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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↗
PubMed1998

Contraceptive knowledge: development of a valid measure and survey of pill users and general practioners.

AIMS: To design, pilot, and validate a questionnaire to test contraceptive knowledge in combined oral contraceptive pill users. METHOD: To ensure face and content validity the questionnaire was developed using existing unvalidated instruments and in consultation with GPs, local and national family planning experts, and with pill users. The questionnaire was then piloted with 15 current oral contraceptive pill users and 10 local GPs, modified, and a contraceptive knowledge 'score' developed. Construct validity-that the degree of family planning training should predict contraceptive knowledge-was tested in four groups: family planning trainers (n=28), GPs (n=40), current pill users (n=53), and male medical students (n=59). Thirty current pill users were sent the questionnaire after two weeks to determine test-retest reliability. RESULTS: The questionnaire showed construct validity: there was a gradient of scores across the four knowledge groups. Family planning trainers had the highest scores, followed by GPs, and current pill users, with male medical students having the lowest scores (Kruskal-Wallis test p<0.001). Women had good knowledge of situations when pill efficacy is reduced but poorer knowledge of what action to take subsequently. Predictors of knowledge in pill users were educational level, age, and the importance attached to not falling pregnant-thus providing further evidence for the construct validity of the questionnaire. Test-retest reliability was good (rank correlation 0. 73). CONCLUSION: A contraceptive knowledge questionnaire suitable for use in audit or research has been developed which is reliable and has face, content and construct validity. Pill users have poor knowledge of what to do in situations of pill failure and about the details of emergency contraception. Trials are needed to assess the effectiveness of different strategies to improve contraceptive knowledge in women.

Adult↗
PubMed1994

Development differences in associative memory: strategy use, mental effort, and knowledge access interactions.

The deployment of memory strategies is resource demanding and more so for younger children than for older children and adults. The associative memory studies reviewed show that accessibility to relevant event knowledge is directly related to the resource demands of using an elaboration strategy. The greater efficiency of strategy use by older children and adults permits the use of available mental resources to support additional task-relevant processing of to-be-learned items. This additional processing might include alternate or more durable encodings of pair relationships, creation of retrieval opportunities (strategies), and effective strategy monitoring. The additional processing enabled by the freeing of information-processing resources is hypothesized to be responsible for the developmental increase in the efficacy of elaboration and other associative strategies. Knowledge access also affects the nature of the relational strategy selected and the recall benefits observed. Although increases in "elaboration" were hypothesized to account for developmental differences in associative memory, the evidence clearly shows that other associative strategies are also involved. Although these other associative strategies involve elaboration in a nontechnical sense, the observed dissociations between them and the elaboration strategy argue for maintaining the distinction. Moreover, further analysis is needed to understand the interactions between strategy selection and knowledge access. In this regard, the initial strategy deployed by a learner is dependent on his or her knowledge about the relative effectiveness of various relational associations and interactions with knowledge access. For example, a younger subject might forgo "elaboration" if the items are "captured" by an "other associative" relationship activated during strategy deployment (particularly if the initial search for an elaboration is very effortful). In contrast, an older subject might persevere at retrieving a relevant event because of his or her knowledge about the benefits of encoding "direct" interactions for pair members. The learner's subsequent strategy selection, either for additional processing or encoding of new pairs, is undoubtedly more complex because of increases in the learner's knowledge about the relationships between strategy use, knowledge access, and resource demands. In conclusion, research examined in this chapter verified relationships between strategy use, mental effort, and knowledge access. Moreover, interactions between strategy use and knowledge access were exposed. These relationships are presumed to underlie developmental differences in the efficacy of memory strategies.

Adolescent↗
PubMed1994

A concept analysis of personal knowledge: application to nursing education.

