Exploring the gap between knowledge and behavior: a qualitative study of clinician action following an educational intervention.

PURPOSE: Many medical education interventions improve clinicians' knowledge but fail to change behavior. The authors exposed this knowledge-behavior gap through standardized clinical interactions, thus allowing in-depth exploration of the contributing factors. METHOD: A typical evidence-based educational intervention in one clinical domain (early signs of autism) was administered to family medicine residents at the University of Toronto in 2001-02, and change in knowledge was assessed through a multiple-choice test. Six to eight weeks later, participants' relevant knowledge was documented, and their clinical behavior was observed during four interactions with standardized patients. Factors producing a knowledge-behavior discrepancy were then explored using semistructured interviews, which were audiotaped, transcribed, and analyzed using grounded theory methods. RESULTS: Half of participants demonstrated varying degrees of knowledge-behavior gap. Eight main rationalizations (relationships, patient agenda, knowledge deficit, clinical style, means to an end, ideals, autism stigma, and systems barriers) were used to justify choices of clinical behavior, and the same rationalizations were used to justify opposite choices of behavior. Two conditions that promote clinical action based on knowledge (level of certainty and sense of urgency) were identified. CONCLUSION: The knowledge-behavior gap was exposed and factors reported to influence clinicians' decisions about whether to implement new knowledge were elicited. That identical rationalizations were used to justify opposite behaviors implies these factors may not be behavioral determinants. Sense of urgency and level of certainty promote clinical action based on knowledge; focusing on these may increase the impact of education on practice.     

Information need,learning need and educational need,definitions and measurements: A systematic review

BackgroundThere are various definitions and tools for Information Need (IN), Learning Need (LN) and Educational Need (EN) which are used interchangeably in the patient education.ObjectiveClarifying the definitions of IN, LN and EN as well as comparing item generation methods and the dimensions of the available tools to be used appropriately.MethodsWe searched PubMed/Scopus/Embase/Science Direct databases from 1960 to 2019. Two reviewers selected studies and extracted data independently.ResultsWe identified 22 tools comprised of 14 IN, 5 LN and 3 EN tools. The Patient Learning Needs Scale (PLNS) was the only general tool. The content of tools includes anatomy, physiology, diagnostic tests, symptoms, treatments, medications, diet, activity and self-care. No difference was found between EN/LN/IN tools in terms of item generation and dimensions according to their concept definitions. Seven tools assessed all 7 domains of patient education components.ConclusionThe EN, LN and IN are different concepts, but using these concepts in the tools is not based on their definitions and they have been used interchangeably. IN and LN tools were more complete and comprehensive.Practical implicationsThe findings of this review can help researchers and clinicians to use EN, LN and IN tools more appropriately.     

Russian-American health care: bridging the communication gap between physicians and patients

OBJECTIVES: The objectives of this article are two-fold: (1) to gather in one place reliable information about Russian-Americans' past medical practices and their current outlook on health care and to provide health care professionals with an overview of the major afflictions suffered by this ethnic group; and (2) to educate Russian-speaking patients about the American heath care system and social services geared towards immigrants by locating and evaluating free, culturally appropriate patient education Web sites available in Russian. METHODS: In order to draw data on specific diseases and conditions affecting the Russian-speaking population, the author searched various scholarly health-related electronic databases. A number of well-established U.S. government consumer-health Web sites were searched to locate patient education resources that can be utilized by recent Russian immigrants. RESULTS: The author provides an overview of the major health problems encountered by the Russian-speaking population before emigration and potential health concerns for Russian immigrant communities. In addition, the author provides a scholarly exploration of patient education materials available in Russian. CONCLUSION: In this increasingly diverse society, physicians are faced with the challenge of providing culturally sensitive health care. Multicultural Web-based health resources can serve as a valuable tool for reducing communication barriers between patients and health care providers, thus improving the delivery of quality health care services. Recommendations for further research are indicated. PRACTICE IMPLICATIONS: The author offers recommendations for practitioners serving Russian-speaking immigrants. Suggestions on utilization of Web resources are also provided.     

A novel educational intervention targeting melanoma risk and prevention knowledge among children with a familial risk for melanoma

Objective

To examine the acceptability of and preliminary effects associated with a novel educational intervention for children at elevated risk for melanoma. The intervention incorporated information on mechanisms through which melanoma preventive behaviors mitigate risk for melanoma and was delivered to parents and children concurrently.

Assessing the knowledge of bronchial asthma among primary health care physicians in Crete: A pre- and post-test following an educational course

Aim  

To assess the level of knowledge for bronchial asthma of the primary healthcare physicians serving a rural population on the island of Crete, both before and immediately after a one-day educational course.     

Improving knowledge,attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial

Objective

To test the effectiveness of an individualized educational intervention on knowledge, attitudes and beliefs about acute coronary syndrome (ACS).

Methods

This multi-site, randomized controlled trial was conducted on 1947 patients with a diagnosis of ACS. Both groups received usual in-hospital education. Participants randomized to the intervention group received a 40-min one to one individualized education session, delivered using motivational interviewing techniques. The intervention was reinforced 1 month and 6 months later. Knowledge, attitudes and beliefs were measured using the ACS Response Index. A total of 1136 patients (control, n = 551; intervention, n = 585) completed the questionnaire at baseline, 3 and 12 months. Data were analyzed using repeated measures analysis of variance. Ethical approval was obtained.

