Increasing Pediatric Primary Care Provider Willingness to Use VOMS: A Theory of Planned Behavior Approach

Abstract

Background: Concussions are common among the pediatric population and can cause a myriad of symptoms including vision and vestibular deficits. Even with the high occurrence of pediatric concussions, vestibular-ocular assessments are not routinely used in many primary care settings during post-concussion management. The Vestibular/Ocular Motor Screening (VOMS) is a brief, low-resource assessment tool that can inform clinical decision making during post-concussion follow-up visits.Purpose: The purpose of this project was to determine whether a brief Theory of Planned Behavior (TPB) informed educational session would increase pediatric primary care providers’ intentions to use the VOMS tool. Methods: This single-site quality improvement project was conducted in a pediatric primary care clinic. A 30–45-minute educational session covered VOMS indications, administration, scoring, and interpretation. The participants received a quick guide, PowerPoint handout, detailed instructions and VOMS scoring sheet. Three providers completed pre- and post- education Likert surveys that included questions regarding comfort, familiarity, and confidence with VOMS. Content relevancy and intention to use VOMS were included in the post survey. Wilcoxon signed-ranks tests were used, with effect sizes calculated r as |Z| √N where N is the number of non-zero pairs. Analyses were performed in SPSS, with the effect sizes computed in Excel. Results: All outcomes moved in the desired direction. Comfort increased from M = 1.33 (SD = 0.58) to 3.67 (0.58), Z = -1.63, p = .102, r ≈ .94. Familiarity increased from 2.00 (0.00) to 3.67 (0.58), Z = -1.63, P = .102, r ≈ .94. Confidence increased from 3.00 (0.00) to 4.00 (1.00) with two improvements and one tie, Z = -1.34, p = .180, r ≈ .95. (nonzero pairs N = 2). Given the very small sample, tests were under-powered and non-significant (two-tailed p > .05), but all changes were concordant with large effect sizes. Post-session items showed high perceived relevance (Mdn = 5, M = 5.00; 100% “Strongly agree”) and high intention to apply VOMS (Mdn = 5; M = 4.67; 66.7% “Strongly agree”, 33.3% “Agree”). No negative ranks were observed. Conclusions: A brief, TPB-informed education was feasible, acceptable, and produced large, consistent improvements in determinants of VOMS use in a small sample. Immediate practice implications include maintaining VOMS reference materials and aids, maintaining a clinic VOMS champion, and adding EHR documentation fields to support documentation and fidelity. Future work should expand the sample, use exact nonparametric tests, explicitly measure TPB determinant of subjective norm, and track provider adoption of VOMS into their workflows.