Well-child Care Clinical Trial
Official title:
Evaluation of an Interventional Program for Family Physicians on Well-child Care for Children Under-5 in Suez Canal Area, Egypt
Background
Despite providing health promotion and preventive measures for children under-5 years are
essential for lifelong health and wellbeing of individuals and countries, studies into family
physicians' knowledge, attitudes, and practices (KAP) regarding comprehensive well-child
services for children under-5 years seem to be scarce in developing countries. This study
aimed to evaluate family physicians' KAP towards well-child care for children under-5 years
in Suez Canal area before and after implementing an interventional program.
Methods A pre-post interventional study was conducted from September 2014 to March 2016 on
comprehensive sample of 39 family physicians, who were under training in the Family Medicine
department, Faculty of Medicine, Suez Canal University. Their KAP were assessed by valid and
reliable questionnaire (78-items) at baseline and after 6 months of implementing a training
program.
A pre-post interventional study was conducted from September 2014 to March 2016. This
interventional study was held in the Family Medicine Department, FOM/SCU. The assessment of
participants' practices was performed in training family practice centers (FPCs) affiliated
to Family Medicine Department, FOM/SCU in Port Said (2 centers), Ismailia (3 centers) and
Suez governorates (4 centers).
Comprehensive sample of 39 family physicians (FPs) was recruited (the response rate was
63.93%), who accepted to participate in this intervention, affiliated to Family Medicine
Department, FOM/SCU, and Ministry of Health and Population (MOHP) and regularly enrolled in
classic postgraduate programs of Family Medicine Department, FOM/SCU.
The study excluded FPs who did not work in Suez Canal region despite they were under training
of Family Medicine Department (FOM/SCU), were not adherent to attend the training program,
did not send one of the pretest or posttest and staff of Family Medicine Department, FOM/SCU.
This study was conducted at 3 phases: preparatory, design and implementation of a training
course, scoring of KAP questionnaire and evaluation and data management. During the
preparatory phase; the questionnaire was designed by the researchers based on relevant
literature [4,21-26].
This questionnaire consisted of 4 parts; the participants' socio-demographic data, and KAP of
them towards well-child care for children under-5 years in Suez Canal area. The first 3 parts
of this questionnaire were self-reported by FPs and the fourth part (practices) was assessed
by the corresponding author via observational checklist during 12 months well-child visits,
because of every well-child visit has its unique items of assessment in literatures and this
visit included the most of targeted training practices in the present study.
Each part of questionnaire's KAP consisted of 3 subscales e.g. growth and developmental
monitoring, risk assessment and screening, vaccination, chemoprevention and counseling for
children under-5.
The participants' KAP were assessed by 30 multiple choice questions (MCQs), 33 items of a
five-point Likert scale (with options of strongly disagree, disagree, no opinion, agree and
strongly agree) and 15 items of 5-point rating scale (with options of clear unperformed,
partially unperformed, borderline performed, partially performed and clear performed),
respectively.
The questionnaire was validated by 3 experts in family medicine. A pilot study included 10
participants, who included in the investigator's sample size; it tested questionnaire's
reliability and assessed the understandability of its items, clearness, acceptability and
meaning to subjects. Cronbach's alpha was used as an internal consistency estimate of the
reliability of KAP questionnaire (0.77, 0.80, and 0.81, respectively). Completion of this
questionnaire lasted from 40 minutes to 50 minutes.
The percentage of correct answers of MCQs was calculated as a representative of knowledge
score for each participant. While each response for Likert items was scored on a scale of 1
(strongly disagree) to 5 (strongly agree), each response for reverse-coded Likert items was
re-coded and scored on a scale of 5 (strongly disagree) to 1 (strongly agree). For each
individual, score of attitudes' responses was summed and converted into percentages (20-100%)
to represent the attitudes score.
Each item for rating scale of practices was scored on a scale of 0 (clear unperformed) to 4
(clear performed). For each individual, score of items was summed and converted into
percentage to represent the participant's practices score. The scores of knowledge and
practices were considered acceptable if they were ≥ 60% according to the working bylaws in
FOM/SCU. The scores of attitudes were considered positive attitudes if they were ≥ 80 %.
These data were collected at baseline and after 6 months of participation in interventional
study. The researchers designed this intervention, which consisted of 3 repeated workshops,
every workshop had held for 2 days, one day per week, the number of attendants was
appropriate/workshop (10 - 15).
Statistical analysis Data were analyzed by SPSS version 20. Paired t test was used to compare
the means of participants' KAP. The 5-point scale items of attitudes were condensed into 2
categories then McNamara's test was used to compare participants' Knowledge and attitudes
changes in this study. The 5-point rating scale items of practices were condensed into 3
categories the marginal homogeneity was used to compare participants' difference of practices
in this pre-post intervention.
Pearson's correlation coefficient was used to assess correlation between participants' KAP.
Multiple linear regression was used to detect predictors of posttest practices score
(dependent variable) and independent variables (affiliation, posttest knowledge score,
duration of practice and posttest attitudes score). Stepwise linear regression was used to
explore the contribution of the significant independent variables to the used model.
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