Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy

ObjectiveZambia suffers from a physician shortage, leaving the provision of care for those with epilepsy to nonphysician health care workers who may not be adequately trained for this task. These individuals are also important community opinion leaders. Our goal in this study was to determine the knowledge, attitudes, beliefs, and practices of these health care workers with respect to epilepsy.MethodsHealth care workers in urban and rural districts of Zambia completed a self-administered, 48-item questionnaire containing items addressing demographics, personal experience with epilepsy, social tolerance, willingness to provide care, epilepsy care knowledge, and estimates of others’ attitudes. Analyses were conducted to assess characteristics associated with more epilepsy care knowledge and social tolerance.ResultsThe response rate was 92% (n = 276). Those who had received both didactic and bedside training (P = 0.02) and more recent graduates (P = 0.007) had greater knowledge. Greater knowledge was associated with more social tolerance (P = 0.005), but having a family member with epilepsy was not (P = 0.61). Health care workers were generally willing to provide care to this patient population, but ∼25% would not allow their child to marry someone with epilepsy and 20% thought people with epilepsy should not marry or hold employment. Respondents reported that people with epilepsy are feared and/or rejected by both their families (75%) and their community (88.8%).ConclusionsKnowledge gaps exist particularly in acute management and recognition of partial epilepsy. More recent graduates were more knowledgeable, suggesting that curriculum changes instituted in 2000 may be improving care. Health care workers expressed both personal and professional reservations about people with epilepsy marrying. In addition to improving diagnosis and treatment skills, educational programs must address underlying attitudes that may worsen existing stigmatizing trends.     

When consultants write orders: physicians' attitudes, beliefs, and practices

The process by which a consultation is performed may significantly impact the extent to which the content of the consultation contributes positively to patient care. The practice of consultants writing orders independent of the explicit permission of the consultation requester is a common event. A survey of 211 multispecialty physicians on the medical staff of a large, urban, Northeastern, teaching hospital about their attitudes, beliefs, and practices regarding consultation on the inpatient service reveal that the majority of respondents in all specialties were unaware of departmental or hospital policy regarding the practice of consultant order writing. Significant differences between specialties existed in the perception of the impact of consultant order writing on patient outcomes, in the practice of discussion with the primary attending prior to order writing, and in the documentation practices. The authors discuss such results and their policy implications in light of important medico-legal and ethical principles, and best practice standards.     

Geriatric euthanasia: attitudes and experiences of health professionals

Summary Increasingly, decisions to withhold treatment for the terminally ill have received considerable attention in medical, ethical, legal and lay publications. Few studies, however, have examined in detail the beliefs of health professionals about euthanasia, and more importantly, the frequency with which euthanasia occurs. A questionnaire was administered to 190 health care professionals (three-fourths of whom were affiliated with long term health care facilities) to examine these two questions. With regard to passive euthanasia, 83% of the respondents had heard of such cases, 56% had participated, 37% had given the permission for it to occur, and 17% had withheld life support system. With respect to active euthanasia, results were as follows: hearsay, 44%; participation, 21%; permission, 37%; and direct action, 20%. This study supports the need for health care professionals to become more active in the development of broad professional and individual institutional ethical guidelines in the care of the terminally ill.     

A cross-cultural study of mental health beliefs and attitudes towards seeking professional help

Background: This study sets out to examine the relationship between culture beliefs about the causes of mental distress and attitudes associated with seeking professional help for psychological problems. It was hypothesised that there is a meaningful and statistical relationship between these variables and that there will be a difference in this relationship between Asians and Westerners. Participants were 287 adults belonging to three groups (British Asian, western European and Pakistanis). Method: Participants completed two questionnaires: the Orientations to Seeking Professional Help (Fischer and Turner 1970) and the Mental Distress Explanatory Model Questionnaire (Eisenbruch 1990) and a demographic data sheet. Results: Analysis indicated that positive attitudes toward seeking professional help for psychological distress were similar for British Asians, Westerners and Pakistanis. There were significant differences between the three groups in the causal attributions of mental distress. Although culture, as a variable, was not a significant predictor of a positive attitude to seeking professional help, causal beliefs of mental distress were significant predictors of attitudes to seeking help for the British Asian and the Pakistani groups. Beliefs were not significant predictors for attitudes to seeking help for the Western group. Conclusion: It was concluded that culturally determined causal beliefs of mental distress contribute to attitudes towards seeking professional help for psychological problems for Asians. Implications for both research and the provision of more appropriate health services for the British Asian minority group in the United Kingdom are discussed. Accepted: 6 March 2000     

