Objectives: The aim of this study was to evaluate the relationship of physicians' awareness and attitude with their practice behaviour to use the recommended wait and watch approach in the treatment of selected acute otitis media cases.

Methods: A cross-sectional survey of primary care physicians was conducted from May to Jul 2008 in the Houston metropolitan area, Texas, USA.

Key findings: Approximately 80% of the respondents (total, n = 89) were reportedly familiar with the recommendation to use the wait and watch approach.  Most of the physicians agreed (82%) with the guideline, finding the recommendations reasonable and were comfortable (76%) using the approach.  In children younger than 2 years and 2 years or older, respectively, 41% and 70% of physicians reported using this approach for at least sometimes.  Greater awareness was found to be correlated with positive attitude (r = 0.45, P less than 0.001) and increased behaviour to use the approach in children aged 2 years or older (r = 0.46, P less than 0.001).  Statistically significant association of physicians' awareness and attitude with the behaviour to use the approach was found in children aged 2 years or older in multiple linear regression analysis.  In general, physicians' attitude showed relatively stronger relationship with the behaviour.

Conclusions: Awareness and attitude among primary care physicians were positively associated with the behaviour towards the use of the wait and watch approach in the management of selected cases of acute otitis media.  Incorporating greater emphasis on improving physicians' attitude in educational efforts to promote use of this non-antibiotic approach should be the direction for future intervention research.