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PubMed1998

Nurses' knowledge of advance directives.

BACKGROUND: The Patient Self-Determination Act offers persons the opportunity to make their end-of-life choices known by the use of advance directives. Although nurses are designated advocates for patients and are available to communicate patients' concerns and wishes to other healthcare providers, few data on nurses' knowledge of advance directives have been reported. OBJECTIVE: To describe nurses' knowledge of advanced directives. SAMPLE: A volunteer sample of 339 RNs in a 600-bed acute care teaching hospital was surveyed. The sample represents 38% of the approximately 900 nurses employed at this hospital. METHODS: Data obtained from a 44-item questionnaire that tested nurses' knowledge of advance directives were analyzed. In addition, the relationship between nurses' knowledge of advance directives and certain demographic factors was analyzed. RESULTS: The mean score for knowledge of advance directives was 78% correct answers. Fifty-five percent of the respondents indicated that they did not have a good understanding of advance directives. Only 14% had completed these end-of-life documents for themselves, and 92% indicated that further education would increase their understanding of advance directives. An analysis of variance produced only one significant finding: the relationship between ethnicity and knowledge about advance directives. CONCLUSIONS: Nurses must increase their knowledge of advance directives. Results of this survey should stimulate caregivers and hospital policy makers to take a long-range view of their responsibilities to patients regarding advance directives and their responsibilities for educating the persons who convey information about advance directives to patients.

Adult↗
PubMed2006

Knowledge work in nursing and midwifery: an evaluation through computer-mediated communication.

Recent changes in policy and culture require health workers to incorporate "knowledge work" as a routine component of professional practice. Innovative computer-mediated communication technologies provide the opportunity to evaluate the nature of "knowledge work" within nursing and midwifery. This study embedded an online discussion system into an acute NHS Trust to support interaction within communities of practice. The complete record of online communications was analysed. Nurses were found to predominantly engage in information work with knowledge work restricted to senior-to-senior level exchanges. In contrast, midwives were observed to employ the technology to support knowledge work between all grades. The study indicates that technology can support knowledge work, including conveying tacit knowledge effectively.

Acute Disease↗
PubMed2000

Knowledge and willingness to use emergency contraception among low-income post-partum women.

We performed a multivariate analysis to determine factors associated with knowledge and willingness to use emergency contraception in a consecutive sample of 371 post-partum women from an inner-city public hospital. Women were queried about previous contraceptive use, pregnancy history including abortions and unplanned pregnancies, and demographic characteristics. Outcomes included knowledge of emergency contraception and willingness to use it. Questionnaires were conducted in person, in English or Spanish.Of 371 women, 3% had used emergency contraception, 36% had heard of it, and 7% knew the correct timing for use. Two-thirds of the population indicated a willingness to use emergency contraception in the future. Factors positively associated with knowledge included being a teenager or more than 30 years old, prior use of condoms, and history of an elective abortion. Being multiparous, monolingual Spanish-speaking, or Asian were negatively associated with knowledge. Willingness to use emergency contraception was positively associated with being multiparous and negatively associated with a higher income, moral or religious objections to the use of emergency contraception, a belief that it is unsafe or a perception that it is an abortificient. Knowledge about emergency contraception, especially correct timing, remains low. Multiparous women should receive increased education given their lack of knowledge but willingness to use emergency contraception. In order to increase the acceptability of emergency contraception, educational efforts must include accurate information about its mechanism of use and safety.

Adolescent↗
PubMed2000

What husbands in northern India know about reproductive health: correlates of knowledge about pregnancy and maternal and sexual health.

