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PubMed2000

Hindsight bias: a by-product of knowledge updating?

With the benefit of feedback about the outcome of an event, people's recalled judgments are typically closer to the outcome of the event than their original judgments were. It has been suggested that this hindsight bias may be due to a reconstruction process of the prior judgment. A model of such a process is proposed that assumes that knowledge is updated after feedback and that reconstruction is based on the updated knowledge. Consistent with the model's predictions, the results of 2 studies show that knowledge after feedback is systematically shifted toward feedback, and that assisting retrieval of the knowledge prior to feedback reduces hindsight bias. In addition, the model accounts for about 75% of cases in which either hindsight bias or reversed hindsight bias occurred. The authors conclude that hindsight bias can be understood as a by-product of an adaptive process, namely the updating of knowledge after feedback.

Adult↗
PubMed2004

Population of linear experts: knowledge partitioning and function learning.

Knowledge partitioning is a theoretical construct holding that knowledge is not always integrated and homogeneous but may be separated into independent parcels containing mutually contradictory information. Knowledge partitioning has been observed in research on expertise, categorization, and function learning. This article presents a theory of function learning (the population of linear experts model--POLE) that assumes people partition their knowledge whenever they are presented with a complex task. The authors show that POLE is a general model of function learning that accommodates both benchmark results and recent data on knowledge partitioning. POLE also makes the counterintuitive prediction that a person's distribution of responses to repeated test stimuli should be multimodal. The authors report 3 experiments that support this prediction.

Analysis of Variance↗
PubMed2004

Suppressing irrelevant information: knowledge activation or inhibition?

In 3 experiments, the authors examined the role of knowledge activation in the suppression of contextually irrelevant meanings for ambiguous homographs. In Experiments 1 and 2, participants with greater baseball knowledge, regardless of reading skill, more quickly suppressed the irrelevant meaning of ambiguous words in baseball-related, but not general-topic, sentences. Experiment 3 demonstrated that participants with greater general knowledge, regardless of reading skill, more quickly suppressed the irrelevant meaning of the ambiguous words in general-topic sentences. As predicted by D. S. McNamara's (1997) knowledge-based account of suppression, ambiguity effects are influenced by greater activation of knowledge related to the intended meaning of the homograph. These results challenge inhibition (e.g. M. A. Gernsbacher, K. R. Varner. & M. Faust, 1990) as the sole mechanism responsible for the suppression of irrelevant information.

Attention↗
PubMed2002

The relationship between socio-demographic characteristics and dental health knowledge and attitudes of parents with young children.

OBJECTIVE: To determine if parental socio-demographic characteristics are associated with dental knowledge and attitude. DESIGN: A questionnaire survey of 500 consecutive parents with children aged approximately 8-months, attending clinics in 1999/2000, in Burnley, Pendle and Rossendale, for health visitor distraction-hearing tests. OUTCOME MEASURES: Scores were obtained for dental knowledge and attitudes. The socio-demographic variables of parental ethnicity, age, education and area of residence were used to determine any associations. RESULTS: Parental age ranged between 16-46 years. Child age ranged between 7-11 months. Significant differences were detected for parental dental knowledge according to ethnicity (P = 0.003), educational status (P = 0.000), and area of residence (P = 0.016). Significant differences were also found in dental attitudes; ethnicity (P = 0.000), educational status (P = 0.004) and area of residence (P = 0.005). Parental age was not significant for either knowledge or attitude. CONCLUSIONS: Lack of further education, being Asian and living in a deprived area means parents have less chances of high dental knowledge and positive dental attitudes.

Adolescent↗
PubMed2001

Nutrition knowledge and food intake of seven-year-old children in an atherosclerosis prevention project with onset in infancy: the impact of child-targeted nutrition counselling given to the parents.

