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PubMed1998

Rural health-care providers' attitudes, practices, and training experience regarding intimate partner violence--West Virginia, March 1997.

Primary health-care providers are an important resource to women who have experienced intimate partner violence (IPV). IPV patients in rural areas often face obstacles to preventive services such as physical isolation from health care and a lack of adequate community services. In March 1997, a pilot project was conducted to survey the attitudes and practices of rural health-care providers (RHCPs) toward women at risk for IPV in primary-care clinics in West Virginia and to determine the training experience of RHCPs in IPV intervention and prevention during the preceding 2 years. This report summarizes the results of the survey, which indicate that most RHCPs recognized barriers to identification and referral of abused women in their practices but few screened female patients for IPV or have had recent continuing education on IPV.

Adult↗
PubMedDate not supplied

Knowledge, attitude, and practice of female health professionals regarding cervical cancer and Pap smear.

BACKGROUND: The objectives of this paper was to determine what female health professionals knew and felt about cervical cancer and Pap smear and their uptake of Pap smear. METHODS: A questionnaire survey of 144 female health professionals at two referral hospitals with facilities for Pap smear. RESULTS: Nurses constituted 52.8% of respondents followed by laboratory scientists (18.8%), doctors (14.6%) and pharmacists (13.9%). One hundred and thirty two (91.7%) respondents had heard of cervical cancer and 80.6% knew it was associated with vaginal bleeding. Twenty two percent could not list any risk factor A significantly greater proportion of doctors (100%) knew the purpose of a Pap smear compared to 59.2% of nurses, 50% of pharmacisits and 48.1% of laboratory scientists (p = 0.003). Only 13 respondents (9%) had everhad a Pap smear with doctors (p = 0.003) and divorced/separated women (p = 0.005) significantly more likely to have done so. Perceived non-availability of Pap smearservice was the main reason (51.3%) for not having had a Pap smear. However, 30.3% had not thought of it or did not consider themselves at risk of cervical cancer. CONCLUSION: Health professionals themselves need to be properly informed about cervical cancer and Pap smears because of their own needs as women and also to improve their effectiveness in educating and encouraging other women to have Pap smears. Available Pap smear services should be publicized and made more affordable.

Adult↗
PubMed2001

Second dose of measles, mumps, and rubella vaccine: questionnaire survey of health professionals.

OBJECTIVE: To determine the knowledge, attitudes, and practices among health professionals regarding the measles, mumps, and rubella (MMR) vaccine, particularly the second dose. DESIGN: Self administered postal questionnaire survey. SETTING: North Wales Health Authority, 1998. PARTICIPANTS: 148 health visitors, 239 practice nurses, and 206 general practitioners. MAIN OUTCOME MEASURES: Respondents' views on MMR vaccination, including their views on the likelihood of an association with autism and Crohn's disease and on who is the best person to give advice to parents, whether they agree with the policy of a second dose of the vaccine, and how confident they are in explaining the rationale behind the second dose. RESULTS: Concerning the second dose of the vaccine, 48% of the professionals (220/460) had reservations and 3% (15) disagreed with the policy of giving it. Over half the professionals nominated health visitors as the best initial source of advice on the second vaccine. 61% of health visitors (86/140), compared with 46% of general practitioners (73/158), reported feeling very confident about explaining the rationale of a two dose schedule to a well informed parent, but only 20% (28/138) would unequivocally recommend the second dose to a wavering parent. 33% of the practice nurses (54/163) stated that the MMR vaccine was very likely or possibly associated with Crohn's disease and 27% (44/164) that it was associated with autism. Nearly a fifth of general practitioners (27/158) reported that they had not read the MMR section in the "green book," and 29% (44/152) reported that they had not received the Health Education Authority's factsheet on MMR immunisation. CONCLUSIONS: Knowledge and practice among health professionals regarding the second dose of the MMR vaccine vary widely. Many professionals are not aware of or do not use the good written resources that exist, though local educational initiatives could remedy this.

Autistic Disorder↗
PubMed2001

Cervical smears: comparison of knowledge and practice of a general practice sample with a high-risk group.