Women in India suffer from a high incidence of reproductive disease, disability and death. Very little work has been done on men, but a much higher incidence of sexual experience outside marriage and sexually transmitted diseases (STDs) among males than previously expected for this population is now being documented. In north India, women are dependent on their husbands and other family members for health-related decisions. Therefore, the behaviour, knowledge and attitudes of men are integral to the reproductive health status of couples there. This study explores knowledge about three distinct areas of reproductive health among 6549 married men in five districts of the northern state of Uttar Pradesh, India. Factors contributing to men's knowledge in the areas of fertility, maternal health and STDs were investigated. Results showed that very few men had basic knowledge in any of these areas. The likelihood of reporting knowledge was associated with a set of determinants that differed in their magnitude and effect across the areas of reproductive health explored. In particular, men's belief about the ability of an individual to prevent pregnancy demonstrated an independent association with men's knowledge. After controlling for factors such as age, parity and educational and economic status, men who believed it not possible to prevent a pregnancy were less likely to know when during the menstrual cycle women would become pregnant and certain facts about STDs, but they were more likely to be able to name two or more symptoms of serious maternal health conditions. Possible explanations for this trend are discussed.

Adolescent↗
PubMed1995

Caring for people with AIDS in a Nigerian teaching hospital: staff attitudes and knowledge.

Health workers (HWs) play a pivotal role in preventative programmes being implemented to combat the steady increase in the prevalence of HIV infection and AIDS in Nigeria. We report on a questionnaire survey conducted in October, 1993 among 111 doctors, 92 nurses and 53 non-health workers at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The aim was to assess their knowledge of AIDS (for all groups) and the attitude of the HWs only towards the care of patients with AIDS (PWAs). Although important gaps in knowledge were found in all groups, doctors performed significantly better than non-health workers on 22 out of 23 knowledge items, and more than nurses on 8 of such items. Nurses scored significantly higher than non-health workers on 18 of the knowledge items and more than doctors on one knowledge item. About one in three nurses would hesitate to nurse a PWA, while half would not participate in birth delivery. Also, about a quarter of doctors would hesitate to treat a PWA while one in three would not carry out surgery despite adequate precautions. The findings compare favourably with those reported from other countries. However, they still indicate the need for a comprehensive AIDS education package to improve the knowledge base and allay fears for all groups and to prepare HWs for the important task of caring for PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The role and theoretical evolution of knowledge translation and exchange in public health.

BACKGROUND: There is an increased emphasis in public health research on effective models and strategies to support knowledge translation (KT), the exchange, synthesis and ethically sound application of research findings within a complex set of interactions among researchers and knowledge users. In other words, KT can be seen as an acceleration of the knowledge cycle-an acceleration of the natural transformation of knowledge into use (Canadian Institutes of Health Services Research. Knowledge Translation Strategy, 2004). The most recent conceptualizations consider the complexities of public health decision-making. The role of practitioners and communities is increasingly considered. METHODS: We identify, describe and discuss the theoretical underpinnings of KT and recommend a way forward to build the evidence for more effective practice. RESULTS: Theoretical perspectives increasingly influence research on KT in public health. A range of innovative work is being conducted to explore methods for KT using practical tools, often with the support of government. CONCLUSIONS: KT describes a crucial and to date under-developed element of the research process. There is an important gap in theoretically informed empirical studies of effectiveness of proposed approaches in public health, health promotion and preventive medicine, and thus much of the debate remains abstract. There is clearly an urgent policy need to establish the effectiveness of KT models in a range of contexts. This must include both the consideration of development and the utilization of knowledge.

Evidence-Based Medicine↗
PubMed2006

Intelligent nursing: accounting for knowledge as action in practice.

This paper provides an analysis of nursing as a knowledgeable discipline. We examined ways in which knowledge operates in the practice of home care nursing and explored how knowledge might be fruitfully understood within the ambiguous spaces and competing temporalities characterizing contemporary healthcare services. Two popular metaphors of knowledge in nursing practice were identified and critically examined; evidence-based practice and the nurse as an intuitive worker. Pointing to faults in these conceptualizations, we suggest a different way of conceptualizing the relationship between knowledge and practice, namely practice as being activated by contextualized knowledge. This conceptualization is captured in an understanding of the intelligent creation of context by the nurse for nursing practice to be ethical and effective.

Attitude of Health Personnel↗
PubMed2004

Undergraduate knowledge of aging: a comparative study of biopsychosocial content.

