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Orientation to community in a family practice residency program.

BACKGROUND: Family practice residencies are expected to include opportunities for trainees to learn about population-based approaches to health care delivery. METHODS: To prepare them for community projects later in training, first-year residents were introduced to a community-oriented primary care (COPC) curriculum by an interdisciplinary team with representatives from public health and academic family medicine. During their mid-year orientation month, the residents spent three afternoons in community settings, each year focusing on a different public health issue. The residents spent the first afternoon discussing principles of community medicine, the COPC model, and planning community interviews. The second afternoon, they interviewed in the community. The residents reported and evaluated on the third afternoon. RESULTS: During the 3 years described, most residents participated with enthusiasm, later reporting increased awareness and use of community resources. However, months after the third experience, a comparison of clinic records before and after the orientation showed no difference in the residents' inclusion of the health issue studied in managing their patients, although social workers and other non-physician faculty team members reported that residents consulted them more frequently following the community orientation. CONCLUSIONS: It is important to provide residents with an efficiently designed and attractive community orientation early in training. An interdisciplinary team should plan and coordinate their experiences, but all faculty should role model good community behavior. Although the 1996 residents described behavioral changes following this brief orientation, this was not documented by a chart review.

Adolescent↗

Oral health knowledge, attitude and practices of primary school teachers in Lagos State.

School teachers are known to exert considerable influence on their pupils and to an extent on the larger community. They have however been shown to have a disappointingly poor knowledge of oral health and disease. This study sought to assess the knowledge, attitude and practices of primary school teachers in Lagos State, Nigeria. A cross-sectional, questionnaire-based survey was carried out on 100 primary school teachers drawn from 10 randomly-selected primary schools in Lagos State. The results revealed that majority of them have a poor attitude to oral health issues. The few of them who have attended a dental clinic mostly had extractions done. It was also found that there is a need for improved knowledge of oral health disease and their prevention among the teachers for an effective school based oral health education programme. The paper suggests ways in which this can be achieved.

Adolescent↗

Knowledge, attitudes, treatment practices, and health behaviors of nurses regarding blood cholesterol and cardiovascular disease.

Knowledge, attitudes, and practice patterns concerning cholesterol and heart disease were evaluated in a stratified, random sample of 206 registered nurses at a major academic medical center in New York City. Virtually all nurses were convinced of the importance of diet in reducing heart disease risk, and most (78%) agreed that nutrition counseling should be their responsibility. Although only 19% reported that they were currently counseling, many more felt prepared to counsel about diet or drug therapy (43%). Nurses who were likely to counsel were those working in general medicine, those who were certified nurse practitioners, those who knew their own blood cholesterol level, and those with higher knowledge scores. Level of overall knowledge was associated with the practice of counseling, an attitude that counseling should be a nurse's responsibility, and personal health behavior (knew own level), regardless of age or occupational or degree status. Despite their enthusiasm for heart disease prevention through diet modification, many nurses had substantial knowledge gaps, suggesting that nurses are currently not adequately prepared to counsel about diet and/or drug treatment for high blood cholesterol. Educational strategies and considerations in integrating an expanded role for nurses with those of physicians and dietitians are discussed.

Academic Medical Centers↗

Female genital mutilation knowledge, attitudes and training needs among health professionals in non-practicing countries: A literature review.

