Health professionals' knowledge, attitudes, and experiences in relation to immigrant patients: a questionnaire study at a Danish hospital

AIMS: A study was undertaken to identify variations in knowledge, attitudes, experiences, and communication among different categories of hospital staff with regard to immigrant patients in order to identify potential barriers for effective diagnosis, treatment, and care of immigrant patients. METHODS: The study is based on a questionnaire mailed to doctors, nurses, and assistant nurses at Bispebjerg Hospital, a major general hospital in Copenhagen. Among the 1,012 persons included the total response rate was 58%. RESULTS: A majority of all three professional groups obtain their knowledge on immigrants through the media and patient contact, and less through travels, courses, and colleagues. Doctors and nurses showed the most positive attitudes towards different statements about immigrants, and assistant nurses the most negative. Doctors and nurses also had most frequent contacts with immigrant patients and found their communication more satisfactory compared with assistant nurses. Many health workers expressed complaints about immigrants' inappropriate use of health services. That doctors and nurses had more positive attitudes towards immigrants than assistant nurses could be explained by their higher education providing a more "fundamental safety feeling", or a feeling of not being in a competitive situation with immigrants. Assistant nurses had the least satisfactory communication with immigrant patients, possibly because they had less frequent contacts compared with doctors and nurses. CONCLUSIONS: The study provides a foundation for new interventions and priorities within the healthcare system regarding immigrant patients.     

三甲医院提升患者感知价值策略研究

随机抽取了广州地区10家三甲医院进行问卷调查。结果显示,患者感知价值与预期价值有一定落差。对此,医院应切实采取重视医患有效沟通、改善医护人员态度、提供及时服务、形成良性互动的意见反馈机制、缩短患者就诊等候时间等措施来提升患者感知价值。     

A survey of doctors' and nurses' knowledge,attitudes and compliance with infection control guidelines in Birmingham teaching hospitals

This study investigated knowledge about infection control amongst doctors and nurses through a cross-sectional survey conducted between March and May 2001 in three Birmingham, UK teaching hospitals. Seventy-five doctors and 143 nurses, representing 7% and 4%, respectively, of potential respondents, participated in the study measuring knowledge of, attitudes towards, and compliance with universal precautions. Overall knowledge of risks of blood-borne virus (BBV) transmission from an infected patient after needlestick injury was low [44.0% for hepatitis B virus (HBV), 38.1% for hepatitis C virus (HCV), 54.6% for human immunodeficiency virus (HIV)]. There were significant differences between doctors and nurses concerning the estimations of HBV (e-antigen +) (P=0.006) and HIV (P<0.001) transmission risks. Eighty-six percent of nurses stated that they treat each patient as if they are carrying a BBV compared with 41% of doctors. Doctors and nurses differed significantly in their attitudes about and reported compliance with washing hands before and after patient contact and with wearing gloves when taking blood (P<0.001 for all). Doctors consistently de-emphasized the importance of, and reported poor compliance with, these procedures. Doctors were also more likely to state that they re-sheath used needles manually than were nurses (P<0.001). Thirty-seven percent of respondents reported that they had suffered a needlestick injury with a used needle, with doctors more likely to be injured than nurses (P=0.005). Twenty-eight percent of these doctors and 2% of the nurses did not report their needlestick injuries (P=0.004). Education, monitoring, improved availability of resources, and disciplinary measures for poor compliance are necessary to improve infection control in hospitals, especially amongst doctors.     

