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PubMed2006

Recognizing tacit knowledge in medical epistemology.

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi's theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino's classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi's epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.

Clinical Competence↗
PubMed2025

Men's Knowledge, Attitudes, Practices, Cultural Beliefs, and Perceived Risk and Susceptibility Regarding Prostate Cancer in the Vhembe District, Limpopo Province, South Africa.

BACKGROUND: Prostate cancer (PCa) awareness and knowledge among men in Vhembe District, Limpopo Province, South Africa, remain inadequately studied despite the high local burden of the disease. This study investigates the knowledge, attitudes, practices, cultural beliefs, and perceived risk of PCa among men aged 40 and above in selected villages under the Mphaphuli and Niani tribal authorities. METHODS: A quantitative survey was conducted with 431 men, utilizing a questionnaire adapted from the African Women Awareness of Cancer (AWACAN) tool. The questionnaire, translated into Tshivenda, assessed socio-demographic data, awareness, knowledge of risk factors and symptoms, health-seeking behavior, and barriers to seeking medical help. RESULTS: The study revealed that 51.3% of participants had heard of PCa, while 48.7% had not. Awareness varied significantly with age, relationship status, education level, and language. Older men and those with higher education levels were more knowledgeable about PCa. Clinics, hospitals, and media were the primary sources of information. Misconceptions about risk factors were prevalent, with 24.0% of men indicating a preference for traditional healers for PCa symptoms. Barriers to medical help included fear of the disease, procedural fears, and cultural taboos. Multivariate analysis identified significant factors associated with PCa knowledge, including age, language, access to tap water, and cell phone ownership. CONCLUSION: These findings underscore the importance of targeted educational interventions considering sociodemographic and cultural contexts. Future public health initiatives should focus on bridging the gap between traditional and modern medical practices to enhance health outcomes in the Vhembe District and similar settings.

Humans↗
PubMed1976

Contraceptive knowledge and practice among undergraduates at a Canadian university.

A total of 509 undergraduate students aged 17 to 23 years, were tested to assess the adequacy of their knowledge of methods of birth control. A level of adequate knowledge was arbitrarily defined a priori as one standard deviation below the mean score of a random sample of second-year medical students, who were assumed to have more than adequate knowledge on the basis of prior courses in reproductive physiology and human sexuality. Of the undergraduate population sampled, 34 per cent were found to have inadequate knowledge. This population is in need of birth control information. Of nonvirgins in the sample, 20.2 per cent risk unwanted pregnancy, the majority (78.3 per cent) in spite of adequate knowledge. This suggests that lack of motivation, rather than purely lack of information, is an important factor contributing to the unwanted pregnancy rate of the college student population.

Adolescent↗
PubMed1992

Knowledge about, and attitudes to, HIV/AIDS among students in a Sydney nursing college.

The purpose of this study was to assess nursing students' knowledge about HIV infection and AIDS. 231 nursing students at a nursing college in Sydney were invited, and agreed, to participate. They were surveyed on knowledge about transmission, precautions to take when providing nursing care and epidemiology, general attitudes to HIV/AIDS, attitudes to patient-care, risk of infection at work and homosexuality. Two knowledge and four attitude scales were constructed. The students showed a fairly high level of knowledge: a mean percentage score of 78 on the transmission scale and 80 on the precaution scale. They also had some misconceptions about transmission routes. A majority (72%) had favourable attitudes to AIDS patient care; a minority (22%) had a clear fear of contagion through occupational exposure; 26% had negative attitudes to homosexuality. Nursing students with AIDS-care experience had significantly more positive attitudes than those who had no such experience. Knowledge and attitudes were positively correlated (correlation range 0.24-0.46). It is suggested that training programmes include experiential learning to address fear, discomfort and anxieties about HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Knowledge and attitude change as predictors of metabolic improvement in diabetes education.