BACKGROUND: With increasing globalization and migration, the number of women affected by female genital mutilation who reside in countries where the practice is not traditionally performed is constantly increasing. Healthcare providers in these settings are required to address the complex health needs of this vulnerable population. We aimed to synthesize recent literature on their knowledge, preparedness, and educational background. METHODS: We conducted a systematic review across PubMed, Scopus and Embase, identifying papers published from January 2015 onwards, examining providers' knowledge, education and attitudes toward female genital mutilation in non-practicing countries. Both quantitative and qualitative observational studies were eligible. Given heterogeneity in study populations, outcome definitions, and assessment tools, findings were synthesized narratively. The review protocol was registered with the International Prospective Register of Systematic Reviews (CRD420251044761). FINDINGS: 1046 records were screened by title and abstract, and 140 full-text articles were assessed for eligibility. 31 studies met the inclusion criteria (23 quantitative, 8 qualitative). Many providers reported clinical experience with women affected by female genital mutilation, yet substantial variability was observed in knowledge, training, and attitudes. Gaps were particularly evident regarding legislation, World Health Organization classification, clinical guidelines, referral pathways, workplace protocols. Midwives and younger professionals tended to demonstrate higher knowledge levels. Training exposure ranged from 5% to 91%, and many participants perceived it as insufficient. Qualitative findings echoed these patterns, highlighting challenges in female genital mutilation classification, legal awareness, documentation systems, the impact of providers' cultural beliefs on care delivery. CONCLUSION: Considerable efforts are needed to equip healthcare providers to deliver high-quality, culturally competent care to women affected by female genital mutilation. Research should develop validated tools to assess preparedness, adopt mixed-methods strategies to capture patient and provider perspectives, and guide standardized, up-to-date training programs, strengthening knowledge in managing female genital mutilation.

Humans↗

Travel health knowledge, attitudes and practices among Australasian travelers.

BACKGROUND: Although the Asia Pacific region is the focus of the fastest-growing tourist and travel industry, few data are available on the knowledge, attitudes and practices (KAP) of travelers from this region with regard to travel-related infectious diseases. METHODS: We conducted a cross-sectional survey among travelers at the departure lounges of five airports in Australasia (Singapore, Kuala Lumpur, Taipeh, Melbourne, Seoul) whose travel destinations were Asia, Africa or South America. Two standardized questionnaires directed towards KAP in travel health, travel immunizations and malaria were administered. RESULTS: Of 2,101 respondents (82% Asian, 17% Western), 31% had sought pretravel health advice and only 4% sought travel health advice from the travel medicine specialist. The risk of vaccine-preventable infectious diseases and malaria at the destination country was perceived to be low. Overall, fewer than 5% of travelers had been vaccinated in preparation for their trip. The most frequent travel vaccinations were for hepatitis A and B. Only 40% of travelers to malaria-endemic areas carried malaria prophylaxis. Compared to Western travelers, those of Asian nationality were significantly less likely to obtain pretravel advice and malaria prophylaxis and to receive travel vaccinations. CONCLUSION: There is an urgent need for increased awareness about travel-related infectious diseases among Asian travelers, and greater uptake of pretravel health advice, vaccinations and malaria prophylactic measures.

Adult↗

Preconception care: who needs it, who wants it, and how should it be provided?

BACKGROUND: Preconception care (PC) aims to identify and reduce a number of modifiable factors that can adversely affect pregnancy outcome. AIM: To ascertain both knowledge of the attitudes towards PC among members of primary health care teams (PHCTs) and registered women of childbearing age in a representative sample of general practices in Harrow. METHOD: A questionnaire survey was conducted in a randomly selected group of nine general practices in the London borough of Harrow. Subjects included all relevant health professionals and female patients of childbearing age registered with the practices. RESULTS: A total of 62/88 (70.5%) health professionals and 811 women (1 in 20 of the entire target population) completed the questionnaires. Nurses' knowledge matched that of the doctors, except in the area of genetics. Over 85% of all health professionals believed that PC could be of benefit to both mother and baby. Women were generally well informed; Asian women, those born outside the UK, those who had never been pregnant, and those who had not undertaken education beyond the age of 18 years were significantly less well informed. Health professionals considered PC to be best delivered opportunistically by nurses, and this method appeared to be acceptable to most female patients of childbearing age, although it was significantly less acceptable among Asians. CONCLUSION: Among health professionals and women of childbearing age, there is generally a good level of knowledge of PC, although certain groups are less well informed than others and could benefit from a targeted education approach. Widespread agreement that PC is worthwhile was found among PHCT members, but this view is less strongly held by the female public, with the acceptability of providing PC opportunistically differing significantly between ethnic groups.

Adolescent↗

[Knowledge, attitude and practices of health personnel with regard to HIV/AIDS in Tamatave (Madagascar)].

