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PubMed2003

Relations among asthma knowledge, treatment adherence, and outcome.

BACKGROUND: Asthma knowledge is frequently assumed to be a prerequisite for optimal asthma treatment. However, the validity of existing asthma knowledge questionnaires has not been rigorously examined, and no contemporary measure of asthma knowledge has received widespread acceptance. OBJECTIVE: To construct and examine the psychometric properties of an asthma knowledge instrument, and its association with demographic and psychosocial variables, asthma medication adherence, and treatment outcome. METHODS: A 25-item Asthma Knowledge Questionnaire was developed with input from national pediatric asthma experts. Parents of 155 children with asthma completed the Asthma Knowledge Questionnaire as well as demographic, family functioning, and home environment measures. Asthma outcomes and adherence with inhaled medication was measured across 12 months. RESULTS: Despite the many steps taken to develop a strong measure of asthma knowledge, reliability was relatively poor. There was also no association between asthma knowledge and treatment adherence or outcomes. Furthermore, asthma knowledge was not a unidimensional construct and was not a simple function of education. CONCLUSIONS: Findings from this study, in combination with previous studies of asthma knowledge questionnaires, suggest that the construction of a simple self-report asthma knowledge instrument for use as a primary outcome measure demonstrating mastery of asthma self-management skills may not be achievable.

Adolescent↗
PubMedDate not supplied

Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma.

PURPOSE: The purpose of this study was to examine the relationship between knowledge, attitudes, and self-efficacy and compliance with prescribed medical regimen, number of emergency department (ED) visits, and hospitalizations in adults with asthma. METHOD: The sample consisted of 29 adults with a diagnosis of asthma. The relationship among knowledge, attitudes, self-efficacy, and compliance with medical regimen was explored through use of a survey design. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire and the Asthma Management Questionnaire that measured compliance were mailed to subjects' homes. Once completed, questionnaires were returned, and demographic data and number of ED visits and hospitalizations were obtained through a retrospective chart review. RESULTS: There was a significant correlation between knowledge and attitudes and knowledge and self-efficacy. The more positive persons' attitudes toward their asthma, the higher their knowledge and self-efficacy scores. There were significant correlations between select demographic variables and knowledge, attitude, and self-efficacy. Women scored higher on attitudes, persons with a college education scored higher on knowledge and attitudes, and persons with mild asthma scored highest on the self-efficacy scale. Compliance with use of peak-flow meters correlated with higher scores on the attitude and self-efficacy scales. The higher total compliance score group had significantly higher self-efficacy scores. In addition, higher self-efficacy scores correlated with lower numbers of hospitalizations. CONCLUSION: Attitudes and self-efficacy rather than knowledge had the most significant impact on compliance and number of ED visits and hospitalizations. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire provides a means for nurses to assess patients' knowledge, attitudes, and self-efficacy regarding their asthma. Patients with low scores could be channeled into programs that would help them improve their ability to manage their asthma.

Adult↗
PubMed2002

Adolescent knowledge about sexually transmitted diseases.

BACKGROUND: Adolescents learn about sexually transmitted diseases (STDs) from many sources, yet little is known about how well these educational sources are teaching them about STDs. GOAL: The goal was to assess basic knowledge about STDs and their prevalence, to determine the correlates of high STD knowledge levels, and to explore whether self-perceptions of STD knowledge correlated with knowledge test scores. STUDY DESIGN: A convenience sample of adolescents from waiting areas in an urban children's hospital were asked by peer educators about their STD education, the sources of this education, and their self-perception of their STD knowledge. They then were given a short assessment testing their knowledge of major, incurable, and curable STDs. RESULTS: In the 393 surveys collected from adolescents aged 12 to 21 years (mean [+/-SD] age, 16.9 +/- 1.8 years), 97% self-reported having been educated about STDs, and the reported major sources were school (70%), parents (52%), and friends (31%). Only 7 (2%) correctly named all 8 major STDs, 35 (9%) named the 4 curable STDs, and 13 (3%) named the 4 incurable STDs. HIV was the mostly commonly named of the 8 major STDs (91%), followed by gonorrhea (77%) and syphilis (65%). Trichomonas infection (22%), human papillomavirus infection (22%), and hepatitis B (15%) were the least-named STDs. Forty-six percent thought HIV was the most common STD in the Philadelphia area. The participants' mean total STD knowledge score was 3.5 +/- 1.9 (maximum possible score, 8). There were fair correlations between knowledge scores and age (correlation coefficient [r] = 0.31; P < 0.0001), as well as between knowledge score and self-perception of STD knowledge (r = 0.23; P < 0.0001). Adolescents educated by parents, school, other relatives, and friends performed better than those educated by other sources. Those educated by multiple sources outperformed those educated by one source. CONCLUSIONS: Adolescents' specific knowledge about non-HIV STDs is only cursory, despite their reports of having received education about STDs. We must attempt to improve and balance our STD education so that adolescents receive and retain detailed age-appropriate STD information that is consistent with their risk for disease.

