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. . . But does it stick? Evaluating the durability of improved knowledge following an undergraduate experiential geriatrics learning session.

Canada's aging population, fewer medical students training in geriatric medicine, and inadequate geriatric curricula require that medical schools immediately address how future physicians will be able to care for older people effectively. The medical literature suggests that experiential learning strategies improve undergraduate medical students' knowledge of and interest in less-popular subjects, but the durability of improvements resulting from these resource-intensive learning approaches remains unclear. In October 2001, a convenience sample of all University of Western Ontario medical students attending the geriatric component of their first year was randomized to attend one 3-hour didactic lecture or 3-hour experiential learning session. Approximately 1 year later, students completed a follow-up knowledge and attitudes survey that was matched to their first-year surveys using date-of-birth data. Of 100 completed follow-up surveys, 42 were used in formal analysis. Although initially the experiential group demonstrated a better knowledge score, at 1-year follow-up, there was no significant difference in knowledge, attitudes toward older people, or interest in geriatric medicine between the didactic (n=17) and experiential (n=25) groups. Nevertheless, these students (n=42) demonstrated better attitude scores than those (n=22) who had not attended either educational intervention. This study challenges the belief that an experiential approach is a superior training method to a didactic approach. One year after an educational intervention, there was no difference in geriatric knowledge, attitude scores, or interest in geriatric medicine between students who underwent a didactic lecture or a participatory, experiential learning session.

Analysis of Variance↗

HIV/AIDS related knowledge, attitudes, and preventive behavior of pregnant Korean women.

OBJECTIVE: To assess HIV-AIDS-related knowledge, attitudes, and preventive behavior of pregnant Korean women before designing patient and public education programs. DESIGN: Pre-experimental cross-sectional survey. POPULATION, SAMPLE, SETTING, YEARS: Convenience sample of 409 women at six prenatal clinics in Seoul, Korea, in 1993. OUTCOME MEASURES: HIV-AIDS-related knowledge, attitudes, and preventive behavior. METHODS: Self-administered questionnaires. FINDINGS: The women described high levels of knowledge about HIV and AIDS risk factors but less knowledge about transmission of the virus, as well as attitudes of rejection toward unrelated people with HIV/AIDS; 16% provided condoms for their husband's use in extramarital sex, the primary risk behavior. CONCLUSIONS: Korean women are at risk for heterosexual transmission of HIV despite knowledge of risk factors. CLINICAL IMPLICATIONS: Korean education programs for women should focus on modes of heterosexual transmission, care of individuals with HIV or AIDS, self-assessment of HIV-AIDS risk, and self protection.

Female↗

Nurses' knowledge of breastfeeding.

The purpose of this study was to survey nurses' knowledge of breastfeeding and to assess whether nurses' education, clinical experience, or personal experience predicted their breastfeeding knowledge. Results suggest that nurses have limited knowledge of breastfeeding, although no variable consistently predicted breastfeeding knowledge. Clinical experience produced the most consistent results, implying that leadership, variety in maternal and newborn nursing experiences, and years of experience result in nurses having more knowledge about breastfeeding.

Adult↗

Socioeconomic differences in glaucoma patients' knowledge, need for information and expectations of treatments.

PURPOSE: To study the specific items for which socioeconomic differences in glaucoma patients' knowledge, need for information and expectations of treatments exist, with the aim of developing a patient education programme. METHODS: A total of 44 randomly selected ophthalmologists assigned 166 consecutive outpatient glaucoma patients to complete a questionnaire that had been systematically developed based on focus group interviews, suggestions from several experts and a pilot test. Topics included knowledge about glaucoma and its treatment, need for information and expectations of treatment. Educational level was used as a measure for socioeconomic status. Logistic regression analysis was conducted to adjust for age, sex and duration of glaucoma. RESULTS: After adjusting for age, sex and duration of glaucoma, knowledge of glaucoma and its treatment was found to be positively correlated with socioeconomic status. Items on knowledge with socioeconomic differences concerned risk factors, pathophysiology and consequences of glaucoma, as well as effects and adverse effects of treatments. The lowest socioeconomic group demonstrated more need for information on public assistance and practical aspects of glaucoma and more often expected that glaucoma damage could be repaired. CONCLUSION: Important socioeconomic differences in knowledge, need for information and expectations of treatment exist in glaucoma patients. Patient education should focus on every glaucoma patient, but better information for the lower socioeconomic groups about specific items mentioned in this study might reduce the negative effects of low socioeconomic status on visual impairment.