OBJECTIVE: To compare nutrition knowledge and food intake in 7-y-old intervention and control children in an atherosclerosis risk factor intervention trial after 6.5 y of nutrition counselling given to the parents. DESIGN, SUBJECTS AND METHODS: Intervention families in the Special Turku Coronary Risk Factor Intervention Project received child-oriented nutritional counselling one to three times a year since child's age of 7 months, aimed at reduced saturated fat and cholesterol intake. Children's nutrition knowledge was analysed in a time-restricted cohort of 70 seven-y-old (34 boys) intervention children and 70 control children (40 boys) with a picture identification test. For comparison, children's food intake was evaluated using scores developed for the project that reflected quality and quantity of fat and quantity of salt in children's two or three 4-day food diaries recorded between 5.5 and 7 y of age. RESULTS: Child-targeted nutrition counselling of the intervention families only slightly increased intervention children's knowledge of heart-healthy foods (42.6% vs 34.9% correct answers by the intervention and control children, P = 0.057). Only < or = 20% of the children were able to adequately justify their answers in the test. The food diaries of the intervention children comprised more foods low in saturated fat and high in unsaturated fat than those of the control children (57.1% vs 41.7% of the maximum score for low fat foods, P = 0.0001; 48.9% vs 37.7% for high unsaturated fat foods, P = 0.0009, respectively), but the intervention and control children consumed similar amounts of low-salt foods (P = 0.23). Nutrition knowledge and food use scores correlated poorly (r = -0.20-0.35). CONCLUSIONS: Child-targeted nutrition counselling repeatedly given to the parents during and after child's infancy strongly influenced food choice scores of the 5.5-7-y-old children but failed to influence children's salt intake or scores in a nutrition knowledge picture test.

Arteriosclerosis↗
PubMed1997

Knowledge of blood pressure measurement among a teaching hospital staff in a developing nation.

Hypertension is a common and potentially serious disease and accurate measurement of blood pressure (BP) is important for its diagnosis and management. The aim of this study was to assess the knowledge of hospital staff on the basic principles of BP measurement. Consultants, junior doctors and nurses in a large teaching hospital in southern Saudi Arabia were requested to answer a questionnaire about the most important aspects pertaining to BP measurement. The overall response rate was about 70%. There was a wide diversity of responses reflecting a poor knowledge of some of the basic techniques of BP measurement. This included inconsistencies regarding the knowledge of cuff size, recording of diastolic BP, position of the arm and rate for deflating the cuff. Overall, 60% of the respondents had insufficient knowledge. Inaccurate BP measurement can seriously affect the diagnosis and management of the patient with this common disease. Hospital staff need to improve their knowledge about BP measurement, and teaching programmes about BP measurement should be developed as part of continuing education.

Adult↗
PubMed2001

Domestic violence: a comparative survey of levels of detection, knowledge, and attitudes in healthcare workers.

The objective of this study was to compare the knowledge, attitudes, responses and levels of detection of domestic violence among a variety of healthcare workers in different specialities.Self-administered questionnaires were sent to community and hospital based healthcare workers in Oxfordshire working in primary care, obstetrics and gynaecology, mental health and accident and emergency. These comprised all principal general practitioners and general practitioner registrars, 50% of practice/district nurses and health visitors in each practice, and all healthcare workers in obstetrics and gynaecology, community mental health teams and accident and emergency in one trust. The amount of domestic violence detected in different healthcare settings was far less than indicated by anonymous surveys and crime figures. Knowledge about many of the issues surrounding domestic violence was inconsistent and there were fundamental deficiencies. The attitudes of healthcare workers to domestic violence were generally sympathetic and supportive. Women, nurses and community mental health workers reported significantly better knowledge and more positive attitudes than other respondents. Gender, role and speciality were independently associated with more positive attitudes and the latter two were independently associated with good knowledge. The response that healthcare workers make when they uncover domestic violence is confused and often inappropriate. In conclusion, most healthcare workers accept that domestic violence is a healthcare issue but lack fundamental knowledge about the issues surrounding domestic violence itself and appropriate agencies that can offer help. They also lack skills in identifying and discussing this issue with patients/clients. A large, unfulfilled training need has been identified.

Attitude of Health Personnel↗
PubMed1997

An investigation into whether nursing student alter their attitudes and knowledge levels regarding HIV infection and AIDS following a 3-year programme leading to registration as a qualified nurse.

The purpose of this study was to examine whether a 3-year programme of nursing studies enabled nursing students to graduate from the course with greater knowledge and more positive attitudes towards HIV infection and AIDS than when they began the course. Students on a maths and information technology course were used as controls. The study involved the use of a questionnaire which gathered information about students' experience, knowledge, attitudes and moral judgement regarding HIV infection and AIDS. The experimental hypothesis stated that nursing students would show a greater increase in knowledge and positive attitude change towards HIV infection and AIDS than maths students. The results showed significant differences between third year nursing students' knowledge about HIV and AIDS when compared with other groups but it was noted that knowledge levels for all groups was quite low. There was no difference between first and third year nursing students' attitudes and moral judgement about HIV and AIDS but there was a significant difference between nursing students and maths students. It was suggested that there is a need to modify nurse education programmes in order to have greater impact on this topic area.