This study assesses undergraduate knowledge of aging, distinguishing between types of deficits (ignorance vs. misinformation) and content areas as delineated by a biopsychosocial framework. Knowledge is examined as an outcome of taking an aging elective, while accounting for course rating and knowledge retention. A diverse body of UCLA undergraduate students who took an aging course (n = 349) and a stratified random comparison group (n = 430) took Palmore's Facts on Aging Quiz and scored 14 and 12 items correct, respectively. Undergraduates (n = 779) showed a good knowledge of aging in the psychological- cognitive domain, but consistent with previous findings, they exhibited deficits primarily in the social-demographic realm. Taking an aging course was significantly related to better overall knowledge of aging (correct) (p </= .0001), and fewer don't know responses (p </=.0001). Course rating and shorter timing until testing were also significantly related to better knowledge.

Adult↗
PubMed1999

STD-related knowledge, beliefs and attitudes of Xhosa-speaking patients attending STD primary health-care clinics in South Africa.

The primary aim of this study was to describe patients at sexually transmitted disease (STD) clinics in Cape Town, South Africa, in terms of gender, education and age differences relative to their STD knowledge and beliefs, their condom use, as well as their attitudes towards condom use and their condom-use behaviour. The information was collected with a view to developing a health education intervention. Structured interviews were conducted with 2978 randomly sampled Xhosa-speaking STD clinic attenders about their knowledge, beliefs and practices regarding STDs and related behaviours. More males (75%) than females (25%) presented for STD treatment. The majority of patients (92%) were younger than 35 years. Female patients were found to be more aware than male patients of the sexual nature of STD transmission, valued personal autonomy in sexual behaviour and expressed a greater need to use condoms. Males perceived STD symptoms to be more serious, had more misconceptions about the cause of STDs and also more negative beliefs and attitudes towards condom use. Only 34.9% of the patients reported using condoms in the last 6 months while only 24.5% reported regular use. Those who reported condom use were more knowledgeable about the sexual transmission of STDs and the effects of STDs on the neonate. They also had fewer misconceptions about the causes of STDs and perceived STD symptoms to be more serious, attached greater value to personal autonomy in sexual behaviour and condom use and had more positive outcome expectancies of refusing sex than those who never used condoms. The data suggest that targeted interventions directed at males will have to address their inadequate knowledge regarding STDs in terms of transmission, causes, consequences, prevention and cure. Their negative beliefs and attitudes towards condoms will need special attention, especially in view of their multiple partner behaviour. Interventions directed at females will need to improve their knowledge regarding STD consequences, causes, recognition of symptoms as well as improve their knowledge of aspects of prevention and cure. All interventions must facilitate personal autonomy in decision making about sexual behaviour and condom use for both men and women, through skills development programmes that promote self-efficacy in the individual and instil a culture of mutual respect of such in the community.

Adult↗
PubMed2003

Trends in community knowledge of the warning signs and risk factors for stroke.

CONTEXT: Poor public knowledge of stroke warning signs and risk factors limits effective stroke intervention and prevention. OBJECTIVE: To examine temporal trends in public knowledge of stroke warning signs and risk factors. DESIGN AND SETTING: Population-based random-digit telephone survey conducted in July-November 2000 among individuals in the greater Cincinnati, Ohio, region. PARTICIPANTS: A total of 2173 survey respondents (69% response rate) were randomly identified based on their demographic similarities to the ischemic stroke population with regard to age, race, and sex. MAIN OUTCOME MEASURES: Spontaneous recall of at least 1 important stroke warning sign and 1 established stroke risk factor in comparison with findings from the same survey in 1995. RESULTS: In 2000, 70% of respondents correctly named at least 1 established stroke warning sign vs 57% in 1995 (P<.001), and 72% correctly named at least 1 established stroke risk factor vs 68% in 1995. Groups of individuals with the highest risk and incidence of stroke, such as persons at least 75 years old, blacks, and men, were the least knowledgeable about warning signs and risk factors. Television was the most frequently cited source of knowledge, 32% in 2000 vs 24% in 1995 (P<.001). CONCLUSIONS: Public knowledge of stroke warning signs within the greater Cincinnati region has significantly improved from 1995 to 2000, although knowledge of stroke risk factors did not improve significantly during the same time period. Public education efforts must continue and should focus on groups at the highest risk of stroke.