Successful cervical screening programmes depend on the participation of an informed target population. A national cervical screening programme is shortly to be introduced in the Republic of Ireland. We compare the knowledge, attitudes and practice of 395 Irish urban women with 323 high-risk women, genitourinary medicine (GUM) clinic attenders. There was little difference in knowledge between the 2 groups. Fifty-five per cent of the general practice (GP) sample and 45% of the GUM sample correctly identified the purpose of a smear. Eighty-three per cent of both groups had had at least one smear but only 59% of the high-risk group had had a smear before attending the GUM clinic. Both groups expressed a preference for a female provider. Socio-economic grouping is the strongest predictor of knowledge and uptake of cervical smears and high-risk women were less likely to have opportunistic cervical smears. Information programmes to encourage participation in screening programmes must build on pre-existing knowledge and focus on the relevance and acceptability of the test.

Adolescent↗
PubMed1999

Moles and melanomas--who's at risk, who knows, and who cares? A strategy to inform those at high risk.

BACKGROUND: Malignant melanoma is uncommon but potentially fatal. Knowledge and attitudes play an important part in the early detection of this skin cancer. AIM: To assess knowledge, risk perception, and intended behaviour related to melanoma compared with actual risk status. To suggest measures to improve the primary and secondary prevention of melanoma in general practice for a high-risk group. METHOD: A prospective questionnaire survey was carried out on consecutive adults attending in 16 randomly selected group practices. Applying MacKie's personal risk factor chart for melanoma, the study assessed self-reported risk, knowledge of skin cancer--especially malignant melanoma--and self-reported preventive activity. RESULTS: A total of 3105 (69%) attenders completed the questionnaire. The responders showed greater concern for minor rather than major clinical signs in pre-existing moles. Young people and the professional classes were the least knowledgeable about skin cancer and exhibited the most risky behaviour in terms of sun exposure, failure to check their skin, and to seek medical advice about new or changing moles. The majority of an 8.7% high-risk group showed lack of awareness of their increased risk, and women in this group reported the highest desire for a suntan and the use of sunbeds. In addition to showing less concern than their low risk counterparts about moles growing in size, they were also reluctant to seek medical advice about new moles. CONCLUSION: Consideration should be given to targeting primary prevention and selective screening in general practice towards a high-risk group for malignant melanoma. Young people and the professional social class should receive particular attention.

Adolescent↗
PubMed1995

The provision of family planning services by family doctors in a health board region.

A survey was carried out to ascertain the extent of family planning services provided by family doctors. Of the 134 doctors surveyed, 119 (88.8%) replied. Of these 97 (81.5%) were male, 30 (25.2%) were aged less than 40 and 22 (18.5%) were greater than 60. Sixty-four (53.8%) worked in single-handed practices, 52(43.7%) were vocationally trained, 101 (84.9%) had the MICGP or equivalent and 42 (35.3%) had a family planning certificate. Of the 119 respondents, 99 (83.2%) give instruction in natural family planning methods, 114 (95.8%) prescribe oral contraceptives, 102 (85.7%) prescribe the "morning after pill", 40 (33.6%) fit diaphragms and 17 (14.3%) fit intrauterine devices. Only 3 (2.5%) perform male sterilisations. Doctors aged less than 60 years were 1.3 times more likely to prescribe oral contraceptives (p < 0.0001), and were four times more likely to fit diaphragms (p < 0.01). Doctors who hold a family planning certificate were 2.4 times more likely to fit diaphragms (p < 0.001) and were 2.5 times more likely to fit intrauterine devices. As to who should provide these services, the family doctor was the preferred option for 95 (79.8%) with regard to natural family planning, 107 (89.9%) for the contraceptive pill, 76 (63.9%) for the diaphragm, 58 (48.7%) for the intrauterine device, 45 (37.8%) for male sterilisations and 4 (3.4%) for female sterilisations. Younger doctors and those with a family planning certificate were more likely to say that family doctors should provide these services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Changes in providers' views and practices about emergency contraception with education.

