Effects of a Videotape to Increase Use of Poison Control Centers by
Low-Income and Spanish-Speaking Families:
A Randomized, Controlled Trial
Nancy R. Kelly, MD, MPH*; Lynne C. Huffman, MD*‡; Fernando S. Mendoza, MD, MPH*; and Thomas N. Robinson, MD, MPH*§
ABSTRACT. Background. Poison control centers
(PCCs) reduce health care costs for childhood poisonings by providing telephone advice for home management of most cases. Past research suggests that PCCs are under-utilized by low-income minority and Spanish-speaking parents because of lack of knowledge and misconcep-tions about the PCC. A videotape intervention was de-signed to address these barriers to PCC use.
Objective. To evaluate the effectiveness of a video-tape intervention (videovideo-tape, PCC pamphlet, and PCC stickers) in improving knowledge, attitudes, behaviors, and behavioral intention regarding use of the PCC in a low-income and predominantly Spanish-speaking popu-lation in Northern California.
Methods. Two hundred eighty-nine parents of chil-dren<6 years of age, attending educational classes at 2 Women, Infant, and Children (WIC) clinics participated in a randomized, controlled trial. WIC classes were ran-domized to receive the video intervention (video group) or to attend the regularly scheduled WIC class (control group). Participants completed a baseline questionnaire and 2 to 4 weeks later, a follow-up telephone interview. Changes from baseline to posttest were compared in the treatment and control groups using analysis of variance.
Results. Compared with the control group, the video group showed an increase in knowledge about the PCC’s function, its hours of operation, and staff qualifications; was more likely to feel confident in speaking with and carrying out recommendations made by the PCC; was less likely to believe the PCC would report a mother for neglect; was more likely to have the correct PCC phone number posted in their homes; and when presented with several hypothetical emergency scenarios, was more likely to correctly answer that calling the PCC was the best action to take in a poisoning situation.
Conclusions. This videotape intervention was highly effective in changing knowledge, attitudes, behaviors, and behavioral intentions concerning the PCC within this population. As a result, use of this video may help increase use of the PCC by low-income and Spanish-speaking families.Pediatrics2003;111:21–26;poison con-trol centers, poison prevention, videotape.
ABBREVIATIONS. PCC, Poison Control Center; WIC, Women, Infant, and Children; CI, confidence interval.
E
ach year more than 1 million cases of uninten-tional poisoning exposures involving children are reported in the United States.1Poisoncon-trol centers (PCCs) provide immediate telephone ad-vice about optimal management of any type of poi-soning exposure. Because the majority of poipoi-sonings involving children can be safely managed at home, PCCs reduce health care costs for childhood poison-ings by preventing unnecessary health care facility visits.2– 4 They also reduce morbidity by expediting
referral to a health care facility when necessary.5
There are 65 PCCs in the United States and of these, 52 are certified by the American Association of Poi-son Control Centers.6To be certified by the
Ameri-can Association of Poison Control Centers, a center must meet specified standards, including accessibil-ity to callers 24 hours every day and multiple lan-guage capabilities.
Unfortunately, many parents do not utilize PCCs for unintentional poisoning incidents involv-ing children. Previous studies by Kelly et al7,8
re-vealed that in an urban Texas community, PCCs were underutilized by low-income minority and Spanish-speaking parents. This underutilization was not simply attributable to lack of knowledge about the PCC but to certain misconceptions about it. Par-ents were unsure of staff qualifications, unclear of the realm of products for which the PCC could offer advice, and, in general, believed that speaking to a physician was preferable. Parents were concerned about the possibility of being reported for neglecting their children. Spanish-speaking parents feared a language barrier. Many parents suggested that they did not feel confident that they could carry out the recommendations of the PCC in a stressful situation and would prefer to call 911 or go to the emergency department.
To address the barriers identified in previous re-search,7,8we created a brief videotape intervention,
targeted to low-income minority and Spanish-speak-ing mothers, designed to improve their knowledge, attitudes, and behaviors concerning the PCC. Our video intervention was tested in a culturally diverse, low-income, predominantly Spanish-speaking popu-lation in Northern California.
