personal ity characteristics about the child and (3) his total offering of information with respect to the child. 2
(2) Mothers' Interactive Behavior with Their Pediatricians
Stepwise regression analysis were performed in the following manner: the three parental health belief factors were entered, as well as the socioeconomic status and the race of the mother (see Table 4).
Mothers' internal ity emerged as a significant predictor of mothers' interaction with the pediatricians, with hicpier levels of internal ity with
Table 3
Criterion/Predictors (Stepwise) R2 E
Results of the Regressions Performed on the Mother’s Health Beliefs and Expectation Predictors and the Pediatrician-Parent Interaction during the Well-Child Examin tion Criteria.
Pediatrician Seeks Descriptional Information from the Mother during the Well-Child Examination
Internality Health Belief Factor .20
"Powerful Others" Health Belief Factor .35 "Chance" Health Belief Factor
Socioeconomic Status Mother's Race Sex of Child Doctor1 9.06** 9.77***
Pediatrician Interrupts the Mother "Chance" Health Belief Factor Internal ity Health Belief Factor
"Powerful Others" Health Belief Factor Socioeconomic Status
Mother's Race Sex of Child Doctor
17 7.55**
Pediatrician Seeks Behavior/Personality Characteristics of the Child
Socioeconomic Status
Internal ity Health Belief Factor
"Powerful Others" Health Belief Factor "Chance" Health Belief Factor
Mother's Race Sex of Child Doctor
11 4.59*
Pediatrician Offers Behavior/Personality Characteristics of the Child
Socioeconomic Status
Internal ity Health Belief Factor
"Powerful Others" Health Belief Factor "Chance" Health Belief Factor
Mother's Race Doctor
32
Crlterion/Predictore fst^nuHoo)
B2 F.
Pediatrician Offers Information with Respect to the Socioeconomic Status
Internality Health Belief Factor
''PowerfUi Others” Health Belief Factor "Chance" Health Belief Factor
Mother's Race Doctor
.22
10
.73
* * * *** • • • • • • • • • • • • • • • • • •• • •
• • •
• ••
• ••
*p<.05
**JK.01 ***p<.001d£“l,38
InDoctor" indicates which pediatrician
Table 4
Results of the Regressions Performed on the Mother's Health Beliefs and Expectation Predictors and Maternal Interaction in the Well-Child Examination Criteria*
(Stepwise) B2 f
Mother Seeks Behavior/Rersonal ity Characteristics of the Child
Internal ity Health Belief Factor
"Powerful others” Health Belief Factor "Chance" Health Belief Factor
Socioeoonanic Status Mother's Race
Doctor1
16 7.28**
Mother Seeks Descriptional Information from the Pediatrician during the Well-Child Examination
"Chanoe" Health Belief Factor Internality Health Belief Factor
"Powerful Others" Health Belief Factor Socioeconomic Status
Mother's Race Doctor
11
66
*Mother Seeks Information of All Types with Respect to the Child
Socioeconomic Status
Internality Health Belief Factor
"Powerful Others" Health Belief Factor "Chanoe" Health Belief Factor
Mother's Race Doctor
24 12.15**
laughs by the Mother during the Well-Baby Examination
Socioeconomic Status .19 9.04**
Internal ity Health Belief Factor
"PcMerfUl Others" Health Belief Factor "Chanoe" Health Belief Factor
Mother's Race Doctor
Mother Offers Behavior/Personal ity Characteristics of the Child
Socioeconomic Status .11 4.48*
Internal ity Health Belief Factor
"Powerful Others" Health Belief Factor "Chanoe" Health Belief Factor
Mother's Race Doctor
34
Criterion/PredictorB (Stewise) B2 F
Mother Sedas Clarification from Pediatrician with Respect to the Well-Child Examination
Socioeconomic Status .10 4.17*
Internality Health Belief Factor
"Powerful Others" Health Belief Factor "Chanoe" Health Belief Factor
Mother's Race Doctor
Mother Offers Confirmation to the Pediatrician with Respect to the Well-Child Examination
Socioeconomic Status
Internality Health Belief Factor
"Powerful Others" Health Belief Factor "Chanoe" Health Belief Factor
Mother's Race Doctor
10 4.36*
Mother Seeks ExplanatioiyEvaluation from the Pediatrician with Respect to the Well-Child Examination
Mother's Raoe
Internality Health Belief Factor
"Powerful Others" Health Belief Factor "Chance" Health Belief Factor
Doctor
14 6.13*
• I
• • I
Mother Seeks Medication form the PediatricianMother's Race
Internality Health Belief Factor
"Powerful Others" Health Belief Factor "Chanoe" Health Belief Factor
Socioeooncmic status Doctor 18 8.41** *p<.05 **p<.01 ***p<.001 df-1,38
^"Doctor" indicates which Pediatrician performed the well-child examination.