宁夏地区中学校医和健康教育教师预防艾滋病知识与态度

目的 了解宁夏地区中学校医预防艾滋病知识、态度及健康教育状况,为中学开展预防艾滋病健康教育提供决策依据。方法 以不记名问卷方式对宁夏4市92名中学校医进行调查。结果 有35.3%的教师曾接受过预防艾滋病健康教育方面的培训,90%以上的教师对艾滋病三大传播途径的知识掌握较好,但对于非传播途径、预防及治疗的基本知识回答正确率较低。分别有95.7%和98.9%的校医赞同在初中和高中开展预防艾滋病健康教育;但几乎所有的回族校医（96.8%）都反对在初中阶段讲解有关避孕套的知识,有49.2%的回族教师反对在高中阶段讲解正确使用避孕套知识。接受过培训的教师预防艾滋病知识得分、对在学校开展预防艾滋病教育态度总得分等均高于未受过培训的教师,且差异有统计学意义。回族教师对在学校开展预防艾滋病教育态度总得分明显低于汉族教师（P〈0.01）。校医预防艾滋病知识主要来自书籍、报刊、杂志（76.9%）,其次为电视、广播（45.2%）,培训在各种来源中居第5位（23.6%）。结论 应加强对民族地区中学校医和健康教育教师进行学校预防艾滋病健康教育的培训;尽快编写符合民族地区情况的学校预防艾滋病健康教育大纲及教师教学参考书。     

启东市居民主要恶性肿瘤死亡情况与减寿分析

目的:了解启东市居民19年来(1986年~2004年)主要恶性肿瘤的死亡情况并进行减寿分析,通过比较不同年代的不同恶性肿瘤对居民寿命的危害程度,为恶性肿瘤的防治提供重要线索。方法:采用减寿分析方法中的最大期望值法。结果:(1)19年间启东居民恶性肿瘤前5位死因顺位依次为肝癌、肺癌、胃癌、结肠直肠癌、食管癌,这期间启东居民的肝癌呈持续高死亡率,肺癌的死亡率也呈逐渐升高趋势,胃癌、结肠、直肠癌死亡率有所下降。(2)减寿年数(PYLL)前5位由高至低依次为肝癌、肺癌、胃癌、白血病、结肠直肠癌;而白血病、肝癌、结肠、直肠癌、乳腺癌等对平均减寿年数(AYLL)影响较大。(3)35岁前恶性肿瘤死亡率最高的是肝癌和白血病,35~65岁死亡率最高的为肝癌和肺癌,65岁以上死亡率高的为肺癌和胃癌。结论:肝癌、肺癌、胃癌、白血病、结肠、直肠癌是引起寿命损失最主要的恶性肿瘤,乳腺癌对女性寿命损失较大。肝癌防治依然是启东慢病控制的重要任务;肺癌死亡率的升高是值得关注的问题。     

Physicians' attitudes toward death and dying

INTRODUCTION: In the study the physicians' knowledge and attitude was examined towards death and dying. During the study a questionnaire survey was executed, including 124 physicians (family doctors from Budapest and from the country, hospital and clinical doctors) in which there were questions edited by the authors and also used the Lester and Neirmeyer scales to assess the fear of death. AIMS: The aim was to assess how much the physicians were prepared during their education to face with dying people and death, how much they are able to get in touch with dying patients, and how much they are afraid of death. METHODS: The questionnaires evaluated by the SPSS statistical program. RESULTS: According to results most physicians in Hungary have a very little knowledge with regard to death and dying. This lack of knowledge, their own fears and refusal in connection with the transitoriness can have a negative influence on their relationship with dying people: their attitudes towards dying are generally negative, many of them try to avoid dealing with the questions worrying the dying people and if after all there is a communication situation most of them avoid the more difficult fields instead. CONCLUSIONS: To draw attention to these problems, to point out the necessity of the gradual education of issues connected to death and dying and to stress how important is to mold attitudes towards dying people. The study is finished with some particular education program-proposals.     