Adult↗
PubMed2001

Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine.

AIMS: The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables. BACKGROUND: Over recent years there has been increased interest among the lay public and health care professionals in complementary and alternative medicine (CAM). Previous studies have shown that several variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. Conflicting reports were found with respect to the relationship between health locus of control and the use of CAM. Israel is a small country comprised mostly of immigrants from vastly differing cultures with differing beliefs about health and health care. Nurses whose origins are similar to the general population are also caregivers who are used to integrating diverse therapies into the plan of care devised with the client. No study was found which investigated these issues among Israeli nurses. DESIGN/METHODS: A systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem, Israel were invited to participate in the study. Informed consent was obtained. Four self-administered, pencil and paper, questionnaires were distributed to the study participants: a questionnaire designed by the authors to determine the level of knowledge and attitudes towards complementary and alternative medicine; a questionnaire which measured satisfaction with the patient-physician relationship; a questionnaire which measured health locus of control; and a demographic questionnaire. Participants received a packet containing the questionnaire and a note explaining the study. The anonymous questionnaires were collected by the ward secretaries and sent in bulk to the researchers. RESULTS: Results demonstrated that nurses in this sample perceived that they had little knowledge of complementary and alternative medicine but were very interested in learning more. Few used complementary and alternative medicine in their nursing practice but levels of personal use were similar to that of the general population. Nurses who used complementary and alternative medicine were satisfied with their care. CONCLUSIONS: In general, nurses tended to be wary of the use of complementary and alternative medicine. Nurses were also not satisfied with their relationships with their physicians. Those of middle age were more likely to use complementary and alternative medicine but no other demographic characteristics were associated with knowledge or attitudes towards complementary and alternative medicine. Nurses had higher levels of internal health locus of control which was associated with more positive attitudes and knowledge levels of complementary and alternative medicine.

Adult↗
PubMed2002

Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion.

BACKGROUND: In Australian hospitals, epidural infusions are commonly used for the management of post-operative pain in maternity and surgical patients, with little research evidence to indicate the efficacy of the educational preparation of nurses undertaking pain management. AIMS: To describe nurses' assessment skills and knowledge related to the management of a patient with an epidural infusion and to explore relationships between these variables and the levels of education/clinical experience of the nurses. METHODS: This descriptive correlational study used a convenience sample of surgical and obstetric unit registered nurses to explore relationships between the knowledge and skill in epidural management and the educational preparation of the nurse. Data were collected via survey and observation, using instruments developed by the research team. RESULTS: The nurses had a good knowledge base for the performance of sensory blockade assessment but scored less well in motor blockade assessment and clinical decision-making. Nurses who had clinical experience, had completed a self- directed learning package and who worked in surgical areas scored higher on the survey than other nurses. Observation scores revealed a range of performance outcomes. There was only a weak correlation between knowledge and skill performance. There were no differences in scores for the observation exercise for different groups of nurses. CONCLUSION: The results of this study indicated that the nurses' theoretical knowledge outweighed their clinical skill performance and clinical decision-making. Education for nurses regarding the management of epidural infusions needs to be comprehensive, context specific and have the capacity to develop the nurse's autonomous critical thinking and clinical decision-making skills. Strategies for this include self-directed learning packages best supplemented by a demonstration of clinical skills and supervised practice.

Analgesia↗
PubMed1997

Scientific knowledge in medicine: a new clinical epistemology?

Technological developments in the field of communications have widened access to research evidence and, as a result, scientific epistemology is in the ascendancy in the area of medical knowledge. This has been the subject of vigorous debate within the medical profession itself, with many opposing the increasing weight given to research evidence at the expense of expert opinion. Medicine has a professional culture which identifies knowledge with particular individuals - a 'person culture'. Much of the authority of physicians derives from the presumption that medical professionals have privileged access to medical knowledge. Scientific epistemology, on the other hand, identifies knowledge with a process of investigation. The esoteric knowledge to which expert individuals claim privileged access has no currency in this process. Because of this, the rise of scientific epistemology in medicine partially undermines the profession's authority. Access to scientific research evidence can be used to undermine the individual authority of professional experts. Illustrative examples are given of the nature of debate within a 'person culture' and of ways in which research evidence has been used to challenge the authority of physicians.