Randomized trials of formal diabetes education have proven that education in isolation from other aspects of diabetes care has limited impact on metabolic control through the simple transfer of information. Comprehensive programme evaluation requires assessment of the process by which knowledge and attitude change affect subsequent control of diabetes. This study examined the impact of a formal diabetes education programme on diabetes-specific knowledge and attitude, and the relationship between these characteristics and metabolic control of the disease over a 15-month period. Knowledge and attitude were assessed using parallel forms of the DKN and ATT39 scales presented randomly as pre-test and post-test to 309 patients attending a 2-day diabetes education programme. Mean knowledge scores increased by 25% (P less than 0.0001) and standardized ATT scores showed a small but significant positive shift after the programme (P less than 0.01) and remained stable in a subset of 177 patients at 3-month follow-up. ATT scores showed a marked convergence towards normal during the intervention (ANOVA, P less than 0.0001). Glycosylated haemoglobin (HbAlc), a medium-term measure of blood glucose control, was recorded in 209 cases for 6 months preceding the programme, and for 15 months following, at intervals of 3 months. The mean HbAlc improvement, from 11.3 to 9.0% (P less than 0.001), was predicted by stepwise regression from initial diabetes control (57% variance) and psychosocial factors (17% variance) including attitude scores and personality characteristics. Diabetes knowledge did not predict improvement in the control of diabetes.

Adaptation, Psychological↗
PubMed1996

Attitude, knowledge and habits of high school pupils in Israel regarding oral health.

The purpose of this project was to study the habits, knowledge and attitudes of 132 high school students in regards to their teeth and oral health. An inflated amount of consumption of snack food and sweet beverages between meals was reported. Seventy-two point seven percent claimed to brush their teeth at least twice daily. Forty-nine point three percent claimed to visit their dentist annually. The results also demonstrated a poor general knowledge and misconceptions concerning teeth, food and oral health throughout the years of high school studies. Knowledge levels correlated with with age. More than half of the pupils attributed esthetical importance to the teeth appearance. The students' knowledge concerning prevention stemmed mainly from their dentist, parents, and the media and only 2.6% learned anything from formal school teaching. In the light of the students' poor knowledge, it would appear that resources should be invested in schools at the elementary and high school level for oral hygiene and caries prevention education in the hope of improving bad habits and perpetuating improved oral health and hygiene.

Adolescent↗
PubMed1996

Knowledge and diabetes self-management.

This paper discusses the role of knowledge in the self-management of diabetes mellitus and addresses limitations in the measurement of knowledge in studies which have been undertaken. In addition, the findings of a recent investigation related to knowledge of diabetes in young adults with the condition are reported. The results showed high levels of knowledge and glycosylated haemoglobin values which were acceptable when length of time with diabetes was considered. However, no relationship between knowledge and level of glycaemic control was demonstrated. In the light of recent research confirming the need for tighter metabolic control, the implications of these findings in relation to future research and the education of health care professionals are considered. Although this paper related to diabetes mellitus many of the issues raised are equally applicable to the wider forum of chronic illness management.

Adolescent↗
PubMedDate not supplied

The human immunodeficiency virus: knowledge and precautions among anesthesiology personnel.

STUDY OBJECTIVE: To compare actual infectious disease precautions with current recommendations and to determine the influence of age, clinical experience, human immunodeficiency virus (HIV) knowledge, previous personal HIV exposure, and education on practices. DESIGN: Direct clinical observations of infectious precautions and preeducation and posteducation surveys of clinical practices and general knowledge of the HIV. SETTING: University teaching hospital. PARTICIPANTS: Forty-six anesthesia department members completed a preeducation survey, and 24 completed a posteducation survey. MEASUREMENTS AND MAIN RESULTS: The survey showed that adequate precautions were used during less than 50% of the routine procedures. Significant positive correlations were found between years of clinical practice and precautions used while inserting vascular catheters. Significant positive correlation was found between years of clinical practice and precautions taken while handling soiled laryngoscopes. Knowledge about the HIV and HIV transmission was limited. We noted a negative correlation between knowledge and precautions during vascular cannulation procedures, emergency department resuscitation, and tracheal suction. More precautions were taken with patients who had proven HIV infections and those at high risk of infection. The posteducation survey demonstrated a significant increase only in the use of gloves during routine procedures. Knowledge scores were only slightly improved and did not significantly reflect infection control practices. CONCLUSIONS: Adequate infectious disease precautions were not taken by anesthesia personnel. An HIV educational program resulted in only a small increase in precautionary measures.

