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PubMed1991

Change in knowledge in a coronary heart disease risk factor intervention study in three communities.

We investigated health and diet knowledge as it relates to coronary heart disease (CHD) in three rural areas which participated in a community-oriented CHD risk factor intervention study. Knowledge of risk factors (risk knowledge) was fairly satisfactory at baseline, but diet knowledge was poor. Males, the young, and individuals with a lower level of education had less knowledge. Intervention consisted of a 3-year small mass media programme in one community (low-intensity intervention, LII), additional interpersonal intervention to high-risk individuals in the second (high-intensity intervention, HII), and no intervention in the control community (C). In the cohorts, with the baseline survey and the follow-up study 4 years apart, knowledge improved by 8.1% points in males (7.5% in females) in the HII community and by 7.1% (6.5%) in the LII community, compared to 5.5% (4.8%) in the C community (P less than 0.01). Diet knowledge improved more than risk knowledge, and individuals with lower initial scores benefitted most. Female scored highest. Educational level made a modest positive contribution to knowledge gain, after adjusting for differences in baseline knowledge. High-risk individuals did not have better knowledge at baseline, nor did they gain more from the intervention. We conclude that community intervention over a 4 year period, based on community diagnosis and tailored to the community's needs, can improve health knowledge.

Adolescent↗
PubMed1989

Knowledge and the child's developing theory of the world.

In this article, I have presented a brief history of research directed toward examining the developing ability of children to comprehend and produce metaphor that occurs with increasing age. I argued that the child's ability in this area does not rest upon developing an ability specific to metaphor, but, instead, metaphor comprehension and production, not unlike other forms of cognition, rests upon a developing theory of the world founded upon an expanding knowledge base. Given that knowledge is central to the child's cognitive development, I turned to an examination of the nature of knowledge. The discussion of knowledge drawn from philosophers who have attempted to propose theories of knowledge in answer to the question, "What is knowledge?" Traditional justificationalist theories of knowledge and subsequently developed nonjustificationalist theories were considered. The discussion was focused upon a number of issues which have divided philosophers with respect to their treatment of knowledge in order to highlight the problematic nature of knowledge. Cognitive and developmental psychologists may wish to consider some of these issues and the implications they hold for their theories as they study knowledge and/or invoke knowledge as a part of their theory construction. Some of the implications of the issues were illustrated in a discussion of the relation of knowledge to the developing child's comprehension and production of metaphor.

Child↗
PubMed1990

Knowledge bases in medicine: a review.

Efforts to represent knowledge effectively have been central to progress in various aspects of medical informatics. These efforts range from relatively simple "electronic textbooks" to fairly sophisticated knowledge-based systems, which function as well as, or even better than, human experts faced with similar problems. Knowledge bases have been developed in many fields, but the relatively limited domains and structured language of medicine, as well as the importance of information in the provision of good medical care, have made research in medical knowledge representation an area of intense activity. This paper reviews representative knowledge bases and knowledge-based systems in medicine: electronic textbooks such as PDQ and the Hepatitis Knowledge Base (HKB), rule-based systems such as MYCIN, causal models (e.g., CASNET), and hypothesis- or frame-based systems, exemplified by PIP and INTERNIST-1. The paper describes the relationships among divergent approaches and provides a sense of current and future trends. It examines problems in knowledge-based systems, particularly in knowledge representation and acquisition, and the responses to these challenges. The latter include the use of domain-independent software shells for constructing knowledge bases, the adaptation and use of previously existing knowledge bases, and multiple uses of the same knowledge base for different purposes.

Artificial Intelligence↗
PubMed1990

A method for the acquisition of formalized knowledge in pathology.

A tool is introduced for the acquisition of pathology knowledge in a formalized form, directly by the expert. Formalization of the knowledge is intended to make descriptive pathology knowledge more suitable for computerized diagnostic support since a formal representation of knowledge allows more extensive indexing, hence more flexible access. The knowledge acquisition (KA) tool also provides a useful research instrument to investigate to what extent pathology knowledge can be made explicit, to what degree ambiguity is present, in what way experts differ when formalizing knowledge, and whether it is feasible to incrementally acquire decision criteria on the basis of the formalized descriptive knowledge. Crucial in the design of the KA tool is the incorporated meta-knowledge, which is reflected by the knowledge-base structure and is used to elicit knowledge from the expert. Knowledge is acquired from the expert via a menu-driven user interface, which follows the general steps of the pathologist when describing a case. The paper discusses the considerations underlying the design, the implementation of the KA tool, and the research goals.