Adult↗

Thermal control of the newborn: knowledge and practice of health professional in seven countries.

Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity. An evaluation of the knowledge and practices of health professionals on the thermal control of newborns was carried out in seven countries: Brazil, India, Indonesia, Kazakhstan, Mozambique, Nepal and Zimbabwe. The evaluation, conceived as a preliminary phase for a one-day training course on thermal control, involved 28 health facilities and 260 health professionals (61 doctors and 199 nurses and midwives). It included an assessment of thermal control practices carried out in each health facility by external investigators and a questionnaire on knowledge about thermoregulation administered to health professionals involved in newborn care. The findings of the evaluation were consistent across countries and showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery; initiation of breastfeeding and contact with mother, bathing; checking the baby's temperature; thermal protection of low birth weight babies, and care during transport. Knowledge on thermal control was also insufficient, especially concerning the physiology of thermoregulation and criteria for defining hypothermia. During the one-day course that followed the evaluation, participants were able to recognize the existing gaps and to identify appropriate interventions. Knowledge and practice on the thermal control of the newborn are currently insufficient. However, awareness of the importance of thermal control and basic knowledge on thermal regulation and thermal protection can be easily acquired and on this basis motivation for improving thermal control practices can be developed.

Body Temperature Regulation↗

Knowledge, perceptions, and attitudes of advanced practice nursing students regarding medical genetics.

PURPOSE: To describe the current medical genetic knowledge and perceptions of graduate advanced practice nursing (advanced practice nurse [APN]/nurse practitioner and nurse anesthetist) students using survey data for future integration of genetic topics, principles, and healthcare issues into curriculum. DATA SOURCES: Survey data of APNs' perceived knowledge of genetics and a review of the literature from past research studies of students and current articles from professional journals and organizations. Web sites were those of the National Coalition of Health Professions for Education in Genetics and National Institutes of Health, Human Genome Research Institute; professional organizations; and the authors' professional, clinical, and educational experiences. CONCLUSIONS: Most APN students perceived they had minimum knowledge and prior training regarding medical genetics. There is a need to integrate genetic concepts, principles, and medical conditions into advanced practice nursing curriculum and to provide clinical experiences in genetic conditions across the life span and throughout the health and illness spectrum. APN students have positive attitudes toward integrating genetics into graduate curricula. Potential methods for program integration include readings, small group discussion, standardized patients, and role-play as measures to increase information. IMPLICATIONS FOR PRACTICE: The National Coalition for Health Profession Education in Genetics, the American Nursing Association, and the American College of Nursing Education have recommended integration of genetics knowledge and skills into routine health care to provide effective interventions for individuals and families. However, previous research and data from this study have revealed that many nurses have minimal training in genetics. Advanced practice nurses must be knowledgeable on genetic principles, topics, and the ethical, legal, and social implications related to medical genetics to increase the ability to diagnose, prevent, and treat diseases and to provide effective care for individuals and families.

Adult↗

Relationship of AIDS education and knowledge to AIDS-related social skills in adolescents.

The AIDS Social Assertiveness Scale (ASAS) and a measure of AIDS knowledge were administered to 490 high school students from 10 South Australian schools selected across a range of public/private, rural/urban, and socioeconomic statuses. Age, grade, hours of AIDS education, and sexual experience (and condom use) also were ascertained. Data indicated the factor structure of the ASAS was similar to that obtained in a previous sample. A close association existed between both age and hours of AIDS education, and AIDS knowledge. Students from country and working class area schools were less knowledgeable about AIDS. These data suggest AIDS social assertiveness is measurable and that it is associated with AIDS knowledge, age, and previous sexual experience. AIDS knowledge in high school students differed between country and urban adolescents and between students in working and middle class areas, but AIDS education is associated with the same level of improvement in all schools sampled.

Acquired Immunodeficiency Syndrome↗

High school students' knowledge of HIV/AIDS and perceived risk of currently having AIDS.