Attitude of Health Personnel↗
PubMed2002

Breast-feeding knowledge and attitudes of teenage mothers in Liverpool.

OBJECTIVES: To determine the knowledge and attitudes of teenage mothers towards breast-feeding. DESIGN: A questionnaire of teenage (< 20 years) and non-teenage (> or = 20 years) primigravidae attending the antenatal care services at the Liverpool Women's Hospital, during the period April-May 2000. RESULTS: Forty teenage primigravidae and 40 non-teenage primigravidae registered for the survey. Teenagers had poorer knowledge about breast-feeding than the non-teenagers, and fewer teenagers considered breast milk the best food for their baby. More teenagers than non-teenagers planned to bottle feed [23 (57.5%) vs. 9 (22.5%), P=0.002]. Only one teenager had knowledge about colostrum. Teenagers were more often single, had a lower level of education, higher unemployment, higher smoking frequency and less contact with a person who had previously breast-fed. CONCLUSION: Teenage primigravidae have poor knowledge regarding breast-feeding compared with non-teenage primigravidae. A greater proportion of teenagers opted not to breast-feed compared with non-teenagers. Health education classes stressing the importance of breast-feeding should be emphasized in antenatal teenage clinics. More research is needed to understand how to improve the knowledge and motivation of adolescent girls to breast feed.

Adolescent↗
PubMed2000

Older patients in the acute care setting: rural and metropolitan nurses' knowledge, attitudes and practices.

Many studies reporting nurses' knowledge of and attitudes toward older patients in long-term care settings have used instruments designed for older people. However, nurses' attitudes toward older patients are not as positive as their attitudes toward older people. Few studies investigate acute care nurses' knowledge of and attitudes toward older patients. In order to address these shortcomings, a self-report questionnaire was developed to determine nurses' knowledge of, and attitudes and practices toward, older patients in both rural and metropolitan acute care settings. Rural nurses were more knowledgeable about older patients' activities during hospitalisation, the likelihood of them developing postoperative complications and the improbability of their reporting incontinence. Rural nurses also reported more positive practices regarding pain management and restraint usage. However, metropolitan nurses reported more positive attitudes toward sleeping medications, decision making, discharge planning and the benefits of acute gerontological units, and were more knowledgeable about older patients' bowel changes in the acute care setting.

Acute Disease↗
PubMed2003

Knowledge level and coping strategies according to coagulation levels in older persons with atrial fibrillation.

The present study examined the knowledge level and the coping strategies of older persons with atrial fibrillation, who were on oral anticoagulant therapy. The relationship among knowledge level, problem and affective-oriented coping strategies, and the level of anticoagulant effectiveness were examined. We also compared differences between subjects who were within a therapeutic range for International Normalized Ratio levels with those who were not. The research design was descriptive and correlational. One hundred older persons completed the Jaloweic Coping Scale (a knowledge questionnaire) and socio-demographic, contextual and clinical characteristic questions. The findings suggested that the knowledge levels were low (53%), and problem-oriented coping strategies were most often used (32.62%) compared to affective-oriented coping strategies (18.96%). Other than praying and putting one's trust in God (P = 0.05), it appeared that no other significant coping strategies differentiated the subjects regarding their level of anticoagulant effectiveness. It is recommended that further examination of the reasons for older persons' low knowledge level, in regard to their oral anticoagulant therapy, occurs and that use of problem-oriented coping strategies, to improve self-care measures, be encouraged.

Adaptation, Psychological↗
PubMed1999

Pakistani moslems with Type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self-monitoring management and glycaemic control.