respect to their children's health relating to more frequent maternal questions to the pediatrician regarding behavioral and personality characteristics of the child.
Mothers' belief in chance as a controlling factor in their child's health was predictive of maternal requesting of descriptions from the pediatrician, with lower levels of maternal belief in chanoe predicting greater maternal requests for descriptions of some aspect of the child's body or health characteristics from the pediatrician.
Mothers' socioeconomic status emerged as a significant predictor of the mothers' interaction with the pediatricians, with higher socioeconomic status predicting hicpier levels of all types of maternal questions and the following individual codes: requesting clarification, offering
confirmation, offering behavior/personality characteristics, and mothers' laughing.
'Ihe race of the mother also emerged as a significant predictor of maternal interaction, with Caucasian mothers seeking higher levels of
evaluaticns/explanations and medications from their pediatricians than did black mothers. It is important to note that which doctor performed the examination, the research site, sex of the child, ordinal position of the child, and age of the mother were not related to pediatrician-parent
interaction as related to maternal health beliefs and expectations regarding pediatric visits.
Maternal Satisfaction Pediatric visits Belated to Pediatrician- P"T W * rrtminln,t,lfir
36
Measures of pediatrician-parent interaction during well-child examinations were used to predict maternal satisfaction with the
examination. Stepwise regression analyses were conducted to explore the hypothesized relationships between: (1)pediatricians' interactive behavior and maternal satisfaction, (2) mothers' interactive behavior and maternal satisfaction and (3) ratios of pediatrician and parent interaction as related to maternal satisfaction.
Stepwise regression analyses were performed in the following manner: the three parental health belief factors were entered, as well as mothers' overall satisfaction with the pediatric visit, socioeconomic status, race of mother, and the doctor performing the examination (see Table 5).
(1) Pediatrician's Interactive Behavior Related to Satisfaction The number of questions asked by the the pediatrician during the
examination was a significant predictor of mothers' overall satisfaction with the well child visit, with higher levels of questions by the doctor that sought a response predicting higher levels of maternal satisfaction with the examination.
Information offered by the pediatrician was not a significant predictor of maternal satisfaction.
(2) Mothers1 2 interactive Behavior Related to Satisfaction
While the number of questions asked by the mother was not significantly predicted by overall maternal satisfaction, it was significantly predicted by mothers' socioeconomic status. Greater questioning of the doctor by the mother was predicted by higher levels of socioeconomic status.