OBJECTIVE: To assess changes in the prescribing practices, knowledge, attitudes, and perceptions of health care providers after an educational program about emergency contraception. METHODS: Health care providers completed self-administered questionnaires before and 1 year after full implementation of the project. The 102 providers who completed both questionnaires were physicians (64%) and mid-level professionals from 13 San Diego County Kaiser Permanente medical offices working in departments such as obstetrics and gynecology, primary care, and emergency medicine. RESULTS: The frequency of prescription for emergency contraceptive pills increased significantly from baseline to follow-up. There was an increase of almost 20% in the percentage who prescribed emergency contraception at least once a year. Knowledge also improved significantly, and perceptions of barriers to prescribing emergency contraceptive pills within the health maintenance organization decreased significantly. In contrast, attitudes about emergency contraception showed little change. CONCLUSION: This study suggests that providers who participate in in-service training and other aspects of a demonstration project show changes in perceptions, knowledge, and behavior. However, findings also suggest that significant gaps remain in knowledge about medications, side effects, and mode of action. It is likely that many providers in other health care settings also need additional information and training concerning protocols of emergency contraception provision and its modes of action and effects.

Adult↗
PubMed2001

A qualitative study on detecting cancer symptoms and seeking medical help; an application of Andersen's model of total patient delay.

Patient delay is the interval between the day someone first becomes aware of an unexplained symptom and the day they seek medical consultation. This pre-diagnostic period is comprised of several stages which may involve delay on the part of the individual. This study investigated factors influencing the process of detecting cancer symptoms and consulting a general practitioner (GP). Twenty-three patients were interviewed about their experiences during this process. Among factors stimulating the process of detection and consultation were associating symptoms with cancer, and discussing symptoms with others. Being ashamed or embarrassed about the symptoms and attributing symptoms to common ailments were among the impeding factors. The findings of the present study suggest that future health education on early detection of cancer should focus on increasing knowledge and providing positive information about early detection of cancer. It is recommended that educational materials be disseminated to the general public via more channels, including non-medical channels.

Adult↗
PubMed2000

A survey of smoking cessation knowledge, training, and practice among U.S. Army general medical officers.

BACKGROUND: Historically, cigarette-smoking rates have been higher among military personnel than among civilians, although recently these rates have decreased. METHODS: In March 1997, a questionnaire assessing (1) training received on smoking cessation, (2) objective knowledge of smoking-cessation techniques, (3) frequency of practice habits, and (4) personal tobacco use among physicians, was successfully mailed to 232 of the total population of 279 Army general medical officers (GMOs). RESULTS: One-hundred-fifty (65%) GMOs returned questionnaires. Of these, 3.3% reported personal cigarette smoking, and 7.3% regularly used smokeless tobacco. During internship, few (13%) GMOs received smoking-cessation training. Primary care programs provided training more frequently than did surgery internship programs. The mean score on the objective knowledge portion was 72%. GMOs had a variable practice pattern in their use of smoking-cessation techniques (percent answering "usually" or "always"): helping patients set quit dates (35%), offering to prescribe the nicotine patch (59%), referring patients to a behavior-modification program (86%). Physicians who received training during internship were significantly more likely (p < 0.01) to help their patients set a quit date. Training did not result in a statistically increased frequency of other practice habits. CONCLUSIONS: GMOs received minimal training on smoking cessation during internship. GMOs refer patients to smoking-cessation classes, reflecting the strategy of the Army Health Promotion program. Strategies to increase the frequency that GMOs prescribe nicotine replacement and assist patients in setting a quit date are needed. Military smoking-cessation efforts may provide valuable lessons for the civilian community.

Adult↗
PubMed2000

From risk factors to health resources in medical practice.

The healing and preventive powers of people's health resources and self-assessed knowledge have so far been grossly underestimated in medicine. In this article, we call attention to ethical and epistemological dilemmas related to knowledge, values, communication, and autonomy embedded in the prevailing risk-oriented epidemiology, and suggest a patient-centred salutogenetic approach to promote a better balance between resources and risks in medicine. Identification and intervention upon risk factors can provide hypotheses about origins of disease and predict and sometimes prevent disease at a group level. However, there are several pitfalls related to this perspective concerning causal factors, group level based possibilities, adequate end points for intervention, informed consent, and medicalization, especially in the individualized context of the clinical encounter. By introducing a salutogenic perspective, we urge to shift the attention toward resources, agency and strength, which may counteract risk of disease and empower the patient. Talk can mediate oppression as well as empowerment. A communicative key question approach, and self-assessed health resources identified through this strategy, are briefly presented as examples of empowerment through dialogue.