Caregivers of Turkish schizophrenic patients: causal attributions,burdens and attitudes to help from the health professionals

The purpose of this study was to examine the causal attributions, difficulties, perceived and expected help behaviour of health care professionals, and hope for the future well-being of the caregivers of Turkish schizophrenic patients in order to form guidelines for forming a collaboration with the families of schizophrenic patients. Sixty caregivers were interviewed by using a semi-structured interview schedule. The responses of the literature in this area. The caregivers guidelines of the literature in this area. The caregivers attributed schizophrenia mainly to psychosocial causes, namely stressful events (50%), family coflicts (40%) and patients' characteristics (28%). The most frequently reported difficulties were family conflicts and disruptions of family life (57%), subjective burden (48%) and financial costs due to the patient (27%). The number of difficulties reported by caregivers was related to the duration of the patient's illness. Caregivers perceived pharmacological treatment (42%), interest and support given to the caregiver (28%), and the hospitalization of the patient (20%) as helpful. Their expectations of help were in similar areas. About half of the caregivers were optimistic about the future wellbeing of their relatives. Optimistic and pessimistic caregivers differed in the educational level of the caregiver and the duration of the patient's illness. The results suggested that the families of schizophrenics need the support of professionals and the establishment of networks focusing on the caregivers and their relationships with their ill relatives and with health care institutions.     

Examining attitudes, beliefs and knowledge of effective practices in psychiatric rehabilitation in a hospital setting

OBJECTIVE: This brief report presents a staff training program based on psychiatric rehabilitation principles used in a hospital setting. The training program intervention significantly promoted the belief that mental illness does not necessarily limit functioning and also improved awareness of research findings, evidence-based practices and community services. METHODS: A randomized controlled study assessed the impact of the program on the staff's attitudes regarding psychiatric rehabilitation and recovery. RESULTS: Findings suggest that in-service training programs within a hospital setting can change staff attitudes in order to support psychiatric rehabilitation. CONCLUSIONS: A psychiatric rehabilitation forum, made up of representatives from all disciplines, including the medical directors of every ward, was set up in the hospital following the training program and has become the main avenue to disseminate information, messages, and goals to the staff at large and to the hospital administration. It is the forum that creates the shared vision about psychiatric rehabilitation within the hospital and has the task of facilitating implementation of services according to that vision.     

Patterns of contact of patients' families with mental health professionals and attitudes toward professionals.

Previous studies have shown that many relatives of mentally ill persons are dissatisfied with their relationships with mental health professionals. In this study, 274 relatives or close friends of 168 recently discharged mental patients reported on 1,198 separate contacts with mental health professionals during the course of the patient's illness. Primary kin, such as parents and spouses, were most likely to be in contact with professionals. Different types of professionals were more likely to be in contact with relatives at different points in the patient's illness. Relatives' satisfaction varied significantly for the different types of professionals. Depending on the reason for the contact, 53 to 73 percent of the relatives reported being very satisfied or satisfied with the outcome. Respondents were most satisfied with their contacts with psychologists, followed by nurses, case managers, social workers, and psychiatrists.     

Comparison of attitudes to the sexual health of men and women with intellectual disability among parents,professionals, and university students

Background This study investigates whether parents, professionals, and university students have different sexual attitudes towards men versus women with intellectual disability (ID) and which factors are related to such attitudes among these three groups.

Method A self-administered survey using the ASQ-ID questionnaire was implemented, and 130 parents, 173 professionals, and 645 university students completed it.

Results University students showed more positive attitudes than parents and professionals. Parents were more likely to have a positive perception of men with ID than of women with ID with regard to “parenting.” Whether they were parents, professionals, or university students was not correlated with their attitudes; instead, their attitudes were associated with participants' age, education, and religion.