Diagnosis, Computer-Assisted↗
PubMed1985

Assessment of medical student fund of knowledge in surgery.

A medical student's fund of knowledge can be assessed by either his demonstrated fund of knowledge on a clinical service or an examination at the completion of the clerkship. During the past 2 years we have evaluated each student's fund of knowledge in two ways: clinical assessment by faculty and residents and performance on the National Board of Medical Examiners Part II Special Surgical Examination given at the end of the surgical clerkship. This study compares the clinical assessment of surgical knowledge for all 100 members of the class of 1984 at the University of Utah with other subjective evaluations such as attitudes and college grade point average and objective measures of performance such as premed MCAT score, Part I National Boards score, and the National Boards Special Surgical Examination. The correlation between clinical assessment of knowledge and the Surgical Examination was 0.23, with a range on individual services from -0.42 to 0.45. There was a higher correlation for the total group of 0.56 between fund of knowledge and attitudes, with a range on individual services of -0.04 to 0.72. The correlations between clinical assessment of knowledge and Part I National Boards, college grade point average, and chemistry MCAT score were 0.23, 0.09, and 0.15, respectively. These results indicate that the clinical assessment of fund of knowledge is not a good predictor of performance on the surgical section of the National Boards. Clinical assessment of fund of knowledge appears to be linked more closely to faculty and resident assessment of student attitudes. There are a couple possible explanations for these results: clinicians are measuring different aspects of knowledge than are National Boards or clinicians do not accurately assess knowledge and confuse attitudes such as interest and enthusiasm with fund of knowledge.

Clinical Clerkship↗
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↗
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↗
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↗
PubMed1986

The role of health belief attitudes, sex education, and demographics in predicting adolescents' sexuality knowledge.

As part of a pretest-posttest design to evaluate a 15-hour Health Belief Model (HBM)-based sex education program, we interviewed 203 teenagers (aged 13-17) of both genders regarding their preintervention sexual and contraceptive knowledge, attitudes toward pregnancy and contraception, and prior sex education and sexual activity experiences. A multiitem sexual and contraceptive knowledge measure yielded several specific topic area scales and a total knowledge score, and a multiitem attitudes measure also yielded five reliable HBM-based scales. A series of regression analyses that used teenagers' previous sexuality-related experiences, demographic information, and attitudes predicted knowledge scores well (R2 = 0.22-0.54). Across specific knowledge areas, HBM-based attitudes (e.g., perceived serious consequences of teen pregnancy) were consistently significant predictors. Interestingly, neither previous sex education nor personal sexual experiences were significantly associated with specific knowledge areas (e.g., venereal disease), although they were related to total knowledge scores. Similarly, age and gender were poor predictors of specific areas of knowledge, but minority ethnic status was consistently associated with less sexual and contraceptive knowledge. Our model was highly successful in accounting for a substantial portion of the variance in total knowledge scores (R2 = 0.54). Results are discussed in terms of their implications for designing sex education programs that focus on motivation for pregnancy avoidance and contraception as well as factual information for teenagers.

Adolescent↗
PubMed1992

The influence of general practitioners' knowledge about their patients on the clinical decision-making process.

Continuity of care is claimed to be an important and integral part of general practice. A main result of continuity is the doctor's accumulated knowledge about his or her patients. The objective of the present study was to evaluate the modifying effects of this knowledge on the decision-making process that takes place in consultations, as experienced by practitioners. A representative sample of 133 Norwegian general practitioners evaluated a total of 3,918 of their own consultations. The main independent variable was the doctor's own subjectively evaluated knowledge about the patient's medical history, while the major outcome measures included the perceived influence of accumulated knowledge on the consultation process in general, and on the diagnostic and management decisions in particular. In two-thirds of all consultations, or in three out of four in which the doctor had previous knowledge about the patient, this knowledge was considered to be clinically useful. In more than one-third of all consultations with previously unknown patients, this lack of information was felt to be a hindrance. Among patients with new medical problems and when the doctor had prior knowledge about the patient, this knowledge was felt to have significantly more therapeutic than diagnostic impact. Accumulated knowledge was generally felt to be of most help in consultations due to psycho-social problems, and was of special diagnostic value in patients presenting new, unspecific problems such as fatigue, fever, and generalized pain. This study indicates that accumulated knowledge about the patient is felt by the general practitioners to play an important and integral part in their clinical decision-making process.

Continuity of Patient Care↗
PubMed1991

Gender differences in adults' knowledge about fat and cholesterol.