Criterion/Predictors (Stewisel B2 Number of Questions Asked by Pediatrician
Overall Maternal Satisfaction .19
Socioeconomic Status
Internality Health Belief Factor
"Powerful Others" Health Belief Factor "Chanoe" Health Belief Factor
Mother's Race Sex of Child Doctor1
Number of Questions Asked by Mother
Socioeoonomic Status . 24
Overall Maternal Satisfaction Internality Health Belief Factor
"Powerful others" Health Belief Factor "Chanoe" Kealtn Belief Factor
Mother's Race Sex of Child Doctor
Ratio of Questions Asked by Doctor to Questions Asked by Mother
Overall Maternal Satisfaction .34
Socioeconomic Status . 48
Internal ity Health Belief Factor
"Powerful Others" Health Belief Factor "Chanoe” Health Belief Factor
Mother's Race Sex of Child Doctor
Ratio of Questions Asked by Doctor to Toted Questions Asked by both the Doctor and Mother
Overall Maternal Satisfaction .29
Socioeoonomic Status
Internal ity Health Belief Factor
"Powerful Others1’ Health Belief Factor "Chanoe" Health Belief Factor
Mother's Race Sex of Child Doctor
Table 5
Results of the Regressions Performed on the Maternal Satisfaction with tl*e Well-Child Examination Predictors Pediatrician-Parent interaction Criteria.
and the E 8.82** 12.10** 17.36*** 14.99***
* ♦ t
• • «• • •
• • •
• • •
♦ * •
13.77***38
Ratio of Questions Asked by Mother to Total Questions Asked by both the Doctor and Mother
Overall Maternal Satisfaction Socioeconomic status
Internality Health Belief Factor
"Powerful Others" Health Belief Factor "Chance" Health Belief Factor
Mother's Race Sex of Child Doctor
18
Ratio of Information Offered by Doctor to Total Information Offered by both Doctor and Mother
Doctor
Overall Maternal Satisfaction Socioeconomic Status
Internal ity Health Belief Factor
"Powerful Others" Health Belief Factors "Chance" Health Belief Factors
Mother's Race Sex of Child
Ratio of Information Offered by Mother to Total Information Offered by both Doctor and Mother
Doctor
Overall Maternal Satisfaction Socioecxaxmic Statue
Internal ity Health Belief Factor
"Powerful Others" Health Belief Factors "Chance" Health Belief Factors
Mother's Race Sex of Child
23
23
Ratio of Total Interaction of Mother (both information and offered end questions asked) to Total Interaction of both the Doctor and Mother
Doctor .14
Overall Maternal Satisfaction .24
Socioeconomic Status
Internal ity Health Belief Factor
"Powerful Others" Health Belief Factor "Chance" Health Belief Factor
Mother's Race Sex of Child 7.62**
11
.21
**11
.20
** 5.50* 5.14**p<.05
**p<.01
***p<.001
df=l,38
indicates which pediatrician performed the well-child examination.
Information offered by the mother to the pediatrician was not a significant predictor of maternal satisfaction.
(3) Ratios of Pediatrician and Parent Interaction Related to Maternal Satisfaction
The ratio of questions asked by the pediatrician to the questions asked by the mother was significantly predictive of overall m t e m a l
satisfaction and socioeconmic status, with a higher ratio predicting higher levels of maternal satisfaction and higher socioeconomic status.
the ratio of questions asked by the pediatrician to the total questions asked by both the doctor and mother was significantly predictive of
maternal satisfaction, with a higher ratio predicting higher levels of natemal satisfaction.
Ihe ratio of questions asked by the mother to the total questions of both the mother and doctor was also predictive of maternal overall
satisfaction, with a higher ratio predicti;g higher levels of satisfaction.
Different relationships emerged when information was offered instaad of requested, 'the ratio of information offered by the pediatrician to total information offered by both the doctor and the mother related to which doctrr performed the examination. Similiarly, the ratio of information offered by the mother to total information offered by both the doctor and mother was also predictive of which doctor performed the examination.
Yet, the ratio of total interaction of the mother (both information
offered and questions asked) to total interactions of both the doctor and mother was significantly related to (l)which doctor performed the
Moreover, overall maternal satisfaction was not significantly predicted by which doctor performed the examination. Additionally, the research site,
sex of the child, ordinal position of the child, and the age of the mother were not significantly related to maternal satisfaction, maternal health beliefs and expectations, or pediatrician-parent interaction.