Adolescent↗
PubMed2000

Measuring team knowledge.

Multioperator tasks often require complex cognitive processing at the team level. Many team cognitive processes, such as situation assessment and coordination, are thought to rely on team knowledge. Team knowledge is multifaceted and comprises relatively generic knowledge in the form of team mental models and more specific team situation models. In this methodological review paper, we review recent efforts to measure team knowledge in the context of mapping specific methods onto features of targeted team knowledge. Team knowledge features include type, homogeneity versus heterogeneity, and rate of knowledge change. Measurement features include knowledge elicitation method, team metric, and aggregation method. When available, we highlight analytical conclusions or empirical data that support a connection between team knowledge and measurement method. In addition, we present empirical results concerning the relation between team knowledge and performance for each measurement method and identify research and methodological needs. Addressing issues surrounding the measurement of team knowledge is a prerequisite to understanding team cognition and its relation to team performance and to designing training programs or devices to facilitate team cognition.

Cognitive Science↗
PubMed1992

[The effects of knowledge and its developmental differences on misconception of weight].

This study aims to examine developmental knowledge related to misconception about weight. Subjects from 5th to 7th graders were asked to reason about justifiable phenomena which never occur in science. After that, before judging weight addition tasks, subjects engaged in some knowledge-generating-tasks to examine which knowledge-generating-tasks relate to misconception. The main results were as follows: (1) Most subjects did not realize untruth about justifiable phenomena, (2) the knowledge which related to misconception were muscular-kinetic-feeling and balance-feeling about weight, and (3) awareness to knowledge-generating-tasks changed with age; 5th graders found the relation about every kind of knowledge-task on chance level responding and 6th and 7th graders found the relation with some justifiable knowledge. Additionally, some 7th graders were not deluded by any knowledge-generating-tasks. These results suggested misconception about weight might relate to inference from some kinds of everyday-knowledge without realizing the inconsistency with science to them. The developmental change of awareness to knowledge-generating-tasks were discussed in terms of coordination subjects' own theory and their use of knowledge.

Adolescent↗
PubMed2002

[Factors associated with change in diabetes knowledge from childhood to adolescence].

BACKGROUND: A multicentric cohort of 142 children with insulin-dependent diabetes has been longitudinally studied to evaluate if their diabetes knowledge was modified by time and to assess the factors associated to this change. METHODS: A knowledge scale, previously translated and validated in French (TDK), was independently completed by the children and their parents at inclusion (T0) and 4 years later (T4). RESULTS: Mean age of the children was 10.2 years at T0. Mean knowledge score of the parents did not differ between T0 and T4 but mean score of the children was significantly higher at T4 than at T0 (22.2 +/- 5.7 vs 26.9 +/- 3.8, p<0.001). Age-adjusted knowledge score of children at T4 was significantly correlated to compliance to treatment (r=0.23, p<0.01). The factors associated with knowledge score of the children at T4 were: age at T4 (r=0.49, p<0.001), knowledge score of children at T0 (r=0.59, p<0.001), school results of the children (r=0.18, p=0.04), educational level of the mother (r=0.21, p=0.01), family income (r=0.19, p=0.03), knowledge score of parents at T0 (r=0.16, p=0.09), number of diabetes summer camp periods (r=0.19, p=0.03). Multivariate analysis showed that these 7 factors accounted for 59% of the variance in predicting knowledge score of the children at T4 (p<0.001). After adjustment, age at T4, knowledge score of the children at T0 and educational level of the mother stayed significantly associated with the knowledge score at T4. CONCLUSION: These results emphasise the importance of diabetes education programs specifically developed for children with the aim of improving diabetes knowledge at adolescence.