Communication↗
PubMed1997

An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: Dentists' knowledge of management methods and their perceptions of barriers to providing care.

AIM: To assess dentists' knowledge of and perceived barriers to treatment of dental injuries. DESIGN: Cross-sectional postal questionnaire and personal interview. SUBJECTS AND METHODS: Questionnaires from 153 GDPs and 53 CDOs were received giving details of emergency options on 17 imaginary dental injuries and perceived barriers to treatment of trauma. Structured interviews with 21 of the GDPs and 19 CDOs seeking knowledge on diagnosis and long-term follow-up and treatment took place. Age and gender of dentist, type of practice and postgraduate courses attended were noted. MAIN OUTCOME MEASURES: Mean knowledge scores. RESULTS: Of a maximum of 14 correct responses on emergency treatment of injured teeth the mean was 7.5. Only 19% knew for how long avulsed teeth should be splinted. Of a maximum of 37 correct responses on long-term follow-up of treatment the mean was 15.4. Only 10% would correctly treat acute abscess on a traumatised tooth. 82% of dentists thought dental trauma should be treated in the primary care service, but 86% of GDPs thought fees for this type of treatment were too low. 72% of CDOs thought the treatment occupied too much clinic time and was not the responsibility of the CDS. CONCLUSIONS: Dentists in the primary care sector have insufficient knowledge to treat dental trauma.

Adolescent↗
PubMed2003

The role of primary healthcare professionals in oral cancer prevention and detection.

AIM: To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. SETTING: Primary care. METHOD: Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. RESULTS: Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. CONCLUSION: The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities.

Clinical Competence↗
PubMed2004

General practitioners' detection and management of patients with a dual diagnosis: implications for education and training.

General practitioners (GPs) are in a unique position to detect and manage patients with co-morbid mental health and substance use disorders (dual diagnosis). It has been estimated that over 30% of patients presenting to general practice have a diagnosable mental disorder and 12% have dual diagnosis. Unfortunately, between 30 and 50% of these problems go undetected in general practice. Limited GP education and training in mental health may account for this deficit, with a little over 8% of GPs receiving any formal postgraduate training in mental health. Prior to developing an educational resource for GPs, the present study aimed to establish baseline estimates of GP treatment practices with patients who have dual diagnosis. Two GP division-wide surveys of screening, assessment and treatment for dual diagnosis were conducted one year apart. In addition, five GPs conducted a clinical audit of 508 patient consultations. Results indicate that without ongoing targeted interventions, patient management activities such as GP counselling, use of screening devices, referral to specialist services, coordination and use of EPC items are not likely to improve and are at risk of declining.

Adult↗
PubMed2000

Patients' autonomy and medical benefit: ethical reasoning among GPs.

BACKGROUND: During the last decades, the traditional role of GPs as decision-makers for their patients has been questioned. OBJECTIVES: The aim of this study was to identify and discuss how GPs deal with and how they reason in situations where there is a possible tension between the obligation to respect the patients' right to self-determination and the obligation to promote their health. METHODS: One hundred and twenty randomly selected Swedish GPs received a mailed questionnaire with two vignettes, one describing a patient reluctant to have a medically motivated intervention, the other describing a patient requesting a medically doubtful intervention. Forty seven of these GPs subsequently were interviewed by telephone. RESULTS: With regard to the first vignette, approximately two-thirds of respondents to the questionnaire (n = 82) answered that they would not accept the patient's reluctance. Older GPs were somewhat more inclined to try to persuade the patient to come to their surgery than were younger colleagues. In the interview, most respondents answered that the right to self-determination ought to be given priority, but the obligation to promote health had a greater influence on their behaviour. Regarding the second vignette, two-thirds of respondents to the questionnaire answered that they would not give way to the patient's request for intervention. Younger GPs said "No" more often than did their older colleagues. In the interviews, justifications for their response referred to medical benefit, uneasy patients, self-protection and justice. CONCLUSION: When facing such conflicts in everyday practice, the ethical codes of medicine are often too categorical to give any guidance. The situational ideal of covenant would be more helpful, and ought to be emphasized by medical teachers as well as tutoring older colleagues.