Adult↗
PubMed1993

Changes in adolescents' knowledge and attitudes about AIDS over the course of the AIDS epidemic.

We compared AIDS-related attitudes of junior and senior high school students from 1988 to 1991 and across grade level to examine how effectively schools are addressing AIDS. Attitudes measured included knowledge and social anxiety about AIDS, as well as perceptions of vulnerability to HIV infection. Junior high school students (grades 7-9) were sampled three times, from 1989 to 1991. High school students (grades 10-12) were sampled four times, from 1988 to 1991. The 1991 junior high school sample had lower AIDS knowledge scores than the 1989 sample. Conversely, the 1991 high school sample had more accurate knowledge than earlier groups. With respect to grade level, 9th graders had more accurate knowledge than 7th and 8th graders, but knowledge did not increase from 10th through 12th grade. Anxiety about interacting with a person with AIDS and perceptions of vulnerability to HIV infection were unrelated to either sampling time or grade level. It is concluded that it will be important to redouble efforts to educate adolescents about AIDS and that particular attention needs to be paid to young adolescents.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Adolescents' knowledge and attitudes about and experience with violence.

PURPOSE: Educational interventions directed to the prevention of youth inter-personal violence make assumptions about the educational needs of adolescents for violence-prevention despite little available data. This paper provides new information on background levels of adolescents' knowledge of, attitudes about and experience with violence. METHODS: Over 400 teens across Boston's neighborhoods were surveyed by rando-digit dialed telephone techniques. RESULTS: Results show that while boys are more often involved in violence, almost one quarter of girls report fighting. Black teens witness more violence and are threatened more often than whites, but they do not fight more. Knowledge scores indicate a need for improvement in adolescents' understanding of risk factors. Attitude scores indicate that adolescents believe fighting can and should be avoided, but they lack knowledge of behavioral options. Regression analyses show a positive relationship between violence experience and knowledge and attitudes. CONCLUSION: These data suggest that preventive interventions should be directed to both improving adolescents' knowledge and understanding of personal risk and increasing their repertoire of conflict-resolution skills.

Adaptation, Psychological↗
PubMed2004

Knowledge, attitudes, and practices of argileh (water pipe or hubble-bubble) and cigarette smoking among pregnant women in Lebanon.

BACKGROUND: Currently, little is known about argileh (water pipe or hubble-bubble) and cigarette smoking among pregnant women in the Arab world, despite emerging evidence on the adverse health effects of argileh smoking and well-established knowledge about the health risks of cigarette smoking during pregnancy. OBJECTIVES: The present study assesses pregnant Arab women's knowledge of chemical contents and related harmful effects of argileh and cigarettes, their attitudes towards smoking argileh and cigarettes, and their actual smoking of argileh and cigarettes, both before and during pregnancy. METHODS: A stratified sample of 864 women from 23 health care centers in Lebanon completed a structured, interviewer-administered questionnaire. Information was collected on basic demographic variables, women's knowledge, attitudes, and cigarette and argileh smoking. RESULTS: Women were partially knowledgeable about the health risks of cigarette smoking, knew little about the harmful ingredients of argileh smoking, and had many misconceptions regarding how argileh worked or how it can produce harm. Attitudes were permissive towards all forms of smoking. Almost one quarter (23%) of participants reported smoking during pregnancy, with 17% smoking only cigarettes, 4% smoking only argileh, and 1.5% smoking both cigarette and argileh. CONCLUSION: A significant and growing percentage of pregnant Arab women are smoking in Lebanon, with four cigarette smokers for every argileh smoker. Smoking behaviors are empirically linked with important gaps in knowledge and with permissive attitudes. These data may be used to design more effective prevention programs targeting this vulnerable population.

Adult↗
PubMed2005

A simplified education program improves knowledge, self-care behavior, and disease severity in heart failure patients in rural settings.