Adolescent↗
PubMed1987

Assessing knowledge of cardiovascular health-related diet and exercise behaviors in Anglo- and Mexican-Americans.

This article describes the Adult and Child Behavior Knowledge Scales that were used as part of the San Diego Family Health Project to measure knowledge of health behaviors related to cardiovascular diseases in two ethnic groups: Anglo- and Mexican-Americans. The psychometric characteristics of these scales indicate acceptable reliabilities for assessing knowledge of dietary sodium, dietary fat, and exercise among both adults and children and differ from other health knowledge scales in that they focus on "behavioral capability" rather than on the link between behavior and disease. It is believed that the type of information measured by our scales is more closely related to behavior changes sought in contemporary cardiovascular disease prevention trials. Results of ANOVA used to test differences in knowledge by ethnicity and sex indicate strong main effects for ethnicity among both children and adults. However, sex was not consistently related to knowledge, except for the general tendency of males to be more knowledgeable about exercise. Step-wise and simultaneous-entry multiple regression were used to test a subset of variables, including sex, education, self-efficacy, acculturation (for Mexican-Americans), and parental health knowledge (for children) as determinants of health knowledge. Education was the strongest predictor for Anglo-American adults, and acculturation level was the strongest for Mexican-American adults. Among children, the only statistically significant variable was parental acculturation level for Mexican-Americans. The scales were found to be useful in measuring differences in knowledge across cultural/linguistic groups and to clearly identify marginally acculturated Mexican-Americans as being least aware of health-behavior knowledge. Implications are discussed.

Acculturation↗
PubMed1991

Cardiovascular health knowledge in the United States: findings from the National Health Interview Survey, 1985.

Knowledge of the risk precursors to cardiovascular disease is thought to be a key component of health decision making. Many intervention programs have been aimed at increasing the nation's general knowledge of risk factors for cardiovascular disease, although the determinants of the level of cardiovascular disease knowledge are not thoroughly understood. We examined cardiovascular knowledge in a nationally representative sample of the United States population with data from the 1985 Health Promotion and Disease Prevention supplement of the National Health Interview Survey. Interviews with 12,551 white women, 770 Hispanic women, 2,547 black women, 9,832 white men, 576 Hispanic men, and 1,440 black men were used in this analysis. We constructed a seven-item index for cardiovascular disease knowledge. After adjustment for age and education, white men and women scored higher on the cardiovascular disease knowledge index than either their Hispanic or black counterparts. We also examined the relationships of age, education, income, marital status, access to medical care, geographic region, and seven self-reported cardiovascular disease risk factors to the levels of cardiovascular disease knowledge. Education was the strongest predictor of cardiovascular disease knowledge. The variables examined accounted for a small portion of the variance in knowledge. Levels of cardiovascular disease knowledge were lower among respondents with less education and income, those who were not married, those with less access to medical care, and those who were smokers or physically inactive. Therefore, efforts to improve levels of cardiovascular disease knowledge should be directed toward subgroups.

Age Factors↗
PubMed2002

Knowledge of object manipulation and object function: dissociations in apraxic and nonapraxic subjects.

An influential account of selective semantic deficits posits that visual features are heavily weighted in the representations of animals, whereas information about function is central in the representations of tools (e.g., Warrington & Shallice, 1984 ). An alternative account proposes that information about all types of objects-animate and inanimate alike-is represented in a distributed semantic architecture by verbal-propositional, tactile, visual, and proprioceptive-motor nodes, reflecting the degree to which these systems were activated when the knowledge was acquired (e.g., Allport, 1985 ). We studied a group of left hemisphere chronic stroke patients, some of whom were apraxic, with measures of declarative tool and animal knowledge, body part knowledge, and function and manipulation knowledge of artifacts. Apraxic (n=7) and nonapraxic (n=6) subjects demonstrated a double dissociation of performance on tests of tool and animal knowledge, suggesting that the apraxic group was not simply more severely impaired overall. Apraxics were relatively impaired in manipulation knowledge, whereas nonapraxics tended to be relatively impaired in function knowledge. Apraxics were also more impaired with body parts than nonapraxics. The association of gestural praxis, tool knowledge, body part knowledge, and manipulation knowledge suggests a coherent basis for the organization of semantic artifact knowledge in frontoparietal cortical regions specialized for sensorimotor functions, and thus provides support for the distributed architecture account of the semantic system.