Figure 1 displays the multiple regression path diagram which summarizes the numerous regression analyses (Nie, Hull, Jenkins, Steinbrenner, &
Discussion
The results fran this study indicate a relationship between
pediatrician-mother interaction, maternal satisfaction, and parental
health beliefs and expectations regarding the well-child examination. Our analyses suggest that pediatrician-parent interaction during well-child visits is responsive to mothers* internality with regard to their
chidren's health and that both pediatrician-parent interaction and
mothers' internal ity are predictive of maternal overall satisfaction. In this section, the implications of the previously presented results will be
Mothers' internal ity with regard to their children's health was
predictive of maternal overall satisfaction. This is an important finding in that previous research has not considered how mothers' internal ity
affects maternal satisfaction with the well-child visit. This is the first study to show a maternal orientation (mothers' internal ity)
affecting maternal satisfaction with child health care. It would appear that mothers who are more internal with respect to the control they
perceive over their child's health are behaving in a way that elicits different behaviors from the physician, thereby increasing maternal satisfaction. Seme of these behaviors our captured through our
interactive coding system, but enough remains unaccounted for to indicate that other behaviors and dynamics are present. These issues should be
investigated in followup research.
M others' socioeconomic status was also predictive of maternal overall 42
satisfaction. This finding is consistent with other studies identifying socioeconomic status as an important factor in satisfaction with health care, but the present findings suggest that independent of socioeconomic status, there are specific health related orientations that are related to maternal overall satisfaction. Unlike socioeconomic status, which is
difficult to modify, these health-related orientations appear to be more susceptible to modification, thus potentially leading to higher levels of satisfaction. The present study includes a measure (Parental Health Beliefs) which allows us to know something else about why parents behave in a certain way with respect to their children's health that goes beyond just socioeconomic status or race. Additionally, which doctor performed the examination, which research site, or the mother's race were not
predictive of maternal satisfaction, suggesting that maternal health locus of control is an important and unique predictor of satisfaction.
Mothers' expectations that the pediatrician would not interrupt her, would laugh, would not be irritated by her questions, and would provide
information without having to request it were predictive of maternal satisfaction. These findings correspond to studies which suggest that physicians' behavior characterized by friendly treatment and warm concern was associated with greater patient satisfaction (Korsch & Negrete, 1981). These results have significant clinical applications for pediatricians: anticipating maternal concerns and interacting in a warm and interested manner increases maternal satisfaction, which is also related to
subsequent maternal compliance (King, 1983).
Fhysician description! information seeking was predictive of mothers' intemality with respect to their childrens' health, as was mothers'
44
socioeconcmic status, suggesting a relationship between mothers' internality and pediatrician-parent communication. Higher levels of pediatrician descriptional information seeking was related to higher levels of mothers' internal ity with regard to their children's health.
Higher levels of pediatrician information offering as well as both seeking and offering behavioral/personality characteristics corresponded to higher levels of mothers' socioeconomic status. This suggests that higher maternal socioeconomic status is related to pediatricians' showing greater interest and/or concern about behavioral/personality dimensions of the well-child visit. While not entirely surprising, the relationship between socioeooncmic status and responsive pediatrician-parent
ocanunication is a dissappolnting one, suggesting a need to educate physicians on this aspect of their interactive behavior.
Maternal seeking behavior/personality characteristics was related to higher levels of maternal internal ity with respect to children's health, thus suggesting a greater interest or concern in children's behavioral and personality-related dimensions among mothers of higher internal ity.
Perhaps this is a health-related dimension where mothers of high
internal ity feel they can particularly affect their child's health and well-being.
Similiar to pediatrician interactive behavior, higher levels of
maternal overall information seeking and descriptional information seeking corresponded to higher levels of mothers' internal ity as related to
children's health as well as socioeconcmic status, while higher levels of maternal information offering was related only to higher levels of
seeking and maternal medication seeking were related to the mother's race, with Caucasian mothers seeking mote expanations/evaluations and
medications for their child. However, this result is limited due to the unrepresentative number of black mothers in the study.
Wasserman and Unui (1983) found a relationship between maternal