Factors associated with AIDS knowledge and perceived risk of currently having HIV infection among adolescents were examined. A modified version of the Centers for Disease Control's Health Risk Survey was administered to 11th and 12th grade students (N = 2,483) in homerooms from nine schools in one southeastern community. Knowledge was based on cumulative responses to 12 questions. Many adolescents incorrectly answered seven questions. Based on multivariate analysis of variance, lower AIDS knowledge was associated with no prior school-based AIDS education (p less than or equal to 0.0001), previous IV drug use (p less than or equal to 0.0001), male gender (p less than or equal to 0.0001), and being Black or "other" ethnic group (p less than or equal to 0.0001). Based on interaction effects, Hispanics not receiving AIDS education in school (p less than or equal to 0.0001) and Black and "other" ethnic group IV drug users (p less than or equal to 0.0011) had a lower AIDS knowledge. When controlling for AIDS knowledge level (p less than or equal to 0.0001), higher perceived risk of current infection with HIV was associated with previous IV drug use (p less than or equal to 0.0001) and male gender (p less than or equal to 0.0001). However, previous IV drug users who never received AIDS education (p less than or equal to 0.0001) or were from Black or "other" ethnic group (p less than or equal to 0.008) had higher perceived risks of presently having HIV infection.

Acquired Immunodeficiency Syndrome↗

The role of academic discipline and gender in high school teachers' AIDS-related knowledge and attitudes.

Adolescents represent the fastest growing segment of HIV+ individuals in the United States. Therefore, high school teachers should be both knowledgeable of and comfortable with issues related to HIV/AIDS. This study examined high school teachers' AIDS-related knowledge and attitudes. One hundred forty-one high school teachers from nine central Massachusetts high schools participated. Participants completed the "HIV/AIDS Knowledge and Attitudes Scales for Teachers," as well as questions regarding their teaching experience and academic disciplines. Results indicated a direct relationship between teachers' knowledge of HIV/AIDS and positive or supportive attitudes toward HIV/AIDS. Significant differences were found based on academic discipline, with allied health teachers scoring significantly higher on the knowledge scale than teachers in any other discipline. Specific examples are discussed, as is the need for increased teacher training and comprehensive AIDS education.

Acquired Immunodeficiency Syndrome↗

Maryland adults' knowledge of oral cancer and having oral cancer examinations.

OBJECTIVES: This study sought to determine (1) knowledge of risk factors for oral cancer, (2) knowledge of signs and symptoms of oral cancers, and (3) factors associated with having had an oral cancer examination among 916 Maryland adults 18 years of age and older. METHODS: A statewide, random-digit dial, computer-assisted telephone survey was conducted. The pretested instrument consisted of 32 questions that required 12 minutes to complete. RESULTS: Overall, level of knowledge about risk factors for and signs and symptoms of oral cancers was low; misinformation was high. Although 85 percent reported hearing about oral or mouth cancer, only 28 percent of the respondents reported having had an oral cancer examination. Of these, 20 percent had the exam during the past year--the recommended frequency for persons 40 years of age or older. In logistic regression analysis, adults more likely to have had an oral cancer examination included those who thought personal behavior causes more cancer than environmental factors; had more knowledge about risk factors for oral cancer; and were 40-64 years of age, white, and better educated than their counterparts (P < .05). The primary reasons for not having an exam were "no reason/didn't know I should" and "doctor/dentist didn't recommend." CONCLUSIONS: These results demonstrate a need for interventions designed to increase knowledge levels of risk factors for, signs, and symptoms of oral cancers and the need for oral cancer examinations; and to increase oral cancer examinations.

Adolescent↗

Oral cancer knowledge and examination experiences among North Carolina adults.

OBJECTIVE: This study assesses knowledge of oral cancer risk factors, clinical signs, and oral cancer examination experience among North Carolina adults. METHODS: A statewide random digit dial, computer-assisted telephone interview was conducted in 2002. Data from 1,096 respondents, with a response rate of 62 percent, were poststratified to 2000 census data by sex, race, and age group to produce population-based estimates. Knowledge of one sign of oral cancer, four or more risk factors for oral cancer, and having ever had an oral cancer examination were compared in logistic regression models using normalized weights. RESULTS: Fourteen (95% confidence interval [CI] +/-2) percent of adults had never heard of oral or mouth cancer. Risk factor knowledge was high for 56 percent (95% CI+/-3) and associated in a logistic regression model with younger age, feeling personal factors cause cancer, and nonuse of snuff. One sign of oral cancer (sore/lesion, red or white patch in mouth, and bleeding in the mouth) was correctly identified by 53 percent (95% CI+/-3) with significantly more correct responses from younger people, nonsmokers, and some college education. Only 29 percent (95% CI+/-3) reported ever having had an oral cancer examination when this procedure was described. Most respondents reported exams performed by dentists. In a weighted logistic regression model, older age, being dentate, nonsmokers, alcohol users, and those with some college education were significantly more likely to report having ever had an oral cancer examination. CONCLUSIONS: Although there is moderate knowledge of signs and risk factors for oral cancer among North Carolina adults, knowledge deficits remain. Oral cancer examinations need to be increased, particularly among tobacco smokers.