Smoking among Shanghai medical students and the need for comprehensive intervention strategies

By cluster sampling, 1392 medical students of Shanghai Medical University were investigated with regard to smoking status and their knowledge and attitudes towards smoking and anti-smoking campaigns. The results showed that the smoking rate of medical students was 12.07%-21.42% for male students and 1.81% for female students. Both daily and occasional smoking rate increased as the curriculum year progressed. Of smoking students, 36.69% had made at least one serious attempt to quit smoking; 11.18% of smoking students intended to be non-smokers by the end of 5 years; and 87.07% of non-smokers and 68.35% of smokers agreed that smoking was harmful to one's health. There were widespread deficiencies in knowledge of smoking as an important causal factor in many diseases and in medical students' knowledge as to the appropriate role of doctors in anti-smoking campaigns. There existed some differences between smokers and non-smokers with respect to knowledge and attitudes towards smoking, doctors' professional responsibilities and smoking-controlling regulations. This study indicates that the current system of medical education in China has little or no effect on the attitudes and behaviours of medical students regarding smoking. It is therefore highly necessary and possible to adopt comprehensive smoking-control interventions and health education among this group.     

The association between knowledge and attitudes about genetic testing for cancer risk in the United States

Attitudes about genetic testing are likely to be an important determinant of uptake of predictive genetic tests among the general public. Several prior studies have suggested that positive attitudes about genetic testing may be inversely related to knowledge about genetic testing. We conducted a random-digit-dialing (RDD) telephone survey of 961 adults in the continental United States to determine the associations among knowledge of, attitudes about, and perceptions of eligibility for genetic testing for cancer risk. Knowledge about genetic testing for cancer risk was generally high, with a mean accuracy score of 72%. Attitudes about genetic testing for cancer risk were also generally positive, with 87% of respondents reporting genetic testing for cancer risk would be used to help doctors manage their health care and 85% to help scientists find cures for diseases. In contrast, 58% of respondents thought genetic testing for cancer risk would be used to prevent them from getting health insurance and 31% to allow the government to label groups as inferior. Twenty-nine percent of respondents thought they were currently eligible for testing. After adjustment for sociodemographic characteristics and family cancer history, higher knowledge was correlated with more positive attitudes about testing, but not with negative attitudes or perceptions of testing eligibility. Family history was positively associated with perceptions of eligibility (OR 3.49, 95% CI 2.36-5.18), and higher levels of education were inversely associated with perceptions of eligibility (OR 0.55, 95% CI 0.32-0.94 for comparison of college or higher vs. less than high school). These results suggest that most members of the general public are knowledgeable and have positive attitudes about genetic testing for cancer risk and that greater knowledge is correlated with more positive attitudes about the benefits of testing.     

澳门妇女和医师对HPV疫苗的认知态度调查及其推广应用分析

目的了解澳门特别行政区女性和执业医师在人乳头瘤病毒(human papillomavirus,HPV)疫苗纳入免费防疫接种计划之前对其认知、接受度,及疫苗的使用情况,分析影响接种的主要因素,评估HPV疫苗在澳门发展情况,为宫颈癌预防工作提供适当的模式。方法 2008年8~12月采用问卷抽样调查方式对澳门特别行政区1 716名女性及108名执业医师进行问卷调查,利用SPSS 13.5软件进行统计分析。结果受调查妇女中,47.1%的女性曾听过HPV,76.7%的女性听过宫颈癌疫苗,认为HPV感染与宫颈癌有关联性的仅为35.4%。另外,38.4%的女性及其中43.4%的母亲愿意自己或女儿接种疫苗。据多因素logistic回归分析得出年龄、个人收入、职业、个人防护、担心患宫颈癌、担心疫苗来源、认为自己年龄太大或太小是影响接受疫苗的主要因素。澳门医师对HPV及HPV疫苗都有中高度认知。约60%受调查医师对HPV疫苗有信心,而评价疫苗的不足主要是价格太贵。结论澳门宣传有关HPV及HPV疫苗的知识是有效的,HPV疫苗在澳门使用人数逐渐增加。为增加澳门居民对疫苗的接受程度,达到预防宫颈癌的目的,政府仍需采用多种宣传方式加强宣传力度。     

Difficulties in the prevention of cervical cancer: adults' attitudes towards HPV vaccination 3 years after introducing the vaccine in Hungary