BACKGROUND: Self-monitoring by heart failure (HF) patients of worsening symptoms caused by fluid overload is a cornerstone of HF care. Disease management has improved outcomes in HF; however, these resource-intensive programs are limited to urban centers and are generally unavailable in rural or limited health care access areas. This pilot study sought to determine whether a simplified education program focused on a single component of disease management (symptom recognition and management of fluid weight) could improve knowledge, patient-reported self-care behavior, and HF severity in a rural setting. METHODS: This randomized clinical trial enrolled 36 rural HF patients into an intervention or control group. The intervention group received a simplified education program with a follow-up phone call focusing on symptom management delivered by a non-cardiac-trained nurse. Patient knowledge, self-care behaviors, and HF severity (B-natriuretic peptide [BNP]) were measured at enrollment and at 3 months. RESULTS: The sample was primarily white men and married with a mean age of 71 years and ejection fraction of 47%. There were no differences between groups in knowledge, self-care behaviors and BNP at baseline; however, knowledge and self-care behavior related to daily weights improved significantly at 3 months in the intervention group (P = .01 and .03, respectively). Although the changes in mean BNP at 3 months were in the hypothesized direction, the difference between the 2 groups was not significant. CONCLUSIONS: A simplified education program designed for use in resource scarce settings improves knowledge and patient-reported self-care behaviors. These findings are important in providing care to patients with HF in limited access settings but should be studied for longer periods in more heterogeneous populations.

Aged↗
PubMed2006

Knowledge of Medicaid coverage and effectiveness of smoking treatments.

BACKGROUND: Tobacco dependence has enormous health and financial repercussions in the United States, particularly among Medicaid enrollees, where a disproportionate share of the population smokes (36% compared to 23% in the general population). This paper examines two factors associated with the use of tobacco-dependence treatments (TDTs) in the Medicaid population: knowledge of TDT coverage and perceived effectiveness of TDTs. METHODS: Medicaid-enrolled smokers and recent quitters in four areas in the United States with comprehensive coverage of TDTs were interviewed as part of a random-digit-dial telephone survey in September 2003. Information was collected on demographics, health status, smoking history, knowledge of Medicaid coverage of TDTs (nicotine replacement patch and gum, Zyban, and counseling), and perceived effectiveness of TDTs. Logistic regression models were estimated to explain variation in enrollee use of TDTs as a function of knowledge of covered benefits and perceived effectiveness of the treatments. RESULTS: Both knowledge of TDT coverage and the perceived effectiveness of TDTs are positively associated with the use of TDTs in the Medicaid population. However, a majority of Medicaid smokers do not know that Medicaid covers TDTs, and the perceived effectiveness of TDTs is often at odds with findings from the scientific literature. CONCLUSIONS: Knowledge of Medicaid coverage and the perceived effectiveness of TDTs are associated with increased use of TDTs in the Medicaid population. Additional research is needed to better inform Medicaid smokers of their coverage and the effectiveness of TDTs in ways that encourage them to use these treatments to assist quit attempts.

Adolescent↗
PubMedDate not supplied

Knowledge and lifestyle behaviors of healthy older adults related to modifying the onset of vascular dementia.

The purpose of this study was to examine the relationship between knowledge and practice of lifestyle behaviors in healthy older adults related to the prevention of vascular dementia. Data were derived from a convenience sample of 281 Canadian participants 55 years of age and older. Lifestyle was measured using the health-promoting lifestyle profile (HPLP). Seven knowledge sub-scales were developed consistent to the HPLP. Multivariate analysis found that four independent variables accounted for 26% of the variance of a healthy lifestyle score and included those who reported a lower level of stress, indicated a higher knowledge of interpersonal relations, had a better general health self-assessment and higher medical knowledge. These Canadian results were compared with those from a study conducted in Australia and found to be similar. The study argues that health professionals and health education programs can better promote and increase awareness of healthy lifestyle behaviors by assisting older adults to apply this knowledge in their daily lives. Specifically, the study discusses policy and practice implications with regards to lifestyle issues relating to health responsibility, physical activity, spirituality, stress management, interpersonal relationships and nutrition.

Aged↗
PubMed2004

Knowledge modeling and acquisition of traditional Chinese herbal drugs and formulae from text.