Cognitive learning theories suggest that an individual's prior knowledge is a major factor for determining what can be learned. The objectives of this study were to compare the organization of knowledge about fat and cholesterol in adult, middle-class men and women and changes in that knowledge after reading an educational bulletin. Forty men and 48 women participated in two semistructured interviews to assess their knowledge; half received a US Department of Agriculture bulletin on fat and cholesterol at the end of the first interview. Concept maps (two-dimensional representations of an individual's cognitive knowledge structure) were made from the interview transcripts to assess knowledge organization. Both genders had limited knowledge, scoring less than 25% of the maximum possible score at interview 1. Overall, known and not known concepts were similar in men and women; however, women had slightly more integrated knowledge and more misconceptions than men. Both groups receiving the bulletin made significant gains in knowledge at interview 2, but knowledge gains were twice as great in men as in women. Our findings indicate that practitioners need not create separate materials about fat and cholesterol for middle-class men and women.

Adult↗
PubMedDate not supplied

Is cardiovascular risk factor knowledge sufficient to influence behavior?

This paper examines the level of cardiovascular risk knowledge in the general population and the relationship between such knowledge and behavior. The following questions are addressed: (1) How informed is the general population about what persons can do to reduce their risk of cardiovascular disease? (2) How do sociodemographic factors, self-perceptions of health, and cardiovascular risk factors relate to knowledge? (3) Is there a relationship between knowledge and behavior? (4) What might explain apparent inconsistencies between knowledge and behavior? The data used in this paper derive from a random sample of 732 men and women form the greater Boston area. We assessed cardiovascular risk factor knowledge by asking respondents what specific steps a person could take to make a heart attack or stroke less likely. Risk factors (including physiological measures), sociodemographic factors, and self-perceptions of health also were measured. Results showed that respondents were most knowledgeable about the relationships of exercise and cholesterol to heart disease. Knowledge was related positively to education, being female, and exercising. When we compared knowledge with behavior, results showed that for smokers and those who were overweight, risk was related to awareness, thus suggesting that knowledge does not lead necessarily to risk-reducing behavior. Implications of these results in terms of education and prevention are discussed.

Adult↗
PubMed1988

Primary knowledge, medical education and consultant expertise.

We have studied the knowledge of students and clinicians that they actually used to follow up four problems in general medicine. Some unexpected similarities and differences in their readily accessible or primary knowledge were found in groups from first-year clinical medical students to consultants. There is no linear increase in the quantity of primary knowledge with experience, but qualitative changes are very much more important. At all levels individuals show a remarkable dissimilarity in the knowledge they use to solve clinical problems, so that the bulk of personal knowledge used is individual. Comparatively rarely do people use the same knowledge to solve any one clinical problem. However, there is evidence of a general tendency towards increasing uniformity in knowledge as a result of the medical school years. After houseman level, individuality increases again. These changes result in consultants achieving an identical profile to first-year clinical medical students in terms of the extent to which their primary knowledge bases are held individually or in common. These findings suggest that consultant expertise is actually based on individual experience rather than a common core of knowledge. The influence of medical school in providing such a common knowledge base is (1) limited and (2) reversed by clinical practice. The results suggest the necessity for increased vocational and practice-oriented components in medical education, particularly in postgraduate education.

Clinical Competence↗
PubMed1986

[Food and nutrition knowledge of students graduating from basic education in the metropolitan area of Santiago, Chile].

The aim of this study was to evaluate the degree of knowledge on food and nutrition in students graduating from Basic Education in the Metropolitan Area of Santiago, Chile. A random sample of 249 students of both sexes (1:1) from public and non-public schools (1:1) and from high, medium and low socioeconomic level (SEL), was selected. SEL was measured through the Graffar Modified Scale, and the degree of knowledge on food and nutrition was evaluated through a standardized test of 29 multiple choice items, based on the objectives of the curriculum program. The test was divided in two areas: Area 1, which contemplated Food and Requirements and Area 2, Food, Personal and Environmental Hygiene. Data were analyzed by chi-square procedure, comparing students who obtained sufficient knowledge (greater than or equal to 50% of correct answers) with those who obtained insufficient knowledge (less than 50% of correct answers). Results of the study indicated that 39.8% of students registered sufficient knowledge, 31.3% and 65.9% in Area 1 and 2, respectively. According to SEL, 62.1% and 12.3% of students from high and low SEL, respectively, registered sufficient knowledge (p less than 0.001), and the same effect was observed in Areas 1 and 2. In relation to sex, 46.3% of females and 33.3% of males registered sufficient knowledge (p less than 0.05), fact which was confirmed in both areas of the test. No significant differences were registered in the degree of knowledge on food and nutrition of students from public and non-public schools. It is therefore concluded that the degree of knowledge on food and nutrition in students graduating from Basic Education differs significantly according to SEL and, sex. This study represents a basic contribution to the better understanding of factors affecting the degree of knowledge on food and nutrition in students graduating from Basic Education in Santiago, Chile, and may serve as base-line for further studies on the subject.

