Knowledge-practice Gap Research Articles

Assessment of Knowledge, Attitude, Practice on Obesity and Associated Disorders among Young Adults

Introduction Overweight and obesity are quickly rising in developing countries like India Aim This study was aimed at to evaluate and compare the knowledge, attitude and practices regarding Obesity among medical and non medical college students. Material and Method We examined Knowledge, Attitude and Practice (KAP) on obesity among 200 medical and non-medical college students. KAP's were assessed and statistical analyses were done. Results We found good and fair knowledge among medical students as compared to non medical student's population. This study also showed a high percentage poor knowledge in non medical student's population. A poor practice was also observed in overall student's population. The study also demonstrated a high level of knowledge practice gap among medical and non medical students. Conclusion Not only enhanced knowledge regarding obesity is enough for prevention of this particular disorder but also development of perfect attitude and proper practice through life-style modification is required.

Kennedy Terminal Ulcers: A Scoping Review.

Kennedy terminal ulcers, a subset of pressure injuries, are associated with the dying process. This scoping review aimed to identify and map the published literature on Kennedy terminal ulcers in terms of its definition, prevalence, assessment, treatment, management, health care costs, and quality of life for patients in all health care settings. Using the Arksey and O'Malley scoping review framework, we systematically searched the Cochrane Library, CINAHL, EMBASE, MEDLINE, and ProQuest databases and 5 guideline repositories between 1983 and 2018. The following search terms were used: Kennedy ulcers, Kennedy terminal ulcers, terminal ulcer, skin failure, and Skin Changes at Life's End. Data were extracted using a purposely developed data collection tool. Initial searches yielded 2997 sources, with 32 included in this review. Most Kennedy terminal ulcer literature was published by nurses in the United States. Kennedy terminal ulcer prevalence data are limited, with no validated assessment tools available. Kennedy terminal ulcers may be misclassified as pressure injuries, potentially resulting in financial penalties to the institution. This scoping review revealed significant knowledge and clinical practice gaps in patient assessment, management, and treatment of Kennedy terminal ulcers. Timely patient education may help them to make informed care and quality end-of-life decisions. Further research is needed to inform clinical practice to improve patient care.

Bridging the knowledge-practice gap in tuberculosis contact management in a high-burden setting: a mixed-methods protocol for a multicenter health system strengthening study

BackgroundPeople in close contact with tuberculosis should have screening and appropriate management, as an opportunity for active case detection and prevention. However, implementation of tuberculosis contact screening and management is limited in high-burden settings. Behaviour change is needed across three levels of the healthcare system—policymakers, healthcare providers, and patients. To bridge the wide policy-practice gap, this study draws on the Consolidated Framework for Implementation Research, the Behaviour Change Wheel, and the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, Maintenance) to respectively understand barriers, implement change, and evaluate process and outcome.MethodsThis methods paper describes a mixed-methods intervention study in Eastern Indonesia. Quantitative data will be collected during baseline, intervention, and sustainability periods and analyzed using time series analysis. The primary outcome is the number of individuals completing tuberculosis preventive therapy by the end of the two-year intervention phase. Of an estimated 10,000 contacts during this period, we anticipate that a minimum of 416 will be found to have active TB or will complete preventive therapy. Qualitative data (semi-structured interviews, focus group discussions, and observations) will be collected from consenting healthcare providers, patients, and contacts. Activities to promote policy implementation include healthcare provider training, quarterly continuous quality improvement workshops, a social media discussion forum, and promotional materials. The Consolidated Framework for Implementation Research will be used to identify reasons for limited policy implementation at baseline. The Behaviour Change Wheel will be used to ensure that a suitable range of activities are implemented to facilitate change. The RE-AIM model will be used as the evaluation framework.DiscussionUse of theoretical frameworks in combination can ensure a comprehensive understanding of, and robust response to, health policy underimplementation. The selected frameworks are highly applicable to this pragmatic intervention study, in a setting where End TB Strategy targets will not be met without substantial behavior change within health systems. Continuous quality improvement cycles will provide a way to engage staff and stakeholders in understanding local data to motivate behavior change. If successful, up to 500 people could be prevented from developing complications of tuberculosis through early case-finding or receiving preventive therapy over a two-year period.Study registrationAustralian New Zealand Clinical Trials Register 375803.

Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons.

Introduction: The consensus among orthopedic surgeons on the management of equinus deformity in cerebral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons’ current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons.Methods: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children’s orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher’s exact test were used to examine the relationship between two qualitative variables.Results: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items.Discussion: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge–practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons’ educational curricula and an updated health referral system.

White spot lesions in orthodontic patients: An expert opinion

Formation of white spot lesions (WSLs) has remained a common occurrence during fixed orthodontic treatments, particularly in patients with poor oral hygiene. Such lesions, if not addressed, may progress to caries, thereby leading to poor aesthetics and patient dissatisfaction. Given the complexities and the alarming rise in the prevalence of WSLs in orthodontic patients, there is a need to develop a set of recommendations based on the Indian scenario to address unmet patient needs in managing WSLs. This paper is an outcome of expert group discussion convened with the primary objective to discuss the knowledge–practice gaps in the field of orthodontics, to understand the prevailing clinical practice patterns in managing WSLs in Indian settings, and to facilitate information exchange among subject matter experts. In brief, patient education and motivation regarding the importance of maintaining good dietary compliance and excellent oral hygiene are the cornerstones for the prevention and management of WSLs. Moreover, identification and management of various risk factors could prove beneficial. Noninvasive treatment of early or active WSLs by means of remineralizing agents could ensure better prognosis and could help prevent WSL progression.

Assessment of Knowledge, Attitude, Practice on Obesity and Associated Disorders among Young Adults

Introduction Overweight and obesity are quickly rising in developing countries like India Aim This study was aimed at to evaluate and compare the knowledge, attitude and practices regarding Obesity among medical and non medical college students. Material and Method We examined Knowledge, Attitude and Practice (KAP) on obesity among 200 medical and non-medical college students. KAP's were assessed and statistical analyses were done. Results We found good and fair knowledge among medical students as compared to non medical student's population. This study also showed a high percentage poor knowledge in non medical student's population. A poor practice was also observed in overall student's population. The study also demonstrated a high level of knowledge practice gap among medical and non medical students. Conclusion Not only enhanced knowledge regarding obesity is enough for prevention of this particular disorder but also development of perfect attitude and proper practice through life-style modification is required.

Whole-grain consumption and its determinants in Malaysian medical students: A cross-sectional study.

Whole-grain consumption is associated with several health benefits. Little is known, however, about whole-grain consumption patterns in medical students in Malaysia. The study was conducted to assess whole-grain intake pattern and factors influencing intake among Malaysian medical students. A cross-sectional study investigating whole-grain intake among 151 medical students in a private medical university in Malaysia was conducted from January to June 2018. A self-administered questionnaire was used to assess sociodemographic variables, the whole-grain intake pattern and the knowledge and attitudes toward whole-grain intake. Data were analyzed using IBM SPSS software. Chi-square test and multivariable logistic regression were used. The prevalence of reported whole-grain intake in the past 3 months was 51%. Chinese ethnicity, readiness to adhere to Malaysian food pyramid, and self-preparation of food, and eating at home were significantly associated with whole-grain consumption. However, the primary determinants of food choice such as education, knowledge, and affordability did not seem to influence whole-grain consumption. Whole-grain consumption is relatively low among Malaysian medical students. Cultural background and self-belief influence this practice despite being from the medical fraternity. Efforts are needed to bridge the knowledge-practice gap by assessing the barriers to whole-grain consumption to design effective initiatives to promote an increase in whole-grain consumption.

Lessons about Motor Learning: How Is Motor Learning Taught in Physical Therapy Programmes Across Canada?