From the *Division of General Pediatrics, Department of Pediatrics, ‡Chil-dren’s Health Council, and §Center for Research in Disease Prevention, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Dr Kelly is currently at Baylor College of Medicine, Houston, Texas. Received for publication Feb 7, 2002; accepted Jun 6, 2002.
Address correspondence to Nancy R. Kelly, MD, MPH, Texas Children’s Hospital, 6621 Fannin St, Suite 1540, Mail Code: 1540.00, Houston, TX 77030. E-mail: [email protected]
DESIGN AND METHODS
We conducted a randomized, controlled trial over a 4-month period at 2 Women, Infant, and Children (WIC) clinics, both located in San Mateo County in Northern California. Participants were parents of young children (age range: 15 months to 6 years), who were scheduled to attend an educational class at 1 of the 2 WIC clinics. Forty-three classes were randomized to either a treat-ment group or a control group using a random numbers table. This study was approved by the Institutional Review Board of Stanford University and by the San Mateo County Health Services Agency.
At the beginning of each class session, a bilingual research assistant invited all eligible parents or relatives to participate in the study. To be eligible, a participant was required to live in the same home with a WIC-enrolled child⬍6 years of age, and to be able to speak the language in which the class was to be conducted (English or Spanish). Parents were asked to complete a preinter-vention questionnaire, to attend the entire class session, and to complete a follow-up telephone interview within approximately 1 month. An incentive of $10 was offered for completion of the first questionnaire and class session, and an additional $10 was offered after the completion of the follow-up telephone interview. After written consent was obtained, all participants completed a 5-page multiple choice and fill-in-the-blank baseline questionnaire. Be-cause of the low literacy level of many of the parents, the ques-tionnaire was read aloud to the class so parents could follow along. The research assistant and WIC staff assisted illiterate par-ents by transcribing their answers onto questionnaires.
After completion of the baseline questionnaire, groups were managed as follows: Participants in the treatment groups viewed the educational video and were given a PCC pamphlet and 2 stickers with the PCC phone number (see description of interven-tion). There was no discussion after the video, and all questions were deferred until after the follow-up telephone interview. Par-ticipants assigned to the control groups attended the regularly scheduled educational classes prepared by WIC. During the study period, control classes were presented on immunizations and healthy snacks.
Approximately 2 to 4 weeks later (postintervention), each par-ticipant was contacted by telephone and asked to respond verbally to the same questions included in the baseline questionnaire. A bilingual research assistant conducted all follow-up interviews and was blinded as to whether a participant was in the treatment group or control group.
Intervention
The intervention included an educational videotape, a PCC pamphlet, and PCC stickers. The videotape “Making the Right Call: The Poison Control Center” was created by the first author (N.R.K.) and colleagues.9It is 9 minutes in duration and is
avail-able in English and Spanish versions. It includes general informa-tion about the funcinforma-tion of the PCC, its hours of operainforma-tion, and the qualifications of the staff. Testimonials from a culturally diverse group of physicians, PCC staff members, and mothers are in-cluded. The Spanish video was filmed with Spanish dialogue and minimal “voice-over” for the English-speakers.
In addition to the testimonials, 2 poisoning scenarios are dra-matically reenacted. In the first poisoning scenario, a Hispanic mother finds her child wet and crying after knocking over a bucket of household bleach and fears she has swallowed some bleach. She calls the PCC and is guided through a short series of questions, advised of appropriate home management, and reas-sured that the child does not need to go to the emergency depart-ment. In the second poisoning scenario, an African American mother discovers that her child has taken one of his grandmoth-er’s anti-hypertensive pills. She calls the PCC and is appropriately advised to take her child immediately to the emergency depart-ment for evaluation. Using this format, mothers model the desired behavior of calling the PCC and the staff demonstrate, in a helpful and caring manner, their expertise in handling poisoning situa-tions. The use of bilingual Hispanic video participants was in-cluded to enhance the effects of the modeling for Hispanic view-ers.
The pamphlet used in the intervention was designed by the California Poison Control System and is available in English and Spanish versions. It includes basic information about the PCC and poison prevention, and it lists potentially poisonous products
found in most households. It briefly discusses poisonous plants and the use of syrup of ipecac to induce vomiting when appro-priate.