Conclusions Awareness of sexual rights related to people with ID, especially women with ID, needs to be discussed among parents and professionals, particularly those in old age, with a low level of education, and those who follow the Buddhist religion.     

Patient, caregiver, and health care practitioner knowledge of, beliefs about, and attitudes toward epilepsy

The medical literature related to knowledge of, beliefs about, and attitudes toward epilepsy was reviewed from the perspective of patients, caregivers, and health care providers. The literature points to a desire for enhanced epilepsy education by patients and caregivers; however, these needs have not been met by primary or specialty care. Surveys of general practitioners (GPs) point to limitations in knowledge and negative attitudes. GPs view their role in epilepsy care as primarily educational and tend to acknowledge their limitations by referring difficult cases. Ongoing education for GPs is important, as is an improved partnership in defining roles for care and education. Health care professionals specialized in epilepsy care acknowledge their own set of barriers to optimal care. Epilepsy education programs have been able to improve knowledge; however, long-term improvements in behavioral outcomes or quality of life are less documented. Suggestions for improvements are provided.     

Australian adolescents'' attitudes and beliefs concerning pregnancy, childbirth and parenthood: the development, psychometric testing and results of a new scale

Recent research suggests that many adolescents hold unrealistic and idealised beliefs about the likely consequences of pregnancy and parenthood. Such attitudes potentially play an important role in the aetiology of adolescent pregnancy. Disillusionment with reality may also contribute to postnatal depression, domestic violence and child abuse. This paper reports on the development of a scale to measure the prevalence of such beliefs. The scale was administered to a sample of 1546 Australian adolescents. Between one-quarter and one-third of the sample exhibited idealised beliefs, with males having higher levels of idealization. On factor analysis, the idealization construct comprised an overestimation of positive aspects and an underestimation of negative ones. Subjects reported that very few of their beliefs derived from formal educational input.     

A national sample of IAPSRS members' responses to the psychiatric rehabilitation beliefs, goals, and practices scale

This study reports on the convergent-discriminant validity of the Psychiatric Rehabilitation Beliefs, Goals, and Practices Scale (PRBGP) which purports to measure practitioners' knowledge of the current consensus in psychiatric rehabilitation. The sample comprised 478 IAPSRS members who represented practitioners from 39 states. The study found that the PRBGP variance among this sample was primarily associated with the number of 15 leading contributors to the psychiatric rehabilitation literature that these practitioners claimed to have read when education, discipline, role, experience, and agency area were controlled. Experience in the behavioral health field and the administrator role were also significantly related to the PRBGP, but these relationships may have also been a function of informational factors associated with IAPSRS membership. For a combined sample (n = 757), it was also found that the PRBGP is primarily related to the number of leading authors that these practitioners read. The PRGBP appears to measure knowledge of the current consensus on beliefs, goals, and practices in psychiatric rehabilitation, and is not a measure of these other responder characteristics.     

Psychometric characteristics of questionnaires designed to assess the knowledge, perceptions and practices of health care professionals with regards to alcoholic patients