Cervical cancer is one of the most prevalent gynaecological malignancies worldwide. The Hungarian incidence and mortality of this disease take the 4th-5th places within the European Union. A survey including 785 male and female adults was conducted to assess the knowledge and attitudes concerning HPV vaccination. We focused on the difficulties of the primary and secondary prevention of cervical cancer and examined some potential sociodemographic predictors of HPV vaccine acceptability.Our findings have identified some important issues like: incomplete knowledge, intense distrust and financial concerns. Almost half of the college students (45.6%) are unaware of HPV infections. We confirmed previous findings that older age and female gender correlates with better knowledge on STDs, including HPV. We found that greater exposure to health information comes with better knowledge and more positive attitudes towards vaccination.One quarter of survey respondents do not believe that cervical cancer may be prevented by vaccination. More than half of the adults do not trust national health care system and the preparedness of Hungarian doctors. General attitudes towards vaccination are broadly positive, 80% of survey participants had expressed desire towards HPV vaccination, however if there was a need to pay for the vaccination the willingness would decrease by half.Primary prevention through HPV-focused educational programs, clear communication and financial support would be important for public health to reduce the high incidence and mortality of cervical cancer in Hungary in the future.     

National clinical portal programme: what information do doctors want?

Electronic patient health information in secondary care is often stored on different IT systems and not accessible to doctors involved in clinical decision-making. The Scottish Government will support clinical portal implementation in all Scottish Health Boards, which will present information from different sources as a virtual electronic patient record. An online survey was developed and sent to secondary care doctors, who were asked to rank the importance of different types of patient-centred information, knowledge support sources, and information to support appraisal and continued professional development that a clinical portal could deliver. Subgroup analysis was performed to investigate whether expectations differed between senior clinicians and doctors in training. Replies were received from 677 senior doctors and 137 trainees. Patient-centric information such as current medication and allergies, clinical alerts, past medical history, diagnostic test results and clinical letters were ranked as most important. Doctors would also like access to knowledge support, such as clinical guidelines. Eighteen of the top 20 ranked information types were consistent between senior doctors and those in training grades. In conclusion, senior doctors and trainees consistently want to see similar information in the clinical portal which is largely patient-centred with some provision for knowledge support.     

Knowledge, Attitudes, Beliefs, and Personal Practices Regarding Colorectal Cancer Screening Among Health Care Professionals in Rural Colorado: A Pilot Survey

ABSTRACT:  Purpose: This study reports the baseline knowledge, attitudes, beliefs, and personal practices of health care professionals regarding colorectal cancer (CRC) screening in the High Plains Research Network (HPRN) of rural Colorado prior to a community-based educational intervention. It also examines the association between health care staff members' knowledge, attitudes, beliefs, and personal practices for CRC screening and patient screening levels by practice. Methods: Surveys were mailed to health care professionals in the HPRN. Participating clinics (n = 21) distributed patient surveys on CRC screening to persons aged ≥50 for a 2-week period in 2006. Results: The survey response rate was 81% for providers (n = 46) and 90% for nursing staff (n = 63). Only 54% of health care professionals knew CRC is a leading cause of cancer deaths. When surveyed on their attitudes toward colon cancer, 92%"strongly agreed" or "agreed" that colon cancer is preventable. About 99% (n = 107) of providers and nurses "strongly agreed" or "agreed" that testing could identify problems before colon cancer starts. Most health care professionals (61%) aged ≥50 years had previously been tested and were up-to-date (52%) with screening. Provider knowledge was significantly associated with higher patient screening (P = .02), but provider attitudes and beliefs were not. Moreover, personal screening practices of health care professionals did not correlate with more patients screened. Conclusion: Background knowledge of CRC among HPRN health care professionals could be improved. The results of this pilot study may help focus effective approaches such as increasing provider knowledge to enhance CRC screening in the relevant population.     