The PCC stickers display the toll-free telephone number and are to be placed on or near the home telephone for easy accessi-bility. At the time of this study, the stickers displayed the state-wide toll-free number for callers in California. However, as of January 2002, there is a national toll-free telephone number (1– 800-222–1222), which can be accessed from anywhere in the United States.
Questionnaire
A 30-item questionnaire was developed for this study. It as-sessed demographic information, knowledge, attitudes, behaviors, and behavioral intentions regarding the PCC.
Knowledge questions such as “What are the hours the Poison Control Center is open?” were asked in a yes/no or multiple-choice format. Attitude questions such as “How likely is it that a mother will be reported for neglecting her child if she calls the Poison Control Center?” were asked using 5-point Likert-type scale format. Behavior questions were in a yes/no format, such as “Do you have the Poison Control Center number posted in your home?” Finally, to assess behavioral intent, parents were pre-sented with 8 emergency scenarios and asked to identify what a parent should do first in each situation. For each scenario, parents were given the following choices: 1) go to the emergency depart-ment, 2) call 911, 3) call the PCC, 4) wait to see if anything happens to the child, 5) call the doctor, or 6) “other,” with space to write their own response. Four poisoning scenarios involved children who were exposed to or ingested specific substances: household bleach, an anti-hypertensive medication, a household plant, and over-the-counter cough syrup. A general poisoning scenario was included in which participants were asked what a parent should do if he/she thinks a child has eaten “something poisonous.” To assess whether participants knew that the PCC can communicate to the public in multiple languages, they also were asked what a parent should do if he/she thinks a child has eaten “something poisonous” and this parent only speaks Spanish. Two nonpoison-ing emergency scenarios also were included—a child who was cut by a rock and is bleeding and a child who is choking on a piece of candy.
Data Analysis
Multiple choice and yes/no questions were coded as “0” if incorrect and “1” if correct. Attitude questions were coded on a 5-point Likert-type scale from⫺2 (least desirable response) to⫹2 (most favorable response). Treatment and control groups were assessed for baseline differences by comparing mean scores using the Studentttest for continuous variables and2tests for
cate-gorical variables. Mean scores were calculated for the categories of knowledge, attitudes, behaviors, and behavioral intent by sum-ming the scores of all questions in each category for each partic-ipant. We then calculated the differences in scores from baseline to posttest (change scores) for each category of questions and com-pared the mean changes between treatment and control groups using analysis of variance. Effect sizes are reported as mean treat-ment-control differences and their 95% confidence intervals. To reduce the risk of type 1 error from multiple testing, statistical tests of differences between the treatment and control groups were only performed on the summed category index scores.
The primary analyses were conducted with individual as the unit of analysis. Although participants were randomized in groups (classes) and the intervention was delivered in a group setting, this was done to facilitate implementation in the real world WIC setting, to maximize the generalizability of the results. The intervention included no group discussion during or after the video. Any questions about the videotape were deferred until after the follow-up interview was completed. Therefore, we per-formed these analyses under the assumption of no within-group correlation of responses (people within the same group are no more likely to respond the same as people in different groups). To check the validity of this assumption, we also repeated the same outcome analyses with class as the unit of analysis.
prin-ciples. All randomized participants were included in the analysis according to the treatment group they were originally assigned, irrespective of dropout or any other intercurrent events. Partici-pants with some missing data at follow-up were conservatively assumed to have an incorrect answer, or, for Likert scale ques-tions, a neutral score of zero. Alpha⫽0.05 was the criterion for statistical significance for all analyses.
RESULTS
Approximately 91% of eligible parents agreed to participate. Of the 323 participants at baseline, 289 (89%) also were assessed at follow-up. Of the 34 not assessed at follow-up, 7 had no phone and 27 were unable to be reached (not at home, moved, or other-wise lost to follow-up). There were no significant demographic differences between participants who were up and those who were not followed-up. There were 43 class sessions conducted and of these, 23 were randomized to control and 20 were randomized to treatment classes. Most classes were held in the morning and the mean⫾standard devi-ation class size was 6.7⫾3.4. There were no differ-ences between treatment and control groups in terms of class size or time of day class was held.