Aged↗
PubMed1999

A strategy for developing practice guidelines for the ICU using automated knowledge acquisition techniques.

OBJECTIVES: To implement practice guideline entry tools in a reminder system in order to provide decision support to health care workers in clinical care and emergency care environments. To design a knowledge acquisition environment that enables physicians to formulate, update, and verify guidelines without the assistance of a knowledge engineer. METHODS: We developed a knowledge acquisition environment for the Intensive Care Unit (ICU) consisting of 1) a graphical knowledge acquisition tool, 2) tools that perform logical and semantic tests on proposed guidelines, 3) a Patient Data Management System (PDMS) containing clinical patient data, and 4) an expert system that reminds ICU health care workers of inconsistencies between a treatment plan and implemented guidelines. Physicians enter the guidelines using the knowledge acquisition tool, after which consistency and correctness tests are performed on the guidelines. The guidelines are then transferred to the knowledge base of the reminder system and validated by applying the new guidelines to a large stored data set of previous patients. If the new guidelines are approved, they are exported to the reminder system that is used in daily practice. RESULTS: ICU physicians used the knowledge acquisition tool to enter 58 guidelines into the reminder system's knowledge base. These guidelines were tested on a data set consisting of 803 previously admitted patients. As a result, 27 guidelines fired at least once, generating 406 reminders in total. Of the 406 generated reminders, 356 (88%) were issued correctly and 50 (12%) were false alarms. The reminders that were issued correctly involved 3 situations: 1) the database contained inconsistent or incomplete information, 2) the actions or decisions of the health care workers were not the most appropriate ones, and 3) there was a potential risk involved. All false alarms were caused by the fact that the corresponding guidelines were not specific enough to handle certain exceptions. As a result of this analysis, the guidelines could be improved in such a way as to eliminate all false alarms. CONCLUSIONS: These first results demonstrate that this bottom-up knowledge acquisition strategy, implemented by the automated knowledge acquisition tools, enables medical specialists to improve the quality of computer support in an ICU without assistance of a knowledge engineer.

Artificial Intelligence↗
PubMed2000

Category learning with minimal prior knowledge.

In 6 experiments, the authors examined the use of prior knowledge in category learning. Previous studies of the effects of knowledge on category learning have used categories in which knowledge was related to all of the category's features. However, people's knowledge of real-world categories often consists of many "rote" features that are not related to their prior knowledge. Five experiments found that even minimal prior knowledge (1 knowledge-relevant feature and 5 rote features per exemplar) can facilitate category learning. Posttests revealed that although the knowledge aided learning, subjects also acquired the rote features that were not related to knowledge, contradicting predictions of an attentional explanation of the knowledge effect. The results of Experiment 6 suggested that subjects attempt to link even rote features to their knowledge.

Cognition↗
PubMed1993

A Pathfinder analysis of pedagogical knowledge structures: a follow-up investigation.

This study is an extension of an earlier investigation of undergraduate students' acquisition of key pedagogical concepts in a physical education teaching methodology course. In that study, Pathfinder, a method for eliciting associative memory networks, was used to describe and compare the pedagogical knowledge structures of students to that of the course instructor. After the course, students' pedagogical knowledge structures corresponded more closely with that of the instructor, and students who corresponded the closest performed better in the course. The results raised an interesting issue regarding the acquisition of knowledge in undergraduate students. Did students acquire a generalizable body of pedagogical knowledge applicable beyond the context of the teaching methodology course or a highly contextualized reflection of their course instructor's knowledge base? In the present study the external validity of the pedagogical knowledge base was examined by using Pathfinder to compare the knowledge structures of students from the initial investigation with knowledge structures of five experienced teacher educators from five different teacher education programs. The findings indicated that students' knowledge structures became significantly more correspondent with that of the experienced teachers' structures from the beginning to the end of the course. Also, students' correspondence with teacher educators' structures following instruction was found to be significantly correlated with academic and teaching performance. The findings point to the external validity of the domain of knowledge under study and the robustness of Pathfinder for capturing pedagogical knowledge.