Adolescent↗

Knowledge and behaviour related to oral health among secondary school students in Khartoum Province, Sudan.

OBJECTIVE: This study explores secondary school students in the Khartoum Province, Sudan, with respect to frequency and quality of use and the socio-demographic distribution of oral health knowledge and behaviour. METHODS: Six secondary schools were selected at random and 10% of the students enrolled in each class (3 grades) were randomly selected to participate. A total of 400 students (207 boys) (mean age 15.3 years) were selected, of which 396 completed questionnaires at school. RESULTS: 44.3% boys and 42.5% girls scored highly on knowledge of caries. The corresponding rates regarding knowledge of gingivitis were 39.2% and 47.0%, respectively. Tooth brushing and use of miswak > or = 2 times a day was confirmed by 67.2% boys and 75.5% girls and by 64.3% boys and 52% girls, respectively. Living in a town, having received oral health information and having a mother of medium education were associated with higher odds for being knowledgeable about tooth decay. CONCLUSION: There is gender equality in knowledge and practise of oral hygiene among secondary school students in Khartoum Province. Awareness of oral health issues is high, but specific misconceptions exist. Mother's education might be used as a social marker in oral health risk group evaluations.

Adolescent↗

Evaluation of sports nutrition knowledge of New Zealand premier club rugby coaches.

Little is known about if and how team coaches disseminate nutrition information to athletes. In a census survey, New Zealand premier rugby coaches (n = 168) completed a psychometrically validated questionnaire, received by either Internet or standard mail (response rate, 46%), identifying their nutrition advice dissemination practices to players, their level of nutrition knowledge, and the factors determining this level of knowledge. The majority of coaches provided advice to their players (83.8%). Coaches responded correctly to 55.6% of all knowledge questions. An independent t-test showed coaches who imparted nutrition advice obtained a significantly greater score, 56.8%, than those not imparting advice, 48.4% (P = 0.008). One-way ANOVA showed significant relationships between total knowledge score of all coaches and qualifications [F(1,166) = 5.28, P = 0.001], own knowledge rating [F(3,164) = 6.88, P = 0.001] and nutrition training [F(1,166) = 9.83, P = 0.002]. We conclude that these rugby coaches were inadequately prepared to impart nutrition advice to athletes and could benefit from further nutrition training.

Analysis of Variance↗

Systemic lupus erythematosus patient guide: influence on knowledge of the disease.

The knowledge of patients with systemic lupus erythematosus about their disease before and after reading a patient guide was tested. The scores for incorrect answers decreased from 28 to 24% after reading the guide, showing that it increased the patients' knowledge of the disease. The patients with an academic background had the best scores before reading the guide, but they did not improve their scores as much as patients with lower educational qualifications. The differences between the groups studied were not significant in a one way analysis of variance. Forty seven questions about the psychology and coping mechanisms of the patients were factorized. These factors, together with data on the duration and severity of SLE and the age of the patient, were used in multiple linear regression analysis, but had no significant predictive value for an improvement in knowledge. The scores in psychological tests were the same before and after reading the guide. It is concluded that the patient guide for SLE increases knowledge of the disease, but does not affect the psychological response of the patient. The improvement in knowledge cannot be predicted on the basis of various psychological and clinical factors or the social background of the patient.

Adult↗

Development and initial validation of an instrument to measure physicians' use of, knowledge about, and attitudes toward computers.