Adult↗
PubMed1997

Age-related differences in breast carcinoma knowledge, beliefs, and perceived risk among women visiting an academic general medicine practice.

BACKGROUND: This study assessed whether age-related differences in breast carcinoma knowledge and perceived risk exist among women in a primary care setting and whether these women's beliefs about the best age to begin screening mammography reflect those of their physicians. METHODS: Consecutive women ages 30-70 years who visited an academic general medicine practice were asked to complete a questionnaire assessing breast carcinoma knowledge, beliefs, and perceived risk. Women's risk estimates were compared with individual risk probabilities derived from the Gail model. Women's beliefs about when to begin screening mammography were compared with the beliefs of the attending physicians in the practice. Questionnaire results were compared across age groups. RESULTS: Six hundred seventy-four women completed the survey. Overall, knowledge scores were negatively correlated with age (correlation coefficient = -0.30, P = 0.001). The level of knowledge about the benefits of mammography was high across all age groups. In contrast, knowledge that breast carcinoma incidence increases with age was poor. Only 28% of all women recognized that breast carcinoma is more common among women age 65 years than among women age 40 years. Among all women, 26% underestimated their risk of developing breast carcinoma in the next 10 years, 32% correctly estimated their risk, and 42% overestimated their risk. Fifty-five percent thought that mammography should begin when a woman is age 30-35 years. In contrast, all surveyed physicians recommended that a woman start undergoing mammography at age 40 years or older. CONCLUSIONS: In this primary care setting, older women had poorer breast carcinoma knowledge than younger women but were equally likely to appreciate the benefits of mammography. Most women were unaware that age is a risk factor for breast carcinoma. Improved education of females by their physicians may resolve some of the observed discrepancies regarding the optimal age to begin screening mammography.

Adult↗
PubMedDate not supplied

Is knowledge of health behavior associated with low birth weight?

OBJECTIVE: To examine the relationship of patient knowledge concerning seven health behaviors identified by the U.S. Public Health Service Expert Panel and low birth weight. METHODS: Interviews of 538 women delivering at an inner-city hospital in New Orleans were conducted. Information concerning patient characteristics, health behavior knowledge, and birth weight was collected. Data were analyzed as dichotomous and compared using odds ratios. Logistic regression was chosen to calculate adjusted odds ratios, including only factors found to be associated with the tested end point, low birth weight. RESULTS: A majority of women knew all seven health behavior items. Individual items were known by > or =80% of respondents. Knowledge associated with low birth weight included avoidance of alcohol and drugs, taking of prenatal vitamins, and following a proper diet. Information on all seven was not associated with a reduction in low birth weight. Other factors found to be associated with low birth weight included inadequate prenatal care, absence of health insurance (primarily Medicaid), and a prior low birth weight infant. Logistic regression confirmed both the importance of the last three factors, and the lack of association with health knowledge about all seven items. CONCLUSIONS: Knowledge concerning health advice behavior recommended by the U.S. Public Health Service was more widely known than previously thought. While individual components were associated with a reduction in low birth weight, overall knowledge was not.

Adult↗
PubMed2001

Correlates of family caregivers' knowledge about Alzheimer's disease.

OBJECTIVE: The aim of the present study was to assess family caregivers' level of knowledge about Alzheimer's disease and its correlates. DESIGN, SETTING AND PARTICIPANTS: Two hundred and twenty informal caregivers of an elderly person suffering from Alzheimer's disease were recruited from four large memory clinics across the country and interviewed by trained research assistants. MEASURES: Knowledge of the disease was assessed using a questionnaire including 17 items examining general knowledge, symptoms, treatment and services. Independent variables included caregivers' socio-demographic characteristics, patients' clinical characteristics and characteristics of the caregiving situation. RESULTS: Overall, low levels of knowledge were found, especially in items related to the prevalence, causes and symptoms of the disease. Low education and being a spouse were the most important vulnerability factors associated with poor knowledge. CONCLUSIONS: Further research on the correlates of caregivers' knowledge about AD should be promoted in order to allow better decision-making processes and better matching of the needs of caregivers and intervention programs.