Purpose: This article describes the content of and delivery methods for motor learning (ML) education and the attitudes and beliefs of instructors with regard to how ML is taught in Canadian physical therapy (PT) programmes. Method: A qualitative descriptive design was employed, using an online questionnaire and semi-structured telephone interviews. A descriptive content analysis was used to develop codes and themes. An online search of PT programme Web sites was conducted to supplement missing data and collect information from schools that did not participate in the online questionnaire or interview. Results: Eight individuals representing seven schools completed the questionnaire; six of the eight also completed the interview. Responses conveyed the fact that ML content was fairly consistent across schools and was predominantly situated in the neurological curriculum. Schools differed in the delivery methods used for clinical application of ML content. Respondents believed that ML underlies PT practice and should be integrated throughout the programme. Conclusion: Current instruction may deliver adequate ML content but may not provide optimal opportunities to apply ML principles in a clinical context. Continuing education emerged as one suggestion for remediating clinicians' knowledge-practice gap and facilitating student learning on placement. Only half the eligible PT schools participated, and all were English-language programmes; thus, the findings may not be generalizable to all Canadian programmes. Future work should explore how ML can be integrated into the PT curriculum to promote the application of ML principles across different fields. Students' perspectives on their understanding of ML and ML principles and self-efficacy for entry to practice should also be explored.

Pressure injury prevention and management practices among nurses: A realist case study.

The prevention and management of a pressure injury is a nurse-sensitive quality indicator in hospitals. Prevention and management of pressure injury practices have been found to be suboptimal despite the availability of interventions. Currently, there is a poor understanding of the mechanisms behind these interventions. The aim of the study was to explain a realistic portrayal of nurses' current practices to prevent and manage pressure injuries in one public hospital in Singapore. A realistic case study design was adopted. Twenty-four nurses were recruited. Audio-recorded interviews were transcribed verbatim to facilitate thematic analysis. Prevention and management was generally facilitated through the timely escalation of care, effective communication, support from the wound nurses, and bridging of the knowledge-practice gap. However, factors such as nurses' intrinsic characteristics and organisational support may affect the outcomes of these facilitators. Overall, nurses strive to achieve patient safety, where pressure injuries are prevented to the best of their abilities. This study provides causal links between contextual factors, mechanisms of the prevention and management, and the outcomes achieved. Further refinement and testing of the specific mechanisms are needed and will contribute to a better understanding of how nurses prevent and manage pressure injuries.

Competing and conflicting messages via online news media: Potential impacts of claims that the Great Barrier Reef is dying

Coverage of issues by news media is known to impact on both public perceptions and policy development aimed at addressing the featured issues. We examine the potential impact of news media coverage regarding the health and potential future of the World heritage-listed Great Barrier Reef, which is under multiple pressures, both natural and anthropogenic. We draw on the extant literature regarding the impact of news media coverage of other complex issues, linking to relevant, albeit limited theoretical concepts that have been applied to previous media studies. We find that media coverage is predominately sensationalized and negative, with the potential to reinforce perceptions that mitigation attempts will be ineffective and thus likely to inhibit future policy development. We discuss the need for a review of existing science communication models and strategies to reduce the knowledge-practice gap between scientists and policy makers, together with proactive strategies to counter negative news coverage.

Assessment of knowledge practice gap regarding sanitary toilet - A hospital based cross-sectional study