Adolescent↗
PubMed1990

The knowledge and use of screening tests for colorectal and prostate cancer: data from the 1987 National Health Interview Survey.

Data based on the 1987 National Health Interview Survey are presented depicting factors associated with the knowledge and use of three tests for the early detection of colorectal and prostate cancer: digital rectal examination, fecal occult blood tests, and flexible sigmoidoscopy. The percentage of the at risk adult population who have ever heard of or had these tests is reported. The association of demographic, personal resource, and health system factors with knowledge of these tests is explored using multivariate logistic regression. Health system factors are most consistently associated with use of the tests and with knowledge. Family income, family size, education, knowledge of cancer early warning signs, and measures of encounters with the health care system are associated both with knowledge of and, independent of knowledge, with use of the tests. Residency in the non-South, being white or female, and having an optimistic attitude about cancer prevention are all factors associated with greater knowledge of the tests, but not greater use among those aware of the tests. Membership in a health maintenance organization is more strongly associated with knowledge and use of fecal occult blood tests than the other tests. No association was found between current smoking status and knowledge of or use of any of the tests.

Adult↗
PubMed1990

Validation of an asthma knowledge questionnaire.

Asthma is responsible for much morbidity and mortality, which might be decreased by increasing parental and patient knowledge about asthma. This report describes the development and validation of an asthma knowledge questionnaire for use in the assessment of asthma knowledge. Two groups of respondents were examined. One group was designated 'high knowledge' and the other 'low knowledge'. The questionnaire had a maximum possible score of 31. The mean score of 69 'high' knowledge parents was 25.3 (median 25, range 18-31). By contrast, the mean score of 69 'low' knowledge parents was 13.0 (median 13, range 0-21). The difference between the two groups was statistically significant (P less than 0.0001). The questionnaire results were reproducible (tau = 0.94, P less than 0.01). Demographic characteristics such as education and socio-economic status were not important confounding variables. Face and content validity of the questionnaire were based on reference to published experience. Concurrent validity was demonstrated by the ability of the questionnaire to distinguish low from high knowledge parents. The questionnaire should prove to be a valuable research tool for the assessment of asthma knowledge either as part of an educational intervention or in a clinical situation.

Asthma↗
PubMed2026

Knowledge on the Haemophilia Care Among Healthcare Providers in Tanzania: A Multicenter Cross-Sectional Study.

BACKGROUND: Haemophilia is a rare inherited bleeding disorder associated with recurrent bleeding, disability, and mortality when diagnosis and management are delayed. In low- and middle-income countries, limited diagnostic capacity, access to treatment and gaps in Healthcare Providers' (HCPs') knowledge are major contributors to morbidity and mortality. In Tanzania, the recent improvement in haemophilia services highlights the need for systematic evaluation of HCPs' knowledge and clinical practices. OBJECTIVE: The study assessed the knowledge of haemophilia care among healthcare providers in Tanzania. METHODS: A multicenter hospital-based cross-sectional study was conducted among HCPs in tertiary and regional hospitals in Tanzania. A structured self-administered questionnaire assessed knowledge on haemophilia, including the pathophysiology, clinical features, diagnosis, treatment, and complications. Data were analyzed using IBM SPSS statistics version 27. RESULTS: Among 799 HCPs assessed (50.9%) aged 20-29 and (59.2%) males. Nurses were the majority (31.8%), and 75.2% had &#x2264;5 years' experience. Overall haemophilia knowledge was high (median 83.3%, IQR: 75.9-88.9), strongest performance in general knowledge and weakest in treatment (68.2%, IQR: 54.5-77.3). Most respondents identified haemophilia as inherited (95.6%), non-infectious (93.7%), and recognized prolonged bleeding after injury or circumcision as key-symptoms (>90%). Knowledge varied by cadre, department, and experience (p<0.05); physicians and specialists scored higher than nurses, while health attendants scored lower. CONCLUSION: Healthcare providers demonstrated fairly adequate general knowledge of haemophilia. However, gaps remain in understanding genetic inheritance, acquired haemophilia, and modern treatment strategies, with knowledge variation by cadre, department, and experience, highlighting the need for targeted education across all HCPs groups.

Tanzania↗