Aged↗
PubMed2002

Impact of undergoing prostate carcinoma screening on prostate carcinoma-related knowledge and distress.

BACKGROUND: Despite the ongoing controversy regarding the utility of prostate carcinoma (PCa) screening, the prevalence of asymptomatic men who participate in free PCa screening programs is on the rise. However, this increased awareness has not been associated with increased knowledge about the potential limitations of PCa creening. We conducted a prospective assessment to delineate men's motivations for undergoing screening and to determine the impact of screening on psychological distress and on men's knowledge about PCa screening. METHODS: We conducted two telephone interviews with a group of 136 men registered to undergo free PCa screening at two hospital-based sites. The first interview was conducted before screening and the second interview followed receipt of the screening results. Interviews assessed demographics and screening history, reasons for undergoing the current screening, cancer-related and general psychological distress, knowledge of risk factors for PCa, and knowledge of the benefits and limitations of screening. Only participants with normal screening results were included in these analyses. RESULTS: "Seeking peace of mind about prostate cancer" was rated as the most important reason for undergoing screening. PCa-related distress decreased following receipt of a negative result (P < 0.01). Stratified analyses indicated that this was particularly true among younger men and African American men (both Ps < 0.001). Awareness of the benefits of screening was very high, but awareness of limitations was low, with fewer limitations reported following screening compared with prescreening (P < 0.01). Although awareness of the established risk factors improved following screening, controversial risk factors (i.e., those with limited empirical support) and factors that were unrelated to PCa risk were also rated as more important in the development of PCa than they were before screening (all Ps < 0.05). Therefore, the results may reflect that following screening, participants were simply more likely to endorse plausible risk factors, rather than actually reflecting an increase in participants' knowledge. CONCLUSIONS: These results suggest the importance of developing informed consent procedures and educational programs for the asymptomatic men who participate in free prostate screening programs each year, as the decision to be screened is being made without the benefit of a full understanding of the current state of medical knowledge about PCa screening. Until the definitive results of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial are available, improved patient education is needed to assist men in making screening decisions consistent with their own preferences.

Black or African American↗
PubMed2003

Has the investment in public cancer education delivered observable changes in knowledge over the past 10 years?

BACKGROUND: During the 1990s, Western countries, such as Australia, directed substantial funds toward public cancer education. An important indicator of whether this investment has been worthwhile is a shift over time in the proportion of the population who have accurate knowledge regarding cancer. METHODS: In the year 2000, a cross-sectional telephone survey was administered to 685 residents selected from the New South Wales (Australia) Electronic White Pages telephone directory. This study replicated in part a survey conducted in 1989. RESULTS: In the 2000 survey, smoking (96.0%) and sun exposure (80.4%) were well-known as risk factors for lung cancer and melanoma, respectively. However, community knowledge of risk factors for colorectal, breast, cervical, and prostate cancer was poor. Most respondents were able to nominate mammograms (82.2%) and Pap tests (86.8%) as screening tests for breast and cervical cancer, respectively. Approximately two-thirds of the sample were able to nominate foods that reduce the risk of developing cancer. Compared with the 1989 data, there appeared to have been improvements in community knowledge of mammograms as a screening test for breast cancer. For the other cancers, knowledge gains appeared smaller or marginal. With regard to the lifetime risk of developing these cancers, community understanding remains poor. Predictors of greater knowledge include a higher level of education. CONCLUSIONS: Where ongoing investments have been made, like in the case of breast cancer education, there have been improvements in community knowledge. However, major challenges remain. Potential targets for future public education campaigns are discussed.

Australia↗
PubMed2006

Knowledge of stroke symptoms and risk factors among Korean immigrants in the United States.