A concept analysis of personal knowledge is completed using the Walker and Avant method. The analysis is based on Polanyi's concept of personal knowledge with a working definition being extrapolated from his writings combined with Belenky and colleagues' concept of constructed knowledge. The goal is to construct a definition of personal knowledge which recognizes the multifaceted processing used by humans in the endeavour to perceive new patterns, and which is free from discrimination based on age, sex, culture, discipline, world view or learning style. Knowledge is defined as pattern recognition which may be probabilistically rather than exactly predictive. Personal knowledge is defined as recognition of a new pattern through processing by the human being. The processing may consist of any combination of human and environmental interaction, 'rational intuiting', appraisal, active comprehension and personal judgement, all in a setting of departure from the current conceptual framework. The pattern may be new to the person or to humanity. Personal knowledge is denoted by perception of the person. The antecedents, attributes and consequences are taken from the literature. The empirical referents are hypothesized from a review of the nursing, social work and education literature. After defining personal knowledge and differentiating it from other phenomena, it is integrated into nursing education. An educator accepting personal knowledge as an expectation for students approaches the teaching/learning situation by planning to create an atmosphere in which individual growth and illumination can occur. Therein personal knowledge is integrated into nursing education using the most barrier-free theoretical frameworks in the areas of learning, curriculum and instruction.

Attitude of Health Personnel↗
PubMedDate not supplied

[Analysis of orthopedic specialty knowledge and comparison of 2 written test methods].

QUESTION: What about the knowledge of specific orthopaedic subjects in medical education as tested with mc-questions and open-ended questions? METHOD: 524 medical students were evaluated by a questionnaire survey to determine the state of orthopaedic knowledge in different periods of medical education. With the same questionnaire the use of two different types of written tests of knowledge (multiple choice questions and open-ended questions) has been tested and the results have been compared. The students participating in the orthopaedical practical (6th clinical semester) have been tested before and after the practical, given as pretest and posttest. RESULTS: The results show that the orthopaedic knowledge corresponds to the educational level so that during medical formation, there is a gradual knowledge gain. Comparison of the results of the pretest and the posttest reveals that the highest knowledge gain occurred during the orthopaedic practical. For all groups candidates performed better in mc-questions than in open-ended questions. Likewise in all groups, open-ended questions were found to be more difficult than the mc-questions. CONCLUSIONS: To summarize it may be concluded that there is a gradual orthopaedical knowledge gain during medical formation. It was found that students gain a considerable part of their technical knowledge during the practicals. Both mc-questions and open-ended questions are useful to measure this knowledge gain where there are hints that open-ended questions give a more accurate assessment of the actual knowledge. The pre- and posttest setting can provide both teachers and students with feedback regarding the realization and acquisition of instructional contents.

Curriculum↗
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↗
PubMed1996

Community knowledge of mental illness and reaction to mentally ill people.

BACKGROUND: We test the hypothesis that negative attitudes to mentally ill people may be fuelled by a lack of knowledge. METHOD: A census of knowledge of mental illness was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill in each area. Three attitudinal factors (Fear and Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the Community Attitudes toward the Mentally Ill (CAMI) inventory (see previous paper) were analysed in respect of their associations with knowledge of mental illness. RESULTS: Most respondents (80%) knew of somebody who had a mental illness but a substantial proportion of respondents had little knowledge about mental illness. Social Control showed an association with knowledge of mental illness. Groups who showed more socially controlling attitudes (especially those over 50 years old, those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about mental illness. Regression analysis revealed that when knowledge was taken into account, age had no effect on Social Control, and the effect of social class and ethnic origin was diminished. Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable about mental illness. CONCLUSIONS: The results support the hypothesis that negative attitudes, especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people with children are not related to a lack of knowledge.

Adolescent↗
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↗
PubMedDate not supplied

An inductive algorithm approach to knowledge acquisition for expert system development. A pilot study.