Adult↗
PubMed1993

Expertise in expert systems: knowledge acquisition for biological expert systems.

In this paper it is argued that an expert system requires more than factual knowledge before it can display expertise in a given domain. The additional knowledge consists of the heuristics or 'rules of thumb' used by an expert to manipulate and interpret the factual knowledge. The knowledge acquisition phase of an expert system project involves determining the factual knowledge (which may be obtained from published sources) and the heuristics used by an expert to manipulate that knowledge--these heuristics can only be obtained from an expert. In reviewing existing biological expert systems it is apparent that many contain only the factual knowledge relating to the domain, and lack the heuristics that enable such systems to show expertise. This paper reviews a number of knowledge acquisition techniques which could be used for acquiring heuristic knowledge and discusses when their use is appropriate. The knowledge acquisition techniques discussed are those suitable for the development of small-scale expert systems as these are most likely to be of interest to biologists. The techniques include the use of questionnaires, interview techniques and protocol analysis; particular emphasis is placed on a modification to the 'twenty questions' interview technique which was developed specifically to elicit taxonomic knowledge relating to water mite identification.

Biology↗
PubMed1997

The forms of knowledge mobilized in some machine vision systems.

This paper describes a number of computer vision systems that we have constructed, and which are firmly based on knowledge of diverse sorts. However, that knowledge is often represented in a way that is only accessible to a limited set of processes, that make limited use of it, and though the knowledge is amenable to change, in practice it can only be changed in rather simple ways. The rest of the paper addresses the questions: (i) what knowledge is mobilized in the furtherance of a perceptual task?; (ii) how is that knowledge represented?; and (iii) how is that knowledge mobilized? First we review some cases of early visual processing where the mobilization of knowledge seems to be a key contributor to success yet where the knowledge is deliberately represented in a quite inflexible way. After considering the knowledge that is involved in overcoming the projective nature of images, we move the discussion to the knowledge that was required in programs to match, register, and recognize shapes in a range of applications. Finally, we discuss the current state of process architectures for knowledge mobilization.

Humans↗
PubMed2000

Ontology acquisition from on-line knowledge sources.

Electronic knowledge representation is becoming more and more pervasive both in the form of formal ontologies and less formal reference vocabularies, such as UMLS. The developers of clinical knowledge bases need to reuse these resources. Such reuse requires a new generation of tools for ontology development and management. Medical experts with little or no computer science experience need tools that will enable them to develop knowledge bases and provide capabilities for directly importing knowledge not only from formal knowledge bases but also from reference terminologies. The portions of knowledge bases that are imported from disparate resources then need to be merged or aligned to one another in order to link corresponding terms, to remove redundancies, to resolve logical conflicts. We discuss the requirements for ontology-management tools that will enable interoperability of disparate knowledge sources. Our group is developing a suite of tools for knowledge-base management based on the Protégé-2000 environment for ontology development and knowledge acquisition. We describe one such tool in detail here: an application for incorporating information from remote knowledge sources such as UMLS into a Protégé knowledge base.

Artificial Intelligence↗
PubMed2001

The role of tacit knowledge in the work context of nursing.

AIMS OF THE STUDY: Previous research on the role of tacit knowledge is ambiguous. Some studies show the superiority of expertise, while other studies found experts would not be better than laymen. This paper aims at clarifying the contribution of tacit knowledge to expertise in the domain of nursing. BACKGROUND: Two important concepts for dealing with critical situations are outlined - tacit knowledge and experience-guided working. The framework of tacit knowledge and experience-guided working can contribute to an explanation of the ambiguous results. Tacit knowledge is acquired implicitly in the course of working and is therefore not subject to reflection. For this reason it can contain erroneous or problematic contents. METHODS: A method for the explication of tacit knowledge was developed and a laboratory study with 16 experienced nurses conducted. In the laboratory study the nurses had to deal with a critical nursing situation that was developed in co-operation with nursing experts. The explicit knowledge of the nurses was tested before the laboratory study. RESULTS: No systematic differences in explicit knowledge could be observed, i.e. differences in performance could not be attributed to this knowledge mode. Results from multidimensional scaling procedures illustrate differences in the tacit knowledge of nurses who successfully accomplished the critical situation and those who did not. CONCLUSIONS: The findings are in line with the assumption that experience-guided working is of the utmost importance for dealing with critical situations. Consequences of these results for nursing and person-related services in general are discussed and the aim of future research is outlined.