Knowledge,attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom

BACKGROUND: Colorectal cancer (CRC) mortality is high. Understanding the social, psychological, and cognitive predictors of early detection practices such as screening may help improve CRC outcomes. This study examined knowledge of CRC and the relationship between knowledge, attitudes to cancer, and intentions to engage in early detection behaviors for CRC in a national representative population sample. METHOD: An interview-based survey was carried out in a British population sample of adults ages 16 to 74 years (n = 1637), assessing knowledge, attitudes, and intention with regard to colorectal cancer. RESULTS: Knowledge levels were very low; 58% (n = 995) of respondents could not list any colorectal cancer risk factors and 24% (n = 393) were unable to identify any warning signs for cancer. Knowledge was lower among men (chi(2)[2] = 52.8, P < 0.0001), younger respondents (chi(2)[10] = 79.9, P <.0001), and those with less education (chi(2)[4] = 73.9, P < 0.0001). Attitudes to cancer were more negative among women (chi(2) [2] = 7.4, P = 0.025), younger participants (chi(2)[10] = 22.4, P = 0.013), and those with less education (chi(2) [4] = 75.0, P < 0.0001). Low knowledge was associated with negative attitudes (P < 0.0001) and both factors were associated with lower intentions to participate in colorectal cancer screening (P < 0.0001). Multivariate analysis indicated that attitudes partially mediated the effect of knowledge on screening intentions. CONCLUSIONS: Increasing knowledge may reduce negative public perceptions of cancer which may impact positively on intentions to participate in screening.     

Occupational health in general practice in an industrial area of Singapore

The aim of this study was to estimate the caseload with regard to the proportion of work-related medical cases in factory workers and to survey knowledge of and attitudes to occupational medicine among doctors in an industrial area in Singapore. To this end, a self-administered questionnaire was given to 74 general practitioners in the industrial district of Jurong in Singapore. Overall, there was an 89.2% response rate. Thirty-three of the 66 respondents were males. Mean age was 40.8 years (range 27-64 years). Twenty-four (36%) had some postgraduate training in occupational medicine (GP-OM) while the rest did not (GP). The caseload for all doctors was similar with regard to the number of adult patients and, more specifically, the number of factory workers seen per day. The majority of doctors (76.6%) felt that <10% of factory workers seen had work-related problems. Most (70%) felt confident in dealing with the occupational problems that arose. However, a large percentage (78% of GPs, 45.8% of GP-OMs) felt that training in occupational medicine was inadequate. This is reflected in the knowledge questions, where GPs did not score as well as GP-OMs. It was concluded that GPs working in this industrial area see a good proportion of factory workers, in a fair number of cases for work-related problems. However, only a third of the GPs are qualified in occupational medicine. These factors highlight the need for more emphasis on occupational medicine training among general practitioners, especially those working in industrial areas.     

Talking about sex to oncologists and about cancer to sexologists

More than 50% of all cancer sufferers suffer from sexual problems. This can be a major issue for them, but is one which is often not dealt with appropriately. Both patients and professionals are reluctant to bring up the topic. The patients are embarrassed, and feel it may be seen as trivial compared to survival. Professionals may also be embarrassed, and may be unsure how to deal with sexual issues should they be discussed. Professionals may also have biased and judgmental attitudes to sex and sexuality, particularly in relation to age and sexual orientation, which interferes with their patient care. Research has shown that patients wish their doctors to discuss sexuality with them, and if mentioned at an early stage in the cancer journey, then the sexual outcomes may be better. There are also practical barriers to open discussion of sex with these patients, such as lack of time and opportunity in relation to the overwhelming issues that have to be faced in relation to the cancer. Sexual counselors with no clinical background would also benefit from some knowledge of cancer and its treatments in order to understand the physical impact of the disease. Improved professional education and increased awareness of sexual issues and modes of treatment coupled with the provision of early information to the patients should greatly improve patient care.     

What Do Healthcare Providers Know About Nutrition Support? A Survey of the Knowledge,Attitudes, and Practice of Pharmacists and Doctors Toward Nutrition Support in Malaysia

Background and Aims: Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers' inadequate knowledge. The aim of this study was to evaluate the self‐reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. Methods: A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. Result: Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients' nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the “average” score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. Conclusion: Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established.     