Demographics
Of the 289 participants who were assessed at fol-low-up, there were 144 in the control group and 145 in the treatment (video) group. Because of occasional missing data, baseline analysis samples ranged from 282 to 289. Group characteristics are reported in Ta-ble 1. There were no significant differences between treatment and control groups for most demographic variables. However, control group participants were more likely to be English speakers or bilingual (⬎80% of bilinguals spoke English and Spanish) and reported completing more school, and although the vast majority of participants in both groups were mothers, there were 8 fathers in the control group and none in the treatment group.
Baseline Comparisons
There were no significant differences between con-trol and treatment groups at baseline for knowledge, attitudes, or behaviors scores (Table 2). There was a small, but statistically significant difference between control and treatment groups for the behavioral in-tent score.
TABLE 1. Baseline Characteristics of Participants
Control n⫽144
Treatment n⫽145
PValue
Variables:
Age (y), mean [SD] 29.1 [6.4] 30.2 [6.6] .17
Gender,n(%)
Female 136 (94) 145 (100)
Male 8 (6) 0 .004
Marital status,n(%)
Married/living together 107 (74) 113 (79)
Single 22 (15) 16 (11)
Divorced/separated/widowed 15 (11) 14 (10) .57
Race/ethnicity,n(%)
Latino 115 (81) 122 (87)
White 11 (8) 9 (6)
Asian or Pacific Islander 8 (6) 6 (4)
African American or other 7 (5) 4 (3) .68
Children⬍6 y at home,n(%)
1 96 (67) 93 (65)
2 42 (29) 41 (29)
3 6 (4) 9 (6) .72
Country of birth,n(%)
United States 25 (17) 17 (12)
Mexico 90 (62) 99 (68)
El Salvador 8 (6) 12 (8)
Guatemala 8 (6) 5 (4)
Other 13 (9) 12 (8) .48
Years lived in the United States,n(%)
⬍5 21 (14) 30 (21)
5–9.9 57 (40) 62 (43)
10–14.9 27 (19) 23 (15)
ⱖ15 39 (27) 30 (21) .35
Languages spoken at home,n(%)
English or other 20 (14) 12 (8)
Spanish 80 (55) 105 (73)
Bilingual 44 (31) 28 (19) .01
Highest grade completed, mean [SD] 10.2 [3.5] 8.8 [4.0] .003 Time to follow up (d), mean [SD] 19.8 [7.7] 21.9 [9.2] .04 WIC clinic attended,n(%)
“A” 90 (63) 88 (61)
“B” 54 (37) 57 (39) .75
Class language,n(%)
English 31 (22) 19 (13)
Spanish 113 (78) 126 (87) .06
Change Comparisons Changes in Knowledge
Changes from baseline to posttest in the treatment and control groups are shown in Table 2, including analysis of variance results for individuals as the unit of analysis and for class as the unit of analysis. The treatment group showed greater improvement for all 4 knowledge questions regarding the PCC. There was only a slight increase in the number of partici-pants in either group who answered the ipecac ques-tion correctly at posttest. Changes in knowledge scores were significantly greater in the treatment group than the control group.
Changes in Attitudes
The treatment group also demonstrated signifi-cantly improved attitudes regarding the PCC in re-sponse to the intervention. Video viewers tended to
report an increased comfort level for talking with the PCC staff and carrying out their recommendations after watching the video. In addition, they were less likely to believe the PCC would report a mother for neglecting her child.