BACKGROUND: Health care workers are key players in the prevention and management of HIV-infection. We surveyed HIV/AIDS-related knowledge, attitudes and practices of health care workers in Tamatave (Madagascar), to assess the feasibility of voluntary counselling and testing for HIV infection in antenatal care. MATERIALS AND METHOD: A Knowledge Attitude and Practice study was conducted during July 2000 in the antenatal health care centres and the hospital of Tamatave. The health workers completed a self-administrated questionnaire on HIV transmission, attitudes and practices regarding AIDS testing and counselling, HIV risk perception and attitudes regarding patients with HIV disease. RESULTS: A 90% response rate was obtained, with completed questionnaires from 45 health care workers. The sample included physicians, midwives, nurses, medical students and nursing auxiliaries. Scientific knowledge about transmissibility of HIV infection was poor: transmission was believed possible by living together without having sex (7%), by breastfeeding a HIV-positive child (9%), by using toilets after a HIV-positive patient (13%) and by blood donation (76%). 73% of the health staff believed a child born of an HIV-positive woman would systematically be infected and interventions to reduce this risk were unknown. Sixty one per cent of the health-workers reported never having advised patients to be tested and less then 10% mentioned correct counselling precautions. Seventy nine percent believed that they were at risk of acquiring AIDS, mainly through occupational exposure. Negative attitudes towards HIV-positive patients were also noted: twenty per cent of the health workers mentioned that AIDS patients should be isolated in quarantine. Physicians and paramedical staff differed only in their better knowledge about transmissibility of HIV. Physicians had the same restrictive attitude towards patients with HIV as paramedical health workers and did not differ by their counselling practice. CONCLUSIONS: Our study revealed gaps in the knowledge of health care workers about HIV infection. Before implementing voluntary counselling and testing in antenatal care, additional HIV/AIDS training for health staff seems necessary.

AIDS Serodiagnosis↗

Mental health-related knowledge, attitudes and practices in two kibbutzim.

BACKGROUND: This study explored mental health-related knowledge, attitudes and practices (KAP) in two kibbutzim (collective villages). These kibbutzim share many features, e. g., history, origin of the population, community institutions, and political affiliation. They differ, however, in that one of them keeps fully the collectivist ideology, while the other is undergoing privatization; this is a process that may loosen the solidarity on which the kibbutz movement was conceived. METHODS: A brief self-administered questionnaire exploring KAP within the kibbutz context was completed anonymously by 108 members in one kibbutz and 90 in the other. Univariate and multivariate methods of analyses were applied. RESULTS: Mental health literacy was high, 75% endorsed a multifactorial causation of mental disorders, and 79% thought that they were treatable. The definition of what constitutes a mental disorder, however, was limited, 43% for psychosis and 10% for depression. Kibbutz members held contrasting attitudes toward members with mental disorders; while the majority supported their social integration, 85% stated that their access to the commune's highest offices would be denied. The kibbutz would provide financial support more often to a member with cancer, 94%, than to one with depression, 81%. Attitudes towards outsiders were more negative, 68% stated that the kibbutz would refuse membership to an applicant that recovered from a mental illness. Use of mental health services was high, with a lifetime rate in the total sample of 38%. CONCLUSION: The mental health KAP among these kibbutz members have not developed in parallel. While the attitudes are mixed at best, knowledge and practice are more positive. Since the kibbutz strives to be an egalitarian society and the members are highly educated, the study of this collective may suggest the possible KAP ceiling in the general society. The privatization process initiated in one of the kibbutzim has not affected the KAP, but the process is too novel to assess its impact.

Attitude to Health↗

Direct observation of smoking cessation activities in primary care practice.