Traditional Chinese medicine has developed over more than 4000 years. A tremendous amount of medical knowledge has been accumulated, among which herbal drugs and formulae are an important portion. This paper presents an ontology for traditional Chinese drugs and formulae, and an ontology-based system for extracting knowledge of drugs and formulae from semi-structured text. The system consists of two components: an executable knowledge extraction language (or EKEL) for specifying knowledge-extracting agents, and a support machine for executing EKEL programs. Experiments show that the system is adequate of extracting knowledge of herbal drugs and formulae from semi-structured text.

Automation↗
PubMed2005

Burn first aid in Western Australia--do healthcare workers have the knowledge?

Burn injuries treated with adequate immediate first aid are associated with more favourable outcomes, limiting tissue damage and subsequent morbidity including the need for surgery. Cool running water at a temperature of between 10-15 degrees C for 20 to 30 minutes is considered adequate burn first aid treatment. A prospective audit of all new patients (n=227) with burns, attending the minor burn facility at Royal Perth Hospital showed only 88 (39%) patients received appropriate first aid. Fifty percent of patients receiving inappropriate first aid, had this delivered by his or her primary health care contact. This study aims to determine the knowledge of burns first aid among healthcare workers (HCW) and compare this to the general population. A customized survey was performed, four sample cases were included with 4 possible answers in a multiple choice format. All case studies asked the participant to record immediate first aid management. On a case by case basis, burn first aid knowledge was fair but overall knowledge very poor, only 18.8% of respondents achieving 4 correct responses. The uptake of first aid courses was high among HCW at 75% but particularly low among the NHCW at 28%. Our study has shown the value of performing such a course, with a statistically significant (p=0.00) difference between participants who had completed a first aid course and those that had not. The purpose of this study was to quantify knowledge of burns first aid with a view to providing directed education, studies have shown the success of multimedia campaigns. It has been shown that good first aid improves the outcome for the burn patient and this study demonstrates that participation in a first aid course improves knowledge. It is justifiable to progress toward compulsory first aid courses which include first aid of the burns patient to improve outcomes for the community as a whole.

Burns↗
PubMed2004

Neural foundations of emerging route knowledge in complex spatial environments.

Behavioral evidence suggests that spatial knowledge derived from ground-level navigation can consist of both route and survey knowledge. Neuroimaging and lesion studies aiming to identify the neural structures responsible for topographical learning in humans have yielded partially inconsistent results, probably due to the lack of an effective behavioral parameter allowing for a reliable distinction between different representations. Therefore, we employed a novel virtual reality environment that provides accuracy and reaction time measures precisely indicating the emergence of route vs. survey knowledge. Functional magnetic resonance imaging (fMRI) was used to localize brain regions involved in the acquisition of pure route knowledge in the form of associations between consecutive landmark views and the direction of intermediate movements. Participants were scanned during repeated encoding of the complex environment from a first-person, ground-level perspective. Behavioral data revealed emerging route knowledge in 11 out of 14 subjects. Overall comparisons between encoding and control conditions identified activation in medial frontal gyrus, retrosplenial cortex and posterior inferior parietal cortex. Most importantly, only posterior inferior parietal regions showed increasing activation across sessions, thus paralleling behavioral measures of route expertise. Given the established role of the posterior parietal cortex in spatial processing, this area is thought to provide the pivotal spatial link between two landmarks encountered in immediate temporal succession.

Adult↗
PubMed2005

A survey of breast cancer awareness and knowledge in a Western population: lots of light but little illumination.

There are conflicting data on breast cancer awareness and knowledge in specific population groups. We assessed awareness and knowledge of breast cancer in the general Irish population to identify sources of information on breast cancer and determine factors associated with knowledge and awareness of the disease. Participants (n=2355, 53% female) completed a multi-part questionnaire. Most (81%) had seen or heard something about breast cancer in the recent past and knowledge of symptoms and treatment was good overall. However, 66% of females overestimated their risk of developing disease, 88% underestimated the age at which it was most likely to develop and 56% underestimated 5-year survival. Knowledge of incidence and survival was higher in males (Odds Ratio (OR) 1.3, 95% Confidence Interval (CI); 1.1-1.5), participants with higher education (1.5; 1.2-1.7) and those who received information from television (1.3; 1.1-1.5). Ignorance regarding incidence, outcome and risk makes it unlikely that the general public or at risk females could currently make informed decisions on a range of breast cancer issues.

Adult↗