Background: Lack of safe drinking water, the absence of basic sanitation and hygienic practices is associated with high morbidity and mortality from excreta-related diseases. Different sanitation programs were failed because people were poorly informed and not aware about the link of sanitation with health. Objective: (i) The objective of the study was to study the awareness about sanitary toilet among study participants and (ii) to assess the knowledge-practice gap among study participants for sanitary toilet use. Materials and Methods: A cross-sectional study was conducted among peoples visiting medicine outpatient department. Pre-designed and pre-tested questionnaire was used for an interview of 384 participants after taking written informed consent. The assessment of knowledge and practice was mainly focused on four subheads, i.e., toilet construction, toilet utilization, toilet cleaning, and sanitary measures during toilet use. Results: Among the study participants 89.58% were aware of the sanitary toilet while only 46.09% were aware about their advantages. 94.79% of participants were aware about different sanitary measures. 88.54% of participants had constructed sanitary toilet and 83.85% of participant’s utilized toilet. 92.7% of participants practice sanitary measures. Only 77.86% cleaned their toilets by disinfectant. Significant statistical difference was seen in knowledge and practice of construction of toilet, their utilization and cleaning. Conclusions: People have better knowledge of sanitary toilet but practices related to toilet construction, its utilization, cleaning, and sanitation were not universally followed among them, so this knowledge - practice gap regarding sanitary toilet can be minimized by giving attention toward practices which will altimetry contribute in the success of Swachh Bharat Mission.

The World Heart Federation Roadmap for Nonvalvular Atrial Fibrillation.

The World Heart Federation has undertaken an initiative to develop a series of Roadmaps to promote development of national policies and health systems approaches, and to identify potential roadblocks on the road to effective prevention, detection, and management of cardiovascular disease in low-and middle-income countries (LMICs) and develop strategies for overcoming these. This Roadmap focuses on atrial fibrillation (AF). AF is the most common, clinically significant arrhythmia and, among other clinical outcomes, is associated with increased risk of stroke. Development of this Roadmap included a review of published guidelines and research papers, and consultation with an expert committee comprising experts in clinical management of AF and health systems research in LMICs. The Roadmap identifies 1) key interventions for detection, diagnosis, and management of AF; 2) gaps in implementation of these interventions (knowledge-practice gaps); 3) health system roadblocks to implementation of AF interventions in LMICs; and 4) potential strategies for overcoming these. More research is needed on determinants and primary prevention of AF. Knowledge-practice gaps for detection, diagnosis, and management of AF are present worldwide, but may be more prominent in LMICs. Potential barriers to implementation of AF interventions include long distances to health facilities, shortage of health care professionals with training in AF, including interpretation of ECG, unaffordability of oral anticoagulants for patient households, reluctance on the part of physicians to initiate oral anticoagulant (OAC) therapy, and lack of awareness of the importance of persistent adherence to OAC therapy. Potential solutions include training of nonphysician health workers and pharmacists in pulse-taking, use of telemedicine technologies to transmit electrocardiogram results, engagement of nonphysician health workers in OAC therapy adherence support, and country-specific support and education programs for noncardiologist health care professionals. AF affects millions of people worldwide and, left untreated, increases the risk and severity of stroke and heart failure. Although guidelines for the detection, diagnosis, and management of AF exist, there are gaps in implementation of these guidelines globally, and in particular in LMICs. This Roadmap identifies some potential solutions that may improve AF outcomes in LMICs but require further evaluation in these settings.

World Heart Federation Cholesterol Roadmap.

The World Heart Federation has undertaken an initiative to develop a series of Roadmaps. The aim of these is to promote development of national policies and health systems approaches and identify potential roadblocks on the road to effective prevention, detection and management of cardiovascular disease (CVD) in low-and middle-income countries (LMIC), and strategies for overcoming these. This Roadmap focuses on elevated blood cholesterol, a leading risk factor for myocardial infarction, stroke, and peripheral arterial disease. Through a review of published guidelines and research papers, and consultation with a committee composed of experts in clinical management of cholesterol and health systems research in LMIC, this Roadmap identifies (1) key interventions for primordial, primary and secondary prevention of CVD through detection, treatment, and management of elevated cholesterol and familial hypercholesterolemia (FH); (2) gaps in implementation of these interventions (knowledge-practice gaps); (3)health system roadblocks to treatment of elevated cholesterol in LMIC; and (4) potential strategies for overcoming these. Despite strong evidence of the importance of cholesterol levels in primary or secondary prevention of CVD, and the effectiveness of statin therapy for cholesterol lowering and reduction of CVD risk, gaps exist in the detection, treatment, and management of high cholesterol globally. Some potential roadblocks include poor access to laboratory facilities or trained professionals for cholesterol management, low awareness of FH among the general population and health professionals, unaffordability of statins for patient households, and low awareness of the importance of persistent adherence to lipid-lowering medication. Potential solutions include point-of-care testing, provision of free or subsidized lipid-lowering medication, and treatment adherence support using text message reminders. Known effective strategies for detection, treatment, and management of elevated cholesterol and FH exist, but there are barriers to their implementation in many low-resource settings. Priorities for health system intervention should be identified at the national level, and the feasibility and effectiveness of proposed solutions should be assessed in specific contexts. Many solutions proposed in this Roadmap mayapply to other cardiovascular conditions and present opportunities for integration of CVD care in LMIC.