UNLABELLED: This paper describes details of four scales of a questionnaire-- "Computers in Medical Care"--measuring attributes of computer use, self-reported computer knowledge, computer feature demand, and computer optimism of academic physicians. The reliability (i.e., precision, or degree to which the scale's result is reproducible) and validity (i.e., accuracy, or degree to which the scale actually measures what it is supposed to measure) of each scale were examined by analysis of the responses of 771 full-time academic physicians across four departments at five academic medical centers in the United States. The objectives of this paper were to define the psychometric properties of the scales as the basis for a future demonstration study and, pending the results of further validity studies, to provide the questionnaire and scales to the medical informatics community as a tool for measuring the attitudes of health care providers. METHODOLOGY: The dimensionality of each scale and degree of association of each item with the attribute of interest were determined by principal components factor analysis with orthogonal varimax rotation. Weakly associated items (factor loading < .40) were deleted. The reliability of each resultant scale was computed using Cronbach's alpha coefficient. Content validity was addressed during scale construction; construct validity was examined through factor analysis and by correlational analyses. RESULTS: Attributes of computer use, computer knowledge, and computer optimism were unidimensional, with the corresponding scales having reliabilities of .79, .91, and .86, respectively. The computer-feature demand attribute differentiated into two dimensions: the first reflecting demand for high-level functionality with reliability of .81 and the second demand for usability with reliability of .69. There were significant positive correlations between computer use, computer knowledge, and computer optimism scale scores and respondents' hands-on computer use, computer training, and self-reported computer sophistication. In addition, items posited on the computer knowledge scale to be more difficult generated significantly lower scores. CONCLUSION: The four scales of the questionnaire appear to measure with adequate reliability five attributes of academic physicians' attitudes toward computers in medical care: computer use, self-reported computer knowledge, demand for computer functionality, demand for computer usability, and computer optimism. Results of initial validity studies are positive, but further validation of the scales is needed. The URL of a downloadable HTML copy of the questionnaire is provided.

Attitude of Health Personnel↗

Knowledge, attitude, practice, and toxicity symptoms associated with pesticide use among farm workers in the Gaza Strip.

AIMS: To assess knowledge, attitude, practice, and toxicity symptoms associated with pesticide use and exposure among 189 farm workers in the Gaza Strip. METHODS: A cross section of agricultural farm workers in the Gaza Strip were asked to fill in a questionnaire on knowledge, attitudes, practice towards pesticide use, and associated toxicity symptoms. RESULTS: Farm workers reported high levels of knowledge on the health impact of pesticides (97.9%). Moderate to high levels of knowledge were recorded on toxicity symptoms related to pesticides. Most farm workers were aware of the protective measures to be used during applying pesticides. However, no one took precautions unless they knew about the measures. Burning sensation in eyes/face was the commonest symptom (64.3%). The prevalence of self reported toxicity symptoms was dependent on mixing and use of high concentrations of pesticides. The highest percentage of self reported toxicity symptoms was found among the farm workers who returned to sprayed fields within one hour of applying pesticides. CONCLUSIONS: Farm workers in the Gaza Strip used pesticides extensively. Despite their knowledge about the adverse health impact of the pesticides, the use of protective measures was poor. Most had self reported toxicity symptoms, particularly the younger workers. It would be useful to minimise the use of pesticides and encourage alternative measures. Prevention and intervention programmes regarding the use of protective measures and monitoring the health status of farm workers should be implemented.

Adult↗

Hindsight bias, outcome knowledge and adaptive learning.

The ubiquitous nature of hindsight bias is a cause for concern for those engaged in investigations and retrospective analysis of medical error. Hindsight does not equal foresight. Investigations that are anchored to outcome knowledge run the risk of not capturing the complexities and uncertainties facing sharp end personnel and why their actions made sense at the time. Important lessons go unlearned if the exercise is simply to back track someone else's decision landmarks. Outcome knowledge can also bias our thinking on the quality of the processes that led to the outcome. This paper examines the influence of outcome knowledge in relation to reconstructive memory and legal testimony, ways for reducing the impact of outcome knowledge, and an adaptive learning framework that places hindsight bias in a broader context of rapid updating of knowledge.

Adaptation, Psychological↗

Lack of knowledge in health professionals: a barrier to providing information to patients?

OBJECTIVE: To assess obstetricians' and midwives' knowledge of routine prenatal screening tests for fetal abnormality and factors associated with such knowledge. DESIGN: Questionnaire assessment of antenatal clinic staff. SETTING: Six hospitals within the United Kingdom (four district general hospitals in London, one district general hospital in Wales, and one teaching hospital in Wales), offering routine prenatal screening tests. SUBJECTS: 29 obstetricians and 97 midwives were invited to participate, of whom 21 and 70 respectively responded to the questionnaire. MAIN MEASURES: Knowledge of prenatal tests, according to 19 item multiple choice questionnaire, reluctance to disclose uncertainty, and clinical experience. RESULTS: The overall response rate was 72% (91/126). In all, 43% of midwives and 14% of obstetricians obtained correct responses on fewer than half the items. Reluctance to disclose uncertainty to patients was associated in obstetricians with having less knowledge about prenatal testing (r = -0.50; p < 0.025, Pearson product moment correlation) and in midwives with more clinical experience (r = 0.43; p < 0.001). CONCLUSIONS: Lack of knowledge and greater clinical experience seem to be important barriers to providing patients with information about prenatal screening tests.

Communication Barriers↗