Changes in Behaviors
After the intervention, treatment group partici-pants increased their mean behavior score signifi-cantly more than the control group. There seemed to be little change for either group for having ipecac at home. However, there was a marked increase in the number of participants in the treatment group who stated that they had the PCC phone number posted at home. To verify that parents did indeed have the PCC number at their home, they were asked to read the phone number back to the interviewer at the time of the posttest. Sixty-three percent of treatment TABLE 2. Mean Scores and Mean Changes Comparing Control and Treatment Groups
Questions Treatment Control Treatment
Versus Control P Value
Baseline Posttest Baseline Posttest Mean Difference
(95% CI)
Knowledge
Knows about PCC (% correct) 38 64 46 43
Knows PCC hours (% correct) 56 90 53 60
Knows days PCC is open (% correct) 51 84 46 55
Knows who works at the PCC (% correct) 45 62 47 41
Knows use of syrup of ipecac (% correct) 34 41 40 41
Total Knowledge Score (analyzed by individual) (number correct, 0–5), mean [SD]
2.23 [1.66] 3.41 [1.42] 2.31 [1.77] 2.40 [1.77] 1.08 (0.78–1.37) ⬍.001
Total Knowledge Score (analyzed by class) (number correct, 0–5), mean [SD]
2.22 [0.89] 3.47 [0.52] 2.45 [1.17] 2.51 [1.00] 1.19 (0.89–1.50) ⬍.001
Attitudes
Comfort level for carrying out PCC’s
recommendations, range⫺2 to⫹2, Mean [SD]
0.48 [1.15] 0.67 [1.30] 0.52 [1.18] 0.33 [1.23]
Comfort level for talking with PCC staff, range⫺2 to⫹2, Mean [SD]
0.93 [1.15] 1.25 [1.08] 0.97 [1.14] 0.90 [1.15]
Likelihood the PCC will report for neglect (reverse scoring), range⫺2 to⫹2, Mean [SD]
0.05 [1.22] 0.66 [1.52] 0.23 [1.33] 0.13 [1.29]
Total Attitude Score,⫺6 to⫹6, (analyzed by individual), mean [SD]
1.46 [2.24] 2.57 [2.80] 1.72 [2.55] 1.36 [2.65] 1.47 (0.95–1.99) ⬍.001
Total Attitude Score,⫺6 to⫹6, (analyzed by class), mean [SD]
1.59 [1.20] 2.87 [1.44] 2.02 [1.35] 1.61 [1.70] 1.63 (1.01–2.26) ⬍.001
Behaviors
Has PCC phone number at home (% “yes”) 32 82 38 33
Has syrup of ipecac at home (% “yes”) 19 23 26 26
Total Behavior Score (analyzed by individual) (number yes, 0–2), mean [SD]
0.50 [0.73] 1.05 [0.64] 0.64 [0.80] 0.59 [0.78] 0.59 (0.47–0.72) ⬍.001
Total Behavior Score (analyzed by class) (number yes, 0–2), mean [SD]
0.51 [0.38] 1.10 [0.24] 0.67 [0.47] 0.62 [0.42] 0.65 (0.49–0.80) ⬍.001
Behavioral Intent Scenarios
Household bleach (% who would call PCC) 30 70 37 33
Anti-hypertensive (% who would call PCC) 30 62 35 26
Household plant (% who would call PCC) 33 66 35 40
Cough syrup (% who would call PCC) 23 61 30 28
“Something poisonous” (% who would call PCC) 52 68 60 60
“Something poisonous” and mother speaks Spanish (% who would call PCC)
27 66 33 28
Cut on rock and bleeding (% who would NOT call PCC)
96 95 99 100
Choking on candy (% who would NOT call PCC) 97 92 99 97
Total Behavioral Intent Score (analyzed by individual) (number correct, 0–8), mean [SD]
3.88 [1.67]* 5.79 [2.04] 4.28 [1.80]* 4.11 [1.86] 2.09 (1.70–2.48) ⬍.001
Total Behavioral Intent Score (analyzed by class) (number correct, 0–8), mean [SD]
3.91 [0.44] 5.93 [0.84] 4.32 [0.84] 4.16 [1.10] 2.17 (1.70–2.65) ⬍.001
group participants were able to give the correct phone number to the interviewer at posttest, com-pared with only 19% of control group participants (P⬍.001).
Changes in Behavioral Intent
For the 8 emergency scenarios, the treatment group significantly increased their correct responses by⬃2 answers more than the control group. For all the poisoning scenarios (except the situation in which a mother believes her child has eaten “some-thing poisonous”), at least twice as many treatment group participants answered correctly at posttest compared with baseline.