AIMS: To study factors such as sex, educational status and place of care, which might influence knowledge and self-management of diabetes, and glycaemic control in a Pakistani moslem diabetic population attending primary care general practices (GP) and secondary care clinics at the Manchester Diabetes Centre (MDC). METHODS: Patients with Type 2 diabetes mellitus took part in a one-to-one semi-structured interview and gave blood for haemoglobin A1c levels. RESULTS: Two hundred and one patients entered the study. Knowledge about diabetic diets was good (average scores 72%), and patients claimed to perform regular glucose measurements (66%), but they were not good at applying their knowledge to problems in daily life. Only 24% knew how to manage persistent hyperglycaemia. Women were worse than men at this (19 vs. 31% (chi2 = 3.8, P = 0.05)), were less likely to understand why glucose levels should be monitored, and had poorer glycaemic control overall (HbA1c 8.8 vs. 8.1%, P = 0.04). Fifty-four patients were completely illiterate. They had similar knowledge scores to readers but were less able to handle problem scenarios. Forty-five of these patients were women, and multiple regression analysis showed they were more likely to have the poorest glycaemic control. No major differences were found between general practitioner and hospital attenders, or between patients with and without known complications, except that hospital attenders were more likely to have complications and poorer control. CONCLUSIONS: Women who cannot read in this population are likely to have poorer glycaemic control and may be finding it more difficult to learn how to apply their knowledge to daily life. This subgroup may need more intensive, culturally appropriate, health education and support.

Age Factors↗
PubMedDate not supplied

Breast cancer: knowledge, attitudes, and practices of female schoolteachers in Lagos, Nigeria.

This article examines the knowledge, attitudes, and practices of female schoolteachers concerning breast cancer. A cross-sectional survey was conducted among 200 schoolteachers randomly selected from 12 schools in Lagos, Nigeria. A self-administered questionnaire was used to investigate their knowledge about the symptoms of breast cancer, methods of diagnosis, risk factors, and breast self-examination. A response rate of 94% (188 respondents) was achieved. Eighty-five percent knew breast cancer was a serious disease, but only 53.2% knew that a breast lump was the most commonly recognized sign. Other symptoms were even less well known. Only 13.8% knew the methods of diagnosis, and knowledge of risk factors was also poor. Breast self-examination was practiced by 62% of respondents; 11% practiced it on a monthly basis, but only 25% were deemed to possess sufficient knowledge about the procedure. One-quarter of participants were categorized as possessing a satisfactory knowledge of breast cancer. The level of awareness on breast cancer is very low among this group of female schoolteachers.

Adult↗
PubMedDate not supplied

The relationship between self-esteem, health habits, and knowledge of BSE practice in female inmates.

This article reports on data derived from an investigation of the self-esteem, health habits, and knowledge of breast self-examination (BSE) practice in female inmates. A descriptive correlational study was conducted with a prison sample of 197 adult females incarcerated in a women's state prison. Major findings of the study suggest that female inmates in general had medium to high self-esteem, poor health habits before incarceration, and minimal knowledge about BSE practice. Only 26% reported correct knowledge related to frequency in BSE practice, and few reported that they knew correct BSE technique. In addition, findings suggest that a correlation does not exist between self-esteem and knowledge of BSE practice, and participants' last grade completed served as a good predictor of women's knowledge of BSE practice.

Adult↗
PubMed1999

Knowledge, patterns of care, and outcomes of care for generalists and specialists.

OBJECTIVE: To critically evaluate the differences between generalist physicians and specialists in terms of knowledge, patterns of care, and clinical outcomes of care. METHODS: English-language articles (January 1981 to January 1998) were identified through a Medline search and examination of bibliographies of identified articles. Systematic evaluation of articles relevant to adult medicine that had a direct comparison between generalist physicians and specialists in terms of knowledge relative to widely accepted standards of care, patterns of care (including use of medications, ancillary services, procedures, and resource utilization), and outcomes of care was performed. MAIN RESULTS: In many survey studies, specialists were reported to be more knowledgeable about conditions encompassed within their specialty. In terms of overall practice patterns, specialists practicing in their area of expertise were more likely to use medications associated with improved survival and to comply with routine health maintenance screening guidelines; they used more resources including diagnostic tests, procedures, and longer hospital stays. In the limited number of studies examining the care of patients with acute myocardial infarction, acute nonhemorrhagic stroke, and asthma, specialists had superior outcomes compared with generalists. CONCLUSIONS: There is evidence in the literature suggesting differences between specialists and generalists in terms of knowledge, patterns of care, and clinical outcomes of care for a broad range of diseases. In published studies, specialists were generally more knowledgeable about their area of expertise and quicker to adopt new and effective treatments than generalists. More research is needed to examine whether these patterns of care translate into superior outcomes for patients. Further work is also needed to delineate the components of care for which generalists and specialists should be responsible, in order to provide the highest quality of care to patients while most effectively utilizing existing physician manpower.

Adult↗