Korean immigrant's knowledge of stroke symptoms and risk factors was assessed in a convenience sample (n = 119) in a Midwestern metropolitan area. Knowledge ranged from very low to moderate. Cluster analysis showed that there were two groups. One cluster had higher knowledge of stroke symptoms and risk factors, but lower knowledge of symptoms and risk factors not associated with stroke. Participants who were older, were not married, and had a history of hypertension had significantly lower knowledge of stroke symptoms and stroke risk factors. Lower knowledge among older adults and/or those who had hypertension is a particular concern because such individuals are at highest risk for stroke.

Adult↗
PubMedDate not supplied

Survey of knowledge and practice on oral contraceptive and emergency contraceptive pills of drugstore personnel in Hat Yai, Thailand.

In Thailand, oral contraceptive (OC) and emergency contraceptive pill (ECP) are available as over-the-counter (OTC) drugs, and drugstores share 30% of services. While the rate of dispensing contraceptive pills has increased, the knowledge and awareness of ECP use is limited among users and providers. The objective of this study was to assess knowledge and practice of drugstore personnel on providing OC and ECP, in order to improve the quality of services. Drugstores located in Hat Yai District, Songkhla Province, Southern Thailand, were the accessible population. There were 109 drugstores, half of them owned by pharmacists. The population was stratified by owner (pharmacist or non-pharmacist) and randomly selected to obtain a sample size of 30 drugstores for each class. Two study methods, questionnaire interview and secret shopping, were used to measure knowledge, and practice, respectively. History-taking, drug-choosing, and advice-giving were the domains measured. The results demonstrated that knowledge on OC was fair, but that on ECP was poor. Pharmacists had better knowledge of proper history taking and ECP indication than non-pharmacists. OC and ECP provision were inappropriately practised in drugstores in the study area. A majority of drugstores were mainly owned by non-pharmacists. For OC practice, drug-choosing was good, but history-taking and advice-giving were poor in both groups. Although both groups dispensed ECP poorly, pharmacists dispensed significantly better than non-pharmacists. Among non-pharmacist staff, the average scores of OC advice-giving, and ECP dispensing, were statistically significantly better among those working in pharmacist-owned drugstores. Both knowledge and practice on OC and ECP should be improved in both types of drugstores in the study area.

Community Pharmacy Services↗
PubMed2001

Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women.

BACKGROUND: Smoking during pregnancy increases the health risks of the unborn child as well as the mother. Although smoking rates for the population as a whole have declined drastically in the past generation, since 1992 there has been an increase in smoking among women, teenagers, and adults living in poverty. The purpose of this study was to assess reading level, tobacco knowledge, attitudes, and practices of tobacco use among pregnant adult and adolescent women in the public health system in north Louisiana. METHODS: A convenience sample of 600 pregnant women was interviewed in person in the Obstetrics Clinics at Louisiana State University Health Sciences Center at Shreveport and E.A. Conway in Monroe. The structured interview contained detailed questions about smoking practices, tobacco knowledge, and attitudes. Reading was assessed using the Rapid Estimate of Adult Literacy in Medicine. Smoking practices were assessed by self-report and verified by measuring urine cotinine levels. The Cochran-Mantel-Haenszel test was used to estimate the relationship between reading level and knowledge and attitude; multiple logistic regression was used to determine which variable(s) predicted current smoking practices. RESULTS: Knowledge about the effects of smoking and concern about the health effect of smoking on their baby varied significantly by reading level, with participants with higher reading levels having more knowledge and greater concern. Smoking practices did not vary by reading level even when race, age, and living with a smoker were controlled. Race was a significant determinant of smoking practices, with more white women reporting currently smoking during pregnancy than African Americans (34% vs 8%). CONCLUSIONS: Reading level was related to knowledge about health effects of smoking. Women with higher reading levels were also more concerned about the adverse health effects of smoking on themselves and their babies. However, reading level was not correlated with smoking prevalence. The most significant determinant of smoking was race (with whites smoking significantly more than African Americans).

Adolescent↗