Adult↗
PubMed2001

Barriers to help seeking in people with urinary symptoms.

BACKGROUND: Urinary incontinence is a common problem but, for those experiencing significant clinical symptoms, help seeking has been reported to be as low as 20%. As many of these people could be helped by simple interventions, there is a clear need to identify barriers to help seeking and develop interventions to overcome these barriers. OBJECTIVES: This study explores help-seeking behaviour in people with urinary symptoms such as leakage, frequency, nocturia and urgency in order to identify barriers to service use. METHOD: Thirty-one people who either had agreed to treatment as part of an intervention study or who were receiving treatment at a hospital out-patient clinic for their urinary problems took part in unstructured, taped interviews. Respondents were questioned about their views on help seeking for urinary problems and their personal experiences of consultations. The data were transcribed, coded and thematic analysis carried out. RESULTS: The most common theme to emerge was a lack of knowledge of the condition and of available treatments. Urinary symptoms frequently were considered a normal part of ageing or childbirth, or it was felt that these types of symptoms were inappropriate for medical intervention. Older people were not only more likely to accept symptoms but were also less likely to want to bother their GP. Patients did not always communicate their concerns about urinary symptoms to their GP, through either embarrassment or misconceptions of what is a 'medical problem'. CONCLUSIONS: There is a clear need for health education and health promotion in this area. Future work should explore professionals' knowledge and views of these types of conditions with the aim of providing guidelines for management in primary care.

Adult↗
PubMed1998

Impact in general practice of the policies of the organised approach to preventing cancer of the cervix.

This cross-sectional survey of cancer screening in May 1996 used a national random sample of a specified group of general practitioners (GPs). The survey included items to assess the impact of the Organised Approach to the Prevention of Cervical Cancer (OAPCC). Of the 1,271 GPs who satisfied the eligibility criteria, 855 (67%) returned a completed questionnaire. Fifty-two per cent indicated they would be 'highly' likely to introduce a discussion about cervical smears to a 58-year-old woman who was in good health and had come for a non-gynaecological consultation. Female sex, RACGP affiliation, practising in a metropolitan area and awareness of the OAPCC booklet were independent predictors of an opportunistic orientation. By contrast, 91% indicated that they would be 'highly' likely to include a Pap smear in a general health checkup. Thirty-eight per cent reported that they had found the booklet about the 1991 screening policy 'very' useful, while 38% found the NHMRC guidelines for the management of women with screen detected abnormalities 'very' useful. Around one-fifth of the GPs were not aware of these documents. Overall, 19% still recommended annual or more frequent screening. GPs from NSW and Queensland were less likely to support biennial screening than GPs from other states. Overall, 26% of GPs did not indicate that they would refer a woman who had tested positive for any grade of CIN for colposcopic assessment. Female GPs were more likely to refer women with CIN for colposcopic assessment while older doctors were less likely to do so.

Adult↗
PubMed1997

Factors that influence practice nurses to promote physical activity.

OBJECTIVE: To investigate what factors may influence practice nurses to promote physical activity. METHODS: Postal questionnaires were sent to all practice nurses in the county of Avon, UK in 1994. Specifically, the questionnaire survey explored whether patient, provider, and practice factors influenced practice nurses promotion behaviour. In addition, the stages of change model was used to measure current levels of promoting behaviour. RESULTS: A response rate of 80.9% was achieved. Over 80% of the sample reported currently promoting physical activity to some degree. "Promoting" nurses more frequently followed up all (new, established or targeted) patients' activity progress when compared with "restricted promoting" nurses (P < 0.05). Nurses who engaged in regular exercise were more likely to encourage physical activity as a treatment than "irregularly active" nurses (P < 0.05) for five of six clinical groups with the single exception of people with diabetes. CONCLUSIONS: This study shows that the two stage measures (activity promotion and personal behaviour) of the health care professional are associated with important differences in patient and practice factors for physical activity promotion. Further investigations into the content and quality of delivery are required before planning strategies to develop physical activity in the general practice.

Adult↗