Rationality in handling biomedical waste: a study on the sanitary workers from a tertiary care hospital in West Bengal

Background: Health-care waste contains potentially harmful microorganisms, which can infect hospital patients, health workers and the general public. The knowledge and practices of sanitary workers needs special attention as these individuals are responsible for managing biomedical waste (BMW) from the point of collection to the point of disposal. The objective was to study the socio-demographic and service profile of the study population and assess their knowledge and practices on Biomedical Waste Management. Methods: A predesigned, pretested and validated proforma was used for data collection from 120 sanitary workers in the hospital. An observation checklist was used to assess their practices. Results: Most of the sanitary workers received no formal training before or after joining service (71.67%). Less than 60% of the sanitary workers knew about treatment of waste in hospital, diseases through waste and immunisation. 40.84% of them did not label the bags prior to waste collection and only 30% transported segregated waste in separate trollies. Conclusions: There is a need for enforcement of strict guidelines and measures to improve work safety in hazardous waste collection, transport and handling. Training program on BMW management should be designed to bridge the knowledge attitude and practice gap of sanitary workers.

Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India

BackgroundUnhealthy eating and lack of exercise during adolescence culminated into earlier onset and increasing burden of atherosclerotic cardiovascular diseases (CVDs) worldwide. Among urban Indian adolescents, prevalence of these risk factors of CVD seemed to be high, but data regarding their pattern and predictors was limited. To address this dearth of information, a survey was conducted among urban adolescent school-students in Kolkata, a highly populated metro city in eastern India.MethodsDuring January–June, 2014, 1755 students of 9th-grade were recruited through cluster (schools) random sampling. Informed consents from parents and assents from adolescents were collected. Information on socio-demographics, CVD-related knowledge and perception along with eating and exercise patterns were collected with an internally validated structured questionnaire. Descriptive and regression analyses were performed in SAS-9.3.2.ResultsAmong 1652 participants (response rate = 94.1%), about 44% had poor overall knowledge about CVD, 24% perceived themselves as overweight and 60% considered their general health as good. Only 18% perceived their future CVD-risk and 29% were engaged in regular moderate-to-vigorous exercise. While 55% skipped meals regularly, 90% frequently consumed street-foods and 54% demonstrated overall poor eating habits.Males were more likely to engage in moderate-to-vigorous exercise [adjusted odds ratio (AOR) = 3.40(95% confidence interval = 2.55–4.54)] while students of higher SES were less likely [AOR = 0.59(0.37–0.94)]. Males and those having good CVD-related knowledge were more likely to exercise at least 1 h/day [AOR = 7.77(4.61–13.07) and 2.90(1.46–5.78) respectively].Those who perceived their future CVD-risk, skipped meals more [2.04(1.28–3.25)] while Males skipped them less [AOR = 0.62(0.42–0.93)]. Subjects from middle class ate street-foods less frequently [AOR = 0.45(0.24–0.85)]. Relatively older students and those belonging to higher SES were less likely to demonstrate good eating habits [AOR = 0.70(0.56–0.89) and 0.23(0.11–0.47) respectively]. A large knowledge-practice gap was evident as students with good CVD-related knowledge were less likely to have good eating habits [AOR = 0.55(0.32–0.94)].ConclusionsCVD-related knowledge as well as eating and exercise habits were quite poor among adolescent school-students of Kolkata. Additionally, there was a large knowledge-practice gap. Multi-component educational interventions targeting behavioral betterment seemed necessary for these adolescents to improve their CVD-related knowledge, along with appropriate translation of knowledge into exercise and eating practices to minimize future risk of CVDs.