To check the validity of our assumption of no nonzero correlation of responses within groups, we repeated the same outcome analyses with class as the unit of analysis (treatment,N⫽20; control,N⫽23). The effect size estimates (differences between groups) were similar with slightly wider confidence intervals (CIs), as would be expected for the smaller sample size, but all treatment versus control differ-ences remained statistically significant at P ⬍ .001 (Table 2). Therefore, our assumption proved correct and the conclusions are the same for both analyses. Secondary Analyses
Analyses were repeated including demographic variables as covariates, to adjust for potential differ-ences between groups. The results did not change when gender, education, language in which class was conducted, and language spoken at home were included as covariates. For knowledge, the mean change score was 1.03 (95% CI: 0.73- 1.33). The mean change score for attitudes was 1.59 (95% CI: 1.05– 2.13). For behaviors, the mean change score was 0.57 (95% CI: 0.44 – 0.70), and for behavioral intent scenar-ios, the mean change score was 2.13 (95% CI: 1.72– 2.54). These differences all remained statistically sig-nificant atP ⬍.001.
DISCUSSION
This study demonstrates that a brief videotape-based intervention can improve knowledge, atti-tudes, behaviors, and behavioral intentions regard-ing use of the PCC among low-income and Spanish-speaking parents. Previous studies indicated that low-income and Spanish-speaking parents in an ur-ban Texas community may have been underusing the poison center for unintentional poisoning inci-dents involving children because of lack of knowl-edge of the PCC, misperceptions about the qualifica-tions of the staff and accessibility for those not speaking English, fear of perceived neglect, and in-security in carrying out the PCC’s recommenda-tions.7,8 Baseline data obtained from the current
study showed low-income parents in Northern Cal-ifornia also have little knowledge about the center. At baseline, less than half of participants in both groups stated that they knew about the PCC and only about one-third stated that they had the phone number at their home. However, after receiving the intervention, significant increases were found in par-ents’ knowledge, attitudes, behaviors, and
behav-ioral intentions concerning the PCC when compared with the control group. Having basic knowledge about the existence of the center and its functions obviously is essential to making a decision to use it. There tended to be only minimal improvement for the question concerning the use of syrup of ipecac. Syrup of ipecac was not discussed in the video, but was described in the pamphlet that was given to video viewers only. This question was intended to help us determine whether watching the video mo-tivated parents to read the pamphlet that was given to them. Our findings suggest that parents may not have read the pamphlet, or that the pamphlet was less effective for improving knowledge. Because of the low literacy level of our participants, we believe the more likely explanation is the parents did not or could not read the pamphlet. This was one of the reasons we chose the video medium for our inter-vention.
Parents’ self-reported attitudes also were changed by the intervention. Those who viewed the video were more likely to feel comfortable talking with someone at the PCC and following their recommen-dations, and were less likely to believe the center would report a mother for neglect compared with parents who did not view the video. In a previous study, these were specific issues raised by parents as contributing to under-utilization of the PCC.8
Ac-cording to the Theory of Reasoned Action, the strength of a person’s intent to perform a health behavior is related in part to his/her attitudes to-ward that health behavior.10In addition, the Health
Belief Model proposes that to effect a behavior change, one must believe the benefits of the behavior change outweigh any barriers.11Thus, if a parent has
a positive attitude concerning a potential interaction with the PCC, the likelihood of that parent calling the center for help may be increased.
In terms of actual behavior change, we found the treatment group had a remarkable improvement in the number of parents who reported to have the PCC number posted at home compared with the video group (82% vs 33%) after the intervention. We were able to verify this by asking the parent to read the phone number back to the interviewer. A signifi-cantly greater number of parents in the treatment group gave the correct phone number compared with the control group (63% vs 19%,P⬍.001). This finding shows that the intervention was successful in eliciting true behavior change. Parents in the treat-ment group were given a PCC sticker displaying the toll-free number at the end of the class session. Thus, parents who were able to correctly provide the inter-viewer with the number had most likely placed the sticker somewhere convenient to the telephone as they were instructed. This is potentially a very im-portant behavior, because the likelihood that a par-ent will call the PCC in the evpar-ent of a poisoning emergency should be increased if the phone number is readily available.
have had to learn about syrup of ipecac by reading the pamphlet, and also would have had to purchase it. Cost and insufficient time to obtain syrup of ipecac may have been barriers for this low-income group of parents.
