A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health.

Lamin Massaquoi,Nancy Edwards

doi:10.3390/ijerph121215018

Abstract

Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians’ environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians’ attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians’ self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients’ responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.

Highlights

The role of health providers in assessing and mitigating the impact of environmental hazards is controversial
Clinicians’ attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health
The inclusion of environmental health in routine practice as well as the reported competence of clinicians was similar for all clinician groups

Summary

Introduction

The role of health providers in assessing and mitigating the impact of environmental hazards is controversial. There are three prominent perspectives regarding how best to prepare clinicians and reorient the health care system towards environmentally-induced diseases. Some argue that an understanding of environmental exposures is fundamental to the training of health professionals, that this constitutes a core competency in primary care clinical practice and can be augmented with support from environmental resource units [2]. Others emphasize the importance of specialty programs, such as occupational health training and the establishment of specialized referral centers [3]. A third perspective is public health-oriented and emphasizes addressing upstream determinants of harmful environmental exposures through strategies such as inter-sectoral policy change [4,5]

Methods

Results

Discussion

Conclusion