Medical Undergraduate Survey on Headache Education in Singapore: Knowledge, Perceptions, and Assessment of Unmet Needs.

There have been no prior studies assessing the status of undergraduate headache training and education in Singapore. Unmet needs of undergraduate medical students in terms of knowledge-practice gaps pertaining to diagnosis and management of headache disorders are unknown. The possible underemphasis of this aspect of the curriculum as compared to other chronic conditions such as diabetes mellitus has also not been ascertained. The aim of this article is to assess the knowledge base and perceptions, thereby identifying the unmet needs of headache disorder education in undergraduate medical students. Students reported their perceived time that was devoted to the subject matter and this was recorded and reported. In order to provide a comparative indication on the level of prioritization, the total duration within the syllabus dedicated to headache education vs other chronic diseases (using diabetes mellitus as a surrogate) was sought. A comprehensive survey consisting of questions assessing the headache curriculum, knowledge, and perceptions was developed. The questionnaire was distributed to final year medical students attending a full-day Neurology review course in their last semester. Attendees were given the duration of the course to complete the questionnaire, and forms were collected at the end of the day. About 127 final year medical students completed our survey. More than half (55.1%) did not receive formal teaching on how to take a complete headache history. The majority (90.6%) have not attended a headache sub-specialty clinic. The mean total number of hours exposed to headache disorders was 5.69h (SD ± 5.19). The vast majority (96.1%) were unfamiliar with locally published clinical practice guidelines, and a significant proportion (74.0%) were unfamiliar with the third edition (beta) of the International Classification of Headache Disorders. Nearly half (47.2%) were unfamiliar with 'medication overuse headache' as a disease entity. Only one (0.8%) respondent was able to correctly classify all listed primary and secondary headache disorders correctly. Only 37.0% were able to identify all 4 indications (headaches that were new, worsening, and unresponsive to treatment or associated with neurological symptoms) that warranted neuroimaging in a patient with a pre-existing diagnosis of migraine. The antidepressants were the most frequently reported incorrect option for the abortive treatment of migraine (16.5%). Nearly one-fifth (18.9%) were unable to name a single abortive treatment correctly, while a significant proportion (39.4%) could not identify a single correct prophylactic migraine treatment. A large proportion (62.2%) opined that their exposure to 'headache diagnosis and management' was inadequate, with a minority (3.1%) being 'very comfortable' in the diagnosing migraine. A significant proportion felt uncomfortable in treating special population groups diagnosed with migraine - pregnant (79.5%), elderly (48.0%), those with cardiac conditions (51.2%). The current medical undergraduate curriculum on headache disorders in Singapore may harbor significant unmet needs. A review of the syllabus to increase headache education may be one method to address this gap. Further studies in this area are required.

Training frontline community agency staff in dialectical behaviour therapy: building capacity to meet the mental health needs of street-involved youth