Perspectives on colorectal cancer screening: a focus group study

Objective To assess attitudes and acceptability of Ontario consumers and doctors towards colorectal screening with faecal occult blood testing (FOBT) and colonoscopy. Design, setting and participants Focus groups with gender‐specific samples of the population, high‐risk gastroenterology patients and family doctors. Method Semi‐structured interview guides used by facilitator to lead groups through knowledge of risk factors and prevention of colorectal cancer, the screening modalities, requirements for implementing screening programmes, barriers to screening and preferences towards screening. Main findings There were low levels of knowledge about colorectal cancer and its prevention in the general population. FOBT was an acceptable screening modality, but considerable education about its use and benefits would be necessary to implement a screening programme. Colonoscopy was not perceived to be a good choice for a primary screen in the general population. The high‐risk group supported use of FOBT in the general population and emphasized the need for education. The doctors were more reluctant about screening, requesting clear guidelines. They also identified the time and resources that would be required if a screening programme were initiated. Conclusion While colorectal screening is acceptable in this sample, information and decision aids are required to enable consumers and providers to make effective decisions. Implementation of colorectal screening programmes requires substantial educational efforts for both consumers and doctors.     

成都市医生吸烟现状及男性医生吸烟行为影响因素研究

目的了解成都市医生的吸烟状况及男性医生吸烟的影响因素。方法采用多阶段随机抽样方法,对抽取的成都市710名医生进行吸烟现状调查,应用Logistic回归模型探讨男性医生吸烟的影响因素。结果本次调查的医生总体吸烟率为17.2%,男性医生吸烟率为37.3%;男性从不吸烟者和曾经吸现在已戒烟者的相关认知均好于吸烟者(F=3.61,P0.01;F=2.98,P0.01),从不吸烟者和曾经吸现在已戒烟者的相关态度均好于吸烟者(F=2.31,P0.01;F=2.29,P0.01);男性医生吸烟的影响因素为年龄、工龄、相关知识得分、相关态度得分和单位禁烟。结论本次调查的医生吸烟率较低,男性吸烟者吸烟相关认知差于不吸烟者,应该根据调查的相关吸烟影响因素制定医院控烟措施,进一步降低医生的吸烟率。     

Teaching and learning in morbidity and mortality rounds: an ethnographic study

Medical Education 2010: 44: 559–569 Objectives In keeping with the current emphasis on quality improvement and patient safety, a Canadian division of general internal medicine began holding weekly morbidity and mortality rounds (M&MRs) with postgraduate trainees. Grounded in the medical education and social sciences literatures about such rounds, we sought to explore the teaching and learning processes that occur in M&MRs in order to understand their role in, and contribution to, the current medical education context. Methods We conducted an ethnography of these M&MRs. We observed the rounds, conducted interviews with both staff doctors and residents and triangulated the resultant data. Concurrent, iterative data collection and analysis enabled sampling to saturation. Results Staff doctors had differing understandings of the role of M&MRs and valued different kinds of teaching. They did not think they were teaching medical content knowledge at these rounds, but rather that they were role‐modelling six skills, attitudes and behaviours, including ‘identifying and addressing process and systems issues affecting care’. Residents primarily wanted to learn content knowledge and tried to extract such knowledge out of the rounds. They did recognise and value that they were learning about process and systems issues. They also agreed that staff doctors were role‐modelling other things, but had varying perceptions of what those were; most did not value this role‐modelled learning as much as they valued the acquisition of content knowledge. Conclusions These M&MRs were effective forums for addressing patient safety and quality improvement competencies. They carried none of the negative functions attributed to such rounds in the sociology literature, focusing neither on absolving responsibility nor on learning socially acceptable ways to discuss death in public. However, this study revealed a marked disjunction between the teaching valued by staff doctors and the learning valued by their trainees.