Adaptation, Psychological↗
PubMed1993

Knowledge and practices of pregnant women in relation to the intake of drugs during pregnancy.

The present study was done to assess Knowledge and practices of expectant women regarding drug intake during pregnancy. To achieve this aim, a simple random sample of 400 pregnant women during their last trimester of pregnancy were selected. A specially designed interview schedule was developed and used to collect the necessary data about the study subjects. The interview schedule consisted of four main parts to cover the following: 1. General characteristics of the sample. 2. Obstetrical characteristics of the sample 3. Knowledge about drug intake during pregnancy. 4. Practices of the study subjects in relation to drug intake during pregnancy. 5. Factors affecting their knowledge regarding drug intake during pregnancy. The main findings of the study were: 1. In general, the study sample lacked the essential knowledge regarding drug intake during pregnancy especially in relation to the risk time for taking drugs in which nearly one-fifth of the sample (19.5%) did not know that it is risky to take drugs during pregnancy without doctor's order. 2. Regarding the practices of the study subjects in relation to drug intake during pregnancy, it was observed that the majority of the sample (86%) took drugs without prescription such as vitamins and general tonics, antacids, analgesics, anti-emetics, sedatives and antibiotics to treat their minor or major complaints during pregnancy. 3. In this study, it was also found that certain factors seemed to affect women's knowledge regarding drug intake during pregnancy. It was more obvious to observe that nearly two-thirds (60.8%) of women whose age was less than 30 years were more likely to have inadequate and poor knowledge in this respect. It was observed that the majority (81.9%) of illiterate women were more likely to have inadequate and poor knowledge about drug intake during pregnancy. It was also found that nearly three-quarters (72.3%) of housewives were more likely to have poor and inadequate knowledge. It was also noticed that the majority (81.5%) of the primigravidae women were more likely to have poor and inadequate knowledge. It was also noted that the majority of women (87.1%) who had previous abortions were more likely to have poor and inadequate knowledge.

Abnormalities, Drug-Induced↗
PubMed1990

Effects of an AIDS education program on the knowledge, attitudes and practices of low income black and Latina women.

The purpose of this study was to test the effects of an AIDS education program on the knowledge, attitudes and practices of low income black and Latina women. A pretest-posttest nonequivalent control group design was used with a 2-3 month retest of the experimental group. The sample consisted of 506 experimental and 206 control group women who were clients of the Public Health Foundation's Nutrition Program for Women, Infants and Children in Los Angeles County. The program included a slide-tape presentation, and educational and resource brochures in English and Spanish. Knowledge, attitudes, and sexual and drug use practices were measured using a structured questionnaire that was developed in English and Spanish. Content validity and reliability of the questionnaire were established. A 2-way repeated measures ANOVA examined differences in pretest-posttest knowledge, attitudes, and practices for experimental and control groups and for both racial/ethnic groups. The experimental group made significant gains over the control group on pretest-posttest measures of knowledge and attitudes. Both experimental and control groups made significant changes in practice. Changes in knowledge were retained on retest; changes in practices came close to significance on retest. Blacks and Latinas differed on pretest knowledge and attitudes but not practices. Blacks had more knowledge and positive attitudes on pretest. However, posttest improvements for both knowledge and attitudes were greater in Latinas than in blacks. A multiple regression analysis revealed that the best predictors of knowledge, attitudes and practices were racial/ethnic group, education, and religion. It is concluded that a didactic audio visual program can positively affect the knowledge and possibly the practices of participants and that these are retained over time but that changes in attitudes will take further efforts.

Acquired Immunodeficiency Syndrome↗