Knowledge acquisition, which consists of knowledge elicitation and knowledge representation, often is considered the weakest link in the design of expert systems. Systems frequently are built on the knowledge of one expert and require extensive use of knowledge engineering techniques to elicit this knowledge from the expert. Inductive algorithms are a potential alternative method of knowledge acquisition for expert system development. The aim of this pilot study was to examine the feasibility of applying machine learning techniques, specifically, inductive algorithms, to an existing research database as a method for knowledge elicitation and knowledge representation for expert system development. Two inductive algorithms (C4 and Classification and Regression Trees [CART]) that generate decision trees were selected for the analysis using a data set of 201 patients hospitalized for Pneumocystis carinii pneumonia. Neither C4 nor CART produced trees with an accuracy that was significantly better than the baseline accuracy (71.3%) for prediction of outcome in the data set. The mean accuracy of the C4 decision trees was below baseline and the mean accuracy of CART decision trees was 74.6%. The experts found both algorithms comprehensible, but not adequate, and identified important missing predictor variables. The study findings suggest that additional research is needed to examine the appropriate use of inductive algorithms in the transformation of nursing data and information into nursing knowledge.

Algorithms↗
PubMed1993

Toward an interim standard for patient-centered knowledge-access.

Most care-giver "knowledge" needs arise at the point of care and are "patient-centered." Many of these knowledge needs can be met using existing on-line knowledge sources, but the process is too time-consuming, currently, for even the computer-proficient. We are developing a set of public domain standards aimed at bringing potentially relevant knowledge to the point of care in a straight-forward and timely fashion. The standards will a) make use of selected items from a Computer-based Patient Record (CPR), e.g., a diagnosis and measure of severity, b) anticipate certain care-giver knowledge needs, e.g., "therapy," "protocols," "complications," and c) try to satisfy those needs from available knowledge sources, e.g., knowledge-bases, citation databases, practice guidelines, and on-line textbooks. The standards will use templates, i.e., fill-in-the-blank structures, to anticipate knowledge needs and UMLS Metathesaurus enhancements to represent the content of knowledge sources. Together, the standards will form the specification for a "Knowledge-Server" (KS) designed to be accessed from any CPR system. Plans are in place to test an interim version of this specification in the context of medical oncology. We are accumulating anecdotal evidence that a KS operating in conjunction with a CPR is much more compelling to users than either a CPR or a KS operating alone.

Artificial Intelligence↗
PubMed1994

AIDS knowledge and condom use in a birth cohort of 16 year olds.

AIMS: The aims of this study were to examine levels of AIDS knowledge and contraceptive practices in a birth cohort of 16 year old Christchurch born children. METHODS: The study was based on the birth cohort of young people participating in the Christchurch Health and Development Study. At age 16 years 953 subjects were questioned about: (a) levels of AIDS knowledge using a 16 item AIDS knowledge questionnaire; (b) rates of sexual activity; (c) patterns of contraceptive use. RESULTS: Members of this cohort had a generally very high knowledge of AIDS with 92% of the sample responding correctly to 14 or more of the 16 AIDS knowledge questions. Just over a quarter of this sample were sexually active during their 16th year and it was estimated that condoms were used in 59% of all sexual acts reported by sample members. There was a clear tendency for rates of condom use to decline with increasing sexual experience with this decline being due to the fact that as teenagers become more sexually experienced condoms were progressively replaced by other contraceptive methods. Those with high levels of AIDS knowledge used condoms at a higher rate of those with low levels of AIDS knowledge even when due allowance was made for the frequency of sexual activity and other potentially confounding factors. CONCLUSIONS: The results of this study suggest that publicity and education about AIDS has been successful in producing high levels of knowledge about this condition in this cohort. However, this knowledge was not directly translated into high levels of condom use largely as a result of the fact that as teenagers became increasingly sexually experienced there was a tendency for condom use to be replaced by other methods of contraception and notably the contraceptive pill.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The effects of semantic category and knowledge type on lexical-semantic access: a PET study.