In evaluating responses to the poisoning scenarios, we found a dramatic difference between groups after the intervention. Video viewers increased their num-ber of correct responses an average of⬎2 of 8 total, compared with the control group participants. For 4 of 6 poisoning scenarios, there were twice as many participants in the treatment group who answered correctly to “Call the Poison Control Center” at post-test compared with the control group. At baseline, just over half of both groups reported that one should call the PCC for “something poisonous,” and thus, there was relatively less room for improvement for this question. It seems the video also successfully clarifies that the PCC can effectively communicate with persons speaking languages other than English, as illustrated by the increase in correct answers for the scenario involving ‘‘something poisonous“ and the mother only speaks Spanish. In addition, parents were able to generalize the information presented in the video scenarios (involving bleach and an anti-hypertensive medication) to other potential poison-ing situations (household plant and over-the-counter cough syrup).
As measures of behavioral intent, results from the hypothetical scenario questions are expected to pre-dict whether or not a parent will actually use the PCC in the event of a poisoning emergency.10
How-ever, a much larger sample size and much longer study would be required to assess actual PCC use.
Despite randomization, there were some minor demographic differences between the treatment and control groups. The control group included more participants who were male, bilingual, or English-speaking, and had a higher mean educational level than the treatment group. We addressed this poten-tial imbalance by performing a secondary analysis, including these variables as covariates. The results did not change when adjusting for these baseline differences in demographic variables. Baseline be-havioral intent scores were also significantly differ-ent between control and treatmdiffer-ent groups. Interest-ingly, the control group had a slightly higher mean baseline score than the treatment group. However, the large improvements in the treatment group dwarfed these baseline differences, and argue against regression to the mean, scaling, and other potential alternative explanations of our findings.
One of the important strengths of our study is its potential generalizability. We wanted to test our in-tervention just as it would be used in the community. We selected WIC as the setting because it serves predominantly a low-income and lower-literate pop-ulation and clients are required to periodically attend educational classes. Our intervention was substi-tuted into WIC’s existing educational curriculum during the study period with minimal disruption to the clinic. The randomized, clinical trial design and the conservative intention-to-treat analysis provide
strong internal validity for the study, and thus, the ability to confidently attribute the observed changes to the intervention.
CONCLUSION
This brief and relatively low-cost video interven-tion was highly effective in changing knowledge, attitudes, actual behaviors, and behavioral intentions concerning the PCC within this low-income and pdominantly Spanish-speaking population. These re-sults suggest that this intervention approach may be effective if used nationwide in WIC, Head Start, and other programs and/or agencies that have contact with parents and caregivers of young children. We believe these are important steps toward the ultimate goal of increasing appropriate use of the PCC and decreasing unnecessary medical facility visits for mi-nor poisoning incidents.
ACKNOWLEDGMENTS
This study was supported by the Child Health Research Fund at Stanford University School of Medicine and by a gift from the California Poison Control System, San Francisco Division.
We thank the following organizations who funded the produc-tion of the videotape, “Making the Right Call: The Poison Control Center”: Southeast Texas Poison Center, Texas Advisory Commis-sion on State Emergency Communications, Texas Department of Health and Baylor College of Medicine. This video may be pur-chased by contacting the first author at the following address: Nancy R. Kelly, MD, MPH, Texas Children’s Hospital, 6621 Fan-nin St, Suite 1540, Mail Code 1540.00, Houston, TX 77030.
We also thank Jennifer R. Najera, MA, and Elise Stone, MS, CHES, for their significant contributions to this project. We greatly appreciate the Redwood City and San Mateo WIC clinics’ staff and clients for making this study possible.
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DOI: 10.1542/peds.111.1.21
2003;111;21
Pediatrics
Nancy R. Kelly, Lynne C. Huffman, Fernando S. Mendoza and Thomas N. Robinson
and Spanish-Speaking Families: A Randomized, Controlled Trial
Effects of a Videotape to Increase Use of Poison Control Centers by Low-Income
Services
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DOI: 10.1542/peds.111.1.21
2003;111;21
Pediatrics
Nancy R. Kelly, Lynne C. Huffman, Fernando S. Mendoza and Thomas N. Robinson
and Spanish-Speaking Families: A Randomized, Controlled Trial
Effects of a Videotape to Increase Use of Poison Control Centers by Low-Income
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