Failure of the French health care services to diagnose and manage problem drinkers has been established on many occasions. This results from a relative lack of knowledge of the basics of alcoholism and the low level of involvement of health care professionals in the management of these patients. In response to this inadequacy, the French Public Health Ministry promoted the development of managed care and coordination of care for these patients. Teams in charge of coordinating care for problem drinkers have been implanted in 96 French hospitals since 1996. These teams aim to provide support to health care providers caring for problem drinkers. For this purpose, they have delivered continuing medical education designed to prepare health care providers to identify and manage these patients in various settings. However, no formal assessment of the impact of these interventions on the knowledge, perceptions, and practices of health care professionals has been planned. The assessment of these interventions can rely on qualitative methods such as observation, focus groups, or individual interviews. However, qualitative methods require specific skills, are time-consuming, and cannot be implemented on a large scale. In contrast, quantitative methods using survey questionnaires or standardized instruments appear to be more appropriate for large scale or repeated evaluations. However, the accuracy of ratings provided by these instruments can be affected by many methodological factors, including the quality of the instrument in terms of validity, reliability, and sensitivity to changes. The aim of this paper is to describe the properties of French and English language questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients. METHODS: The instruments were retrieved by searching the Medline, Pascal, and Sudoc computerized bibliographic databases from January 1964 to December 2002. The following medical Subject Headings (MeSH) and text words were used: "*alcoholism/psychology/therapy", "questionnaire", "healthy care surveys", "attitude of health personnel", and "*knowledge/attitude/practice". In addition, the table of contents of the French journals devoted to alcoholism that were not indexed in electronic bibliographic databases were examined (Alcoologie et addictologie, Alcoologie). The bibliographies of relevant articles were also examined for additional citations. Finally, a phone survey of 34 professionals caring for alcoholic patients located in French university hospitals was carried out to retrieve unpublished questionnaires. Two authors independently extracted data from each study using a standard date abstract form. Disagreements were resolved through consensus. They extracted information on the development process and properties of validity, reliability, and sensitivity to changes. Validity is a concept concerned with the extent to which an instrument actually measures what it is supposed to measure. It is assessed through different facets (content, construct, criterion, discriminant, and predictive validity). Reliability reflects the amount of error inherent in any measurement. Sensitivity to change corresponds to the property of an instrument to identify small but clinically significant changes in attitude or practice. RESULTS: A total of 57 relevant publications involving 39 original instruments were identified. Eighty questionnaires were not available, despite the solicitation of their developers. Overall, the study included 21 instruments. Of these, 20 were English-language questionnaires and one was in French. The conceptual frameword was specified for only two questionnaires: "the Addiction Belief Scale" and "the Alcohol and Alcohol Problems Perception Questionnaire". The number of items ranged from 9 to 122. Items were derived from qualitative surveys in only two cases. In the other cases, they were derived from the literature, expert panels, or form unknown sources. The internal construct validity of eight questionnaires was assessed using principal component analysis, factor analysis, or cluster analysis. We considered that external construct validity was analyzed by testing empirical hypotheses derived from the literature for 15 of the instruments studied. Predictive validity cas evidenced for only one questionnaire. Internal consistency was documented for seven instruments, using Cronbach's coefficient. Test-retest or inter-rater reliability was assessed for none of the instruments. The sensitivity to change of two instruments was analyzed. The response rate to the instruments ranged from 46% to 93%. DISCUSSION: The main finding of this study is that properties of validity, reliability, and sensitivity of questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are neglected. Moreover, these questionnaires generally lack a theoretical background. Hence, the interpretation of responses to these questionnaires may be misleading. The present study has several limitations. The search strategy could be criticized for searching only a small number of databases, and selecting French and English language questionnaires. However, given the large range of journals included, it was unlikely that the strategy has limited the generality of the results. In addition, we identified no additional relevant articles by contacting professionals working with alcoholic patients in French university hospitals. Articles reporting instruments designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are incomplete. Journals should require minimum evidence of validity, reliability, and sensitivity when reporting results of surveys, development of questionnaires or standardized instruments. CONCLUSION: The psychometric characteristics of French language questionnaires were given very little attention. In order to evaluate the effectiveness of their continuing medical education programs, the teams that train French medical staff caring for alcoholic patients should either develop a standardized survey questionnaire following a strict methodology or translate an English language instrument, which would also require a cross-cultural validation.     

The relationship of causal beliefs and contact with users of mental health services to attitudes to the 'mentally ill'

Programmes to destigmatise 'mental illness' have traditionally been based on the 'mental illness is an illness like any other' metaphor and have been largely unsuccessful. By measuring attitudes towards, and etiology beliefs about, 'mental illness' before and after a series of four undergraduate lectures presenting the psychosocial causes of, and solutions to, severe mental health problems, this study (a) replicated previous studies demonstrating a relationship between biogenetic causal beliefs and negative attitudes towards 'mental patients'; (b) found that following the lectures attitudes improved, particularly around the key variables of dangerousness and unpredictability; and (c) demonstrated that amount of contact with people who had received psychiatric treatment was an even stronger predictor of positive attitudes than acceptance of a psychosocial perspective.