Results

There was a significant effect of the intervention on mean knowledge (p < 0.001), attitude (p = 0.003) and belief (p < 0.001) scores at 3 and 12 months.

Conclusion

Ensuring patients retain information post education has always been difficult to attain. This study demonstrated that patient education using motivational interviewing techniques and an individualized approach has the potential to alter knowledge, attitudes and beliefs about ACS among a high risk population.

Practice implications

This relatively short, simple and effective educational intervention could be delivered by nurses in multiple settings.     

Patient knowledge of immunotherapy before and after an educational intervention: a comparison of 2 methods.

BACKGROUND: Immunotherapy is an invaluable therapy for allergic asthma, allergic rhinitis, and hymenoptera hypersensitivity. It is, however, not without risks. OBJECTIVES: To examine patient knowledge regarding immunotherapy and to determine the most effective educational method to improve their knowledge by answering the following questions: Before educational intervention, what is the current knowledge level regarding allergy vaccinations of patients receiving immunotherapy? What effect does an educational encounter have on that level of knowledge? Which educational intervention--a one-on-one session vs a handout--if either, increases patient knowledge more? METHODS: An original, self-administered patient questionnaire was distributed to all patients receiving immunotherapy. Patients were randomly assigned to a control group, an intervention group that received an educational handout monthly for 2 months, or an intervention group that had a one-on-one educational session with a physician or nurse practitioner. After 3 months, all patients completed an identical follow-up questionnaire. Pretest and posttest scores were compared for each group and among the different groups to determine which method was more effective. Repeated-measures analysis of variance was used to determine the effect of instruction type on differences in pretest and posttest scores. RESULTS: All 3 groups significantly improved their mean overall questionnaire scores (P < .001). The amount of change was greater in the intervention groups than in the control group, but it did not reach statistical significance (P = .59). CONCLUSIONS: Baseline immunotherapy knowledge of allergy vaccination patients was better than expected, and further educational interventions did not significantly improve this knowledge.     

Newer directions for plant drug research: The need to examine and investigate traditional remedies for pharmacotherapy of animal and zoonotic diseases

Traditional remedies for animal diseases have not been investigated as much as those for human diseases. Yet, there is a wealth of knowledge available to be tapped from the remedies used in the treatment of animal and zoonotic diseases. The indigenous knowledge available could be rationalized in the modern pharmaceutical context and applied directly to field use where appropriate. Furthermore, it is well known that many drugs have been developed initially through their use in animals because the ethical issues are easier to handle. It is worth examining some the indigenous medicinal plants that are used for both human and animal disease treatment, and determine the practical and cost-effective ways of exploiting the values of these plants.     

Breaking bad news in obstetrics and gynecology: educational conference for resident physicians

Summary To educate the Obstetrics and Gynecology residents about how to conduct conversations about poor prognoses, a panel discus-sion was scheduled, with patient-educators teaching about their experiences receiving bad news. The resident physicians reported that this conference format was an effective method for teaching this content. The patient-educators appreciated assisting the physicians, were comfortable in the conference setting, and reported a willingness to return for conferences in the future. Accepted August 20, 2002; Published online October 1, 2002 Correspondence: Jillian Romm RN, LCSW, Department of Obstetrics and Gynecology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road – L466, Portland, OR 97201, U.S.A; e-mail: rommj@ohsu.edu     

The gap between physicians and the public in satisfaction with the National Health Insurance system in Korea

The Korean National Health Insurance (NHI) system was an unprecedented accomplishment that was achieved in a short period of time. In this study, we sought to identify gaps between physicians and the public with respect to attitudes toward the NHI system in Korea. The study population was derived from the 2008 Korean Medical Association Survey, which was conducted to investigate satisfaction with and perceptions of the NHI system among physicians (n = 961) and the public (n = 935). Only 6.5% of the physicians were satisfied with NHI system, and 71.5% were dissatisfied with it. In contrast, 28.3% of the public were satisfied with the NHI system, and 21.4% were dissatisfied. The level of dissatisfaction expressed by physicians (2.03 ± 0.91 on a five-point scale) was also higher than that expressed by the public (3.06 ± 0.84). Despite rapid growth of NHI system, a large gap in satisfaction exists between physicians and the public.     

The gap between back pain patients' prior knowledge and scientific knowledge and its evolution after a back school teaching programme: a quantitative evaluation

This study presents a method for quantitative evaluation of the congruence between patients' representations and teachers' scientific knowledge, which is used as the standard of assessment. First, the patients' knowledge and the teachers' scientific concepts before a back school (BS) programme were compared (T₀). Then the evolution of patients' knowledge at 1 month (T₁) and 1 year (T₂) after the teaching was evaluated. Patients' knowledge was assessed blind by a multidisciplinary panel of nine independent judges. Mean scores were computed for each set of data (T₀, T₁, T₂); these scores were then submitted to an analysis of variance. The results showed an important gap between patients and teachers before BS with an improvement after the teaching. Knowledge referring to know-how and/or attitudes evolved differently when compared to theoretical knowledge.     