OBJECTIVE: Our goals were to determine how often family physicians incorporate smoking cessation efforts into routine office visits and to examine the effect of patient, physician, and office characteristics on the frequency of these efforts. STUDY DESIGN: Data was gathered using direct observation of physician-patient encounters, a survey of physicians, and an on-site examination of office systems for supporting smoking cessation. POPULATION: We included patients seen for routine office visits in 38 primary care physician practices. OUTCOMES MEASURED: The frequency of tobacco discussions among all patients, the extent of these discussions among smokers, and the presence of tobacco-related systems and policies in physicians' offices were measured. RESULTS: Tobacco was discussed during 633 of 2963 encounters (21%; range among practices = 0%-90%). Discussion of tobacco was more common in the 58% of practices that had standard forms for recording smoking status (26% vs 16%; P=.01). Tobacco discussions were more common during new patient visits but occurred less often with older patients and among physicians in practice more than 10 years. Of 244 smokers identified, physicians provided assistance with smoking cessation for 38% (range among practices = 0%-100%). Bupropion and nicotine-replacement therapy were discussed with smokers in 31% and 17% of encounters, respectively. Although 68% of offices had smoking cessation materials for patients, few recorded tobacco use in the "vital signs" section of the patient history or assigned smoking-related tasks to nonphysician personnel. CONCLUSIONS: Smoking cessation practices vary widely in primary care offices. Strategies are needed to assist physicians with incorporating systematic approaches to maximize smoking cessation rates.

Adult↗

Understanding our patients. An anthropological approach.

OBJECTIVE: To provide an accurate description of the views of a suburban population on health, disease and its causes and the provision of medical and other forms of care. A specific purpose of this paper is to draw attention to the relevance of this research methodology and its similarity to general practice. METHOD: An ethnographic study. A discrete Australian coastal suburb with a broad socio-demographic mix. RESULTS: The health beliefs of the population and their views on the delivery of care are briefly summarised. A fuller report is available from the General Practice Evaluation Program--Grant No. 275. CONCLUSIONS: The application of ethnographic methods of Australian suburbia provides new, valid and reliable information which is needed if the health messages and care provided to people are to be relevant.

Anthropology, Cultural↗

Views on respiratory tract symptoms and antibiotics of Dutch general practitioners, practice staff and patients.

OBJECTIVES: To explore views on respiratory tract symptoms (cough, sore throat and earache) and antibiotics of GPs, practice staff, and patients. METHODS: In a nationwide study, 181 GPs, 204 practice staff members and 1250 patients from 90 practices participated by answering 14 items relating to views on respiratory tract symptoms and antibiotics in a written questionnaire. Differences in means were compared. RESULTS: Patients more than GPs endorsed the seriousness of respiratory tract symptoms, the need to consult a GP, the need to prescribe antibiotics, and the ability of antibiotics to speed up recovery. GPs were more than patients convinced of the self-limiting character of respiratory tract symptoms and of the fact that antibiotics have side effects. Practice staff took a middle ground in most of these views. CONCLUSIONS: Differences between GPs, practice staff and patients must be taken into account when exploring patients' complaints and advising on treatment. Education and knowledge programmes for practice staff might be advocated.

Adult↗

Cervical screening among immigrant Vietnamese women seen in general practice: current rates, predictors and potential recruitment strategies.

OBJECTIVE: To ascertain cervical screening rates among Vietnamese women attending Vietnamese-speaking general practitioners (GPs) in Sydney, their recall of opportunistic recruitment by these GPs and their preferences for strategies to encourage screening. METHOD: Women born in Vietnam aged 18-69 years were recruited through the waiting room of their GP and completed questionnaires in either Vietnamese or Chinese before and after their consultation. RESULTS: Of 355 women seen during the survey period, 170 were ineligible. Of those eligible, 118 women (64% response rate) completed waiting room questionnaires. Of 86 women 'at risk', 56 (65%) reported having a cervical smear within two years or due on that day; 26 (86%) of those 30 women overdue for screening reported visiting a GP at least twice in the past six months. After adjustment for age and education, women who were more acculturated or had resided in Australia for the most years remained significantly more likely to be screened (p = 0.027 and p = 0.037 respectively). In the follow-up questionnaire, returned by 49 women (52%) who agreed to receive it, recall of opportunistic advice from the GP was low. Female GPs, free screening and more information in Vietnamese were the three most popular recruitment strategies. CONCLUSION: Study confirms low participation rates in cervical screening by Vietnamese women using self-report. Recent immigrants and the least acculturated are least likely to be screened. IMPLICATIONS: A community-based strategy involving Vietnamese-speaking GPs shows promise, inviting behavioural evaluation.

Adolescent↗

Oral health profile of schoolchildren, mothers and schoolteachers in Zanzibar.