Neuropsychological studies of patients with category-specific recognition disorders, as well as PET investigations of semantic category effects in visual recognition tasks, have led some authors to the hypothesis that visual-perceptual knowledge plays a crucial role in the recognition of natural items, such as animals, while functional-associative information is more important for the recognition of man-made tools. To study the cerebral correlates of the retrieval of different types of semantic knowledge about living and nonliving entities, we performed a PET experiment in which normal subjects were required to access visual- and functional-associative information related to visually presented words corresponding to animals and tools. The experimental conditions were the following: (1) Rest. (2) Baseline: letter detection in pseudo-words. (3) Animal, visual knowledge: decide whether the animal has a long or short tail with respect to the body. (4) Animal, associative knowledge: decide whether the animal is typically found in Italy. (5) Tool, visual knowledge: decide whether the object is longer than wider or vice versa. (6) Tool, functional knowledge: decide whether the object is typically used as a kitchen tool. Lexical-semantic access (all lexical conditions pooled) activated the prefrontal cortex on the left and the parietal-occipital junction and posterior cingulate cortex bilaterally. An analysis of the individual experimental conditions in comparison with the nonword baseline showed that accessing visual versus associative knowledge was associated with different activation patterns: predominantly frontal in the case of visual features, temporoparietal for associative knowledge. While the activation patterns involved similar areas for living and nonliving entities, in the case of the latter they were restricted to the left hemisphere. The analysis of main effects confirmed these findings: there were several significant differences in the visual-associative comparison, while category-related differences were less prominent. These findings indicate that the retrieval of different types of knowledge is associated with distinct patterns of brain activation; on the other hand, category-related differences were less evident than in picture matching and naming tasks.

Adult↗
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↗
PubMed1995

A measure of knowledge and confidence in relation to HIV and AIDS: reliability and validity.

Knowledge of HIV and AIDS is widely seen as an important determinant of anxiety about such infection in health care workers. However, existing measures of this knowledge suffer from a number of methodological problems and few demonstrate adequate reliability and validity. This paper documents the development of a new measure detailing its reliability and validity. Knowledge, and also confidence in knowledge, were assessed across seven domains of relevant information (e.g. epidemiology, personal risk, symptomatology) in one non-expert group (non-medical undergraduate psychologist) and in three groups with greater expertise (nursing students and third year and final year medical students). The measure was shown to be reliable and to discriminate between the four groups in a manner consistent with the level of education received by each group and in terms of both the scale scores for the seven domains and the individual items. In general, final year medical students were shown to be more knowledgeable, and more confident in their knowledge, than the other groups. The non-medical undergraduates showed the lowest level of knowledge. In general, the groups appeared under-confident in their knowledge about HIV/AIDS. This was interpreted in terms of members of these groups exhibiting caution and the perceived fluctuating nature of the HIV knowledge base. Implications for the training of health care workers in relation to HIV/AIDS are discussed.

Adult↗
PubMed1998

Rural youth: HIV/STD knowledge levels and sources of information.

Though it is recognised that a sound knowledge of HIV/STD transmission is insufficient on its own to ensure that young people practise safer sex, knowledge of this sort is a necessary prerequisite to safe sex behaviours. Research on the HIV/STD knowledge levels of young people has shown that, while they have high levels of HIV knowledge, they generally have little idea about the transmission of other STDs. Moreover, most of this research has been conducted with more accessible youth in large urban centres. The research reported in this paper focused on HIV/STD knowledge levels, awareness of safe and unsafe sexual practices, and the information sources accessed by 1168 young people living in small rural towns in Queensland, Tasmania and Victoria. As with mainstream youth, the participants in this study had high levels of HIV knowledge and very low levels of knowledge about the transmission of other STDs, their names and symptoms. Practical knowledge of the safety of sexual practices was good, although a number of students confused high risk practices with high risk groups. Students mainly accessed informal information sources such as parents, peers and magazines and took little advantage of more formal sources even when they were available in their towns. There were few gender differences in levels of knowledge; however, girls accessed more information sources and knew more names of STDs. The implications of these findings are discussed in relation to young people developing critical attitudes towards more informal sources, and the better use of more formal sources.

Adolescent↗