Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis.

Steven J Hoffman,Guang Shi,Masoumeh Dejman,John N Lavis,Francisco Becerra-Posada,C A K Yesudian,Parasurama Ramachandran,Katayoun Falahat,Harkanwal Randhawa,Hossein Malek-Afzali,G Emmanuel Guindon

doi:10.4269/ajtmh.15-0538

Abstract

Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices “often or very often” (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.

Highlights

Educators, researchers, practitioners, and policymakers are increasingly cognizant and concerned that findings from research evidence are often not being put into action.[1,2] A growing body of literature continues to demonstrate that research evidence is not consistently disseminated to health professionals who require it to inform their clinical practice and improve their patients’ well-being
This reality is especially overwhelming for low- and middle-income countries (LMICs), which suffer greater limitations in resources compared with high-income countries
This study aims to examine the gap between what is known internationally through research evidence about tuberculosis treatment interventions and the related knowledge and practices of health professionals in LMICs

Summary

Introduction

Researchers, practitioners, and policymakers are increasingly cognizant and concerned that findings from research evidence are often not being put into action.[1,2] A growing body of literature continues to demonstrate that research evidence is not consistently disseminated to health professionals who require it to inform their clinical practice and improve their patients’ well-being This knowledge deficit may result in substandard care, ineffective service provision, inefficient resource use, and further inequities in health outcomes. This reality is especially overwhelming for low- and middle-income countries (LMICs), which suffer greater limitations in resources compared with high-income countries This situation is especially concerning when cost-effective interventions exist to address global health challenges but are not being fully or appropriately used.[3]. This gap between research evidence and clinical practices is salient for improving tuberculosis control because of the proven effectiveness of treatments (i.e., combinations of first-line tuberculosis drugs)[4] and past findings of suboptimal knowledge on this topic.[5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32] Despite recent progress in controlling tuberculosis and achievement of the Millennium Development Goal (MDG) target to reverse the epidemic by 2015,4,33 there remains a pressing need for improvement given documented observations such as the disparities in regional progress[33]; the potential for 10-fold returns in economic growth on investment[34]; the disproportionate burden carried by those least able to manage it[33]; and the health gains that can be achieved by continued progress.[33]

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