OBJECTIVE: To analyse oral health status and oral health practices of schoolchildren in Zanzibar, to assess oral health knowledge, attitudes and practices of the mothers, and to describe knowledge and attitudes of schoolteachers in relation to oral health education of children. DESIGN: Cross-sectional surveys of standards 1 and 5 children and their mothers were carried out based on the WHO pathfinder principle. The children were clinically examined and the mothers responded to personal interviews. Self-administered questionnaires were used to collect information on a convenience sample of schoolteachers. SETTING: The surveys were conducted to aid the planning and evaluation of school-based oral health promotion in Zanzibar. SUBJECTS: Two hundred and fifty-nine standard 1 and 226 standard 5 children participated in the survey; the sample was balanced by gender and degree of urbanisation. A total of 455 mothers (92% of original sample) and 123 schoolteachers (100% of sample) were included. OUTCOME MEASURES: For children, dental caries experience (dmft/DMFT) and CPI were recorded. For mothers, knowledge about causes and prevention of dental disease, dental attitudes and oral health behaviour were ascertained. For teachers, dental knowledge and attitudes to health education were investigated. RESULTS AND CONCLUSIONS: The mean caries experiences were 2.1 dmft (standard 1) and 0.7 DMFT (standard 5) and the prevalence was higher in urban than in rural areas. Daily toothcleaning was reported for 59% of the children and 67% of the mothers. The use of traditional Miswaki was frequent in rural areas whereas toothbrushes were common in urban areas. The level of knowledge was similar for mothers and teachers. Training in oral health topics is needed for schoolteachers to provide for school-based health education of children.

Attitude to Health↗

A community-based program for cardiovascular health awareness.

OBJECTIVE: The objective of the Cardiovascular Health Awareness Program (CHAP) is to improve the processes of care related to the cardiovascular health of older adults. PARTICIPANTS: Two Ontario communities including family physicians (FP), pharmacists, public health units and nurses, volunteer peer health educators, older adult patients and community organizations. SETTING: Community pharmacies and family physician offices. INTERVENTION: CHAP is designed to close a process of care loop around cardiovascular health awareness that originates from, and returns to, the FP. Older patients are invited by their FP to attend pharmacy CHAP sessions. At these sessions, trained volunteer peer health educators (PHEs) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile. This information is relayed to their respective FP via an automated computerized database. Pharmacists and patients receive copies of the results. Based on these cumulative risk profiles, patients are advised to follow-up with their FP. OUTCOMES: Of the FPs and pharmacists asked, 47% and 79%, respectively, agreed to participate in the project. 39% of older adult patients invited by their FPs attended the CHAP community pharmacy sessions. Of these, 100% agreed to having their risk profile, including their blood pressure readings, forwarded to their FP. Positive feedback about CHAP was expressed by the volunteer PHEs, the FPs and the pharmacists. CONCLUSION: The community-based pharmacy CHAP sessions are a feasible way of improving patient, physician, and pharmacist access to reliable blood pressure measurements and to cardiovascular health information. A randomized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure.

Attitude of Health Personnel↗

Preventive care in Canterbury general practice.

AIMS: To describe the preventive care attitudes, beliefs, priorities and systems of Canterbury general practitioners, to compare their beliefs about appropriate care with evidence-based guidelines and to investigate possible associations between preventive care beliefs and attitudes, and selected practitioner variables. METHOD: A questionnaire was mailed to all 375 general practitioners in Canterbury, with a response rate of 70%. RESULTS: Respondents expressed positive attitudes to preventive care, their views about appropriate care corresponding well to United States Preventive Services Task Force recommendations. The responses of practitioners who had qualified more recently were closer to the recommendations, with these practitioners more likely to want to carry out more preventive care. Membership of an independent practice association or the Royal New Zealand College of General Practitioners was associated with more positive attitudes to preventive care and with believing more interventions to be appropriate. Relatively few preventive interventions appeared to be offered to patients in a systematic way. CONCLUSIONS: Canterbury general practitioners were well-informed about, and interested in carrying out, more preventive care. Preventive care delivery could be enhanced in many practices by the adoption of a more systematic approach.

Attitude of Health Personnel↗