Assessment of the quality and content of website health information about herbal remedies for menopausal symptoms

ObjectiveTo assess the quality, readability and coverage of website information about herbal remedies for menopausal symptoms.Study designA purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage.Main outcome measuresNon-parametric and parametric tests were used to explain the variability of these factors across types of websites and to assess associations between website quality and information coverage.Results39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p = 0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r = 0.69, p < 0.001, n = 39).ConclusionOverall website quality and information coverage are poor and the required reading level high.     

A psycho‐educational intervention for depressed women: A qualitative analysis of the process

Yalom (1995) has stated that psycho‐educational interventions could be made more effective by incorporating a focus on the interpersonal process. A qualitative analysis is proposed to investigate the degree of fidelity with which a psycho‐educational intervention for women with depressive symptoms was delivered and to identify Yalom's significant therapeutic mechanisms operating in group therapy. The intervention consisted of six 2 two‐hour weekly sessions organized around educational material. Eight groups were conducted with 5 ? 19 participants each. A qualitative analysis was undertaken based on Kvale's (1996) technique of ‘categorization of meanings’ for the transcribed registers of audiotaped recordings. The analysis led to the definition of five major group process categories: establishment of rules, educational exchange, experiential exchange, reflexive work designed to achieve cognitive and behavioural change, and limitations on the exchange process. It showed that the facilitators largely adhered to the goals of the intervention, its strategies and model, and that the main limitations concerned facilitators' and participants'speaking for over‐long periods of time and facilitators' failure to cover all the material due to lack of time. The subsequent analysis identified four of Yalom's categories: installation of hope, didactic instruction, catharsis, and universality. In support of Yalom's assertion, we concluded that this exercise was useful in that it highlighted important therapeutic factors that could be more purposefully manipulated in the future.     

Perceptions of urgency: Defining the gap between what physicians and nurses perceive to be an urgent issue

IntroductionThrough our research into the design and evaluation of technology systems to improve the quality and safety of clinical communication, we have discovered that physicians and nurses differ in perspective regarding clinical prioritization and desirable response times. This has a number of important consequences including unnecessary interruptions, escalating conflict and deterioration in interprofessional relationships. Understanding the differing perspectives on clinical prioritization, or the gap in perceived urgency, may improve interprofessional relationships.MethodsWe conducted a mixed-methods study utilizing both qualitative (semi-structured interviews) and quantitative (surveys) methods to determine the gap between perceived urgency among physicians and nurses. The survey comprised of real messages extracted from the clinical communication system that was implemented. Physicians and nurses reviewed the messages and assigned an urgency level to each. The semi-structured interviews used open-ended questions to act as a guide to highlight key themes of interest. Thematic analysis, frequency tabulation, and triangulation were used to analyze the data.ResultsAlthough the surveys demonstrated concordance between physicians and nurses when independently ranking the urgency of clinical messages (kappa = 0.66 SE 0.15), agreement was only fair in comparison to the urgency identified by the original nurse who sent the message (kappa = 0.22 SE 0.18). We hypothesize that clinical context has a major role in defining urgency and may explain this finding. The survey data was triangulated with the semi-structured interview data and it was determined that the desired response time significantly impacted the sender's message prioritization. For example, shift changes and anxious family members were associated with discordant prioritizations.DiscussionThis study demonstrated that the perceived communication urgency gap between sending nurses and receiving physicians was primarily related to timeframe and context, not clinical condition. Most disagreement occurred when nurses used urgent messaging for time sensitive but not clinically urgent issues in an effort to expedite the resolution of their issue by the physicians. These results indicate the need for clinical communication systems to incorporate decision support around both clinical prioritization and expected response time in their design. Effective interprofessional communication is essential to the provision of safe, quality-based healthcare; these results highlight some of the sociotechnical aspects of health information technology implementation that must be considered.     

Family-centered communication: A pilot educational intervention using deliberate practice and patient feedback

ObjectiveThere are few opportunities in medical education dedicated to learning skills for effective communication in life altering patient scenarios. We therefore aimed to develop and assess a longitudinal advanced communication curriculum for pediatric residents using patient feedback and deliberate practice.MethodsPediatric residents at a large academic center were randomized into 2 groups. The intervention group received 6 educational sessions from 2019 to 2020, parent feedback of performance via the Communication Assessment Tool (CAT), and monthly communication tips. Communication skills of both groups were assessed at the end of the intervention.ResultsWe collected 937 CAT assessments on 36 first-year residents. The intervention group demonstrated statistically significant improvement in communication skills from pre to post assessment (p = 0.0063, (odds ratio (OR) 1.76, 95 % confidence interval (CI) [1.17, 2.63]) compared to the control group (p = 0.080, OR 1.41, 95 % CI [0.96, 2.05]).ConclusionsThere are patient and self-identified performance gaps in communication skills for pediatric residents, underscoring the need for formalized curricula dedicated to these skills.Practice implicationsOur study highlights the value of deliberate practice and the integration of family feedback as an educational tool in communication skills development.