PurposeThe purpose of this paper is to evaluate the effectiveness of the dialectical behavior therapy (DBT) training which was provided to community agency staff (N=18) implementing DBT in the community with street-involved youth.Design/methodology/approachStaff participated in a multi-component approach to training which consisted of webinars, online training, self-study manuals, and ongoing peer consultation. To evaluate assess the effectiveness of the training, questionnaires assessing evaluating DBT skills knowledge, behavioral anticipation and confidence, and DBT skills use, were completed at baseline, immediately post-training, four to six months post-training, and 12-16 months post-training. Additionally, the mental health outcomes for youth receiving the DBT intervention are reported to support the effectiveness of the training outcomes.FindingsResults demonstrate that the DBT skills, knowledge, and confidence of community agency staff improved significantly from pre to post-training and that knowledge and confidence were sustained over time. Additionally, the training was clinically effective as demonstrated by the significant improvement in mental health outcomes for street-involved youth participating in the intervention.Practical implicationsFindings suggest that this evidence-based intervention can be taught to a range of staff working in community service agencies providing care to street-involved youth and that the intervention can be delivered effectively.Originality/valueThese findings help to close the knowledge-practice gap between evidence-based treatment (EBT) research and practice while promoting the implementation of EBT in the community to enhance positive youth outcomes.

Determinants of evidence use in public health policy making: Results from a study across six EU countries

The knowledge-practice gap in public health is widely known. The importance of using different types of evidence for the development of effective health promotion has also been emphasized.Nevertheless, in practice, intervention decisions are often based on perceived short-term opportunities, lacking the most effective approaches, thus limiting the impact of health promotion strategies. This article focuses on facilitators and barriers in the use of evidence in developing health enhancing physical activity policies.Data was collected in 2012 by interviewing 86 key stakeholders from six EU countries (FI, DK, UK, NL, IT, RO) using a common topic guide. Content analysis and concept mapping was used to construct a map of facilitators and barriers.Barriers and facilitators experienced by most stakeholders and policy context in each country are analysed. A lack of locally useful and concrete evidence, evidence on costs, and a lack of joint understanding were specific hindrances. Also users’ characteristics and the role media play were identified as factors of influence.Attention for individual and social factors within the policy context might provide the key to enhance more sustainable evidence use. Developing and evaluating tailored approaches impacting on networking, personal relationships, collaboration and evidence coproduction is recommended.

The influence of customer-medicine seller transactional dynamics on childhood diarrhoea management: a qualitative study in Ghana.

In 2004, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) jointly revised the recommended treatment for acute paediatric diarrhoea to specify supplementing reduced osmolarity oral rehydration salts (ORS) with zinc. In many countries, however, a significant knowledge-practice gap persists in appropriate diarrhoea management among private healthcare providers. For example, the United States Agency for International Development (USAID)-funded Strengthening Health Outcomes through the Private Sector (SHOPS) project recently demonstrated that over-the-counter medicine sellers (MS) in Ghana recommended inappropriate diarrhoea treatments, despite their demonstrated knowledge of appropriate treatment protocols. To explore and explain these results, we conducted 26 focus groups with MS and their customers using an indirect elicitation approach, presenting simulated drug shop transaction scenarios for each group to analyze and discuss. Through inductive and deductive data analysis, we found that the pattern of customer-MS interactions within the transactional context plays a critical role in shaping dispensing outcomes, not only in diarrhoea management but in other contexts as well. MS who engaged and negotiated with their customers were better able to introduce and promote the appropriate diarrhoea treatment protocol. Several factors hinder optimal interactions. Although MS in fact serve as frontline medical providers, they lack the perceived status of a clinician. Moreover, the need to maintain their customer base creates a power imbalance that favours accommodating customer requests and discourages educational interaction. Finally, many MS lack a complete understanding of the recommended treatment, limiting their ability to educate and negotiate. These findings have important implications for efforts to position community-level private providers to improve outcomes across a number of health areas; the study recommends three broad approaches related to training design, marketing, and professional linkages. More generally, behaviour change initiatives should recognize the potential impact of provider interaction dynamics in facilitating or impeding desired health outcomes.

Physical inactivity among physiotherapy undergraduates: exploring the knowledge-practice gap.

BackgroundPhysical inactivity is a common risk factor for several non-communicable diseases (NCDs). Increasing physical activity could reduce the burden of disease due to major NCDs and increase life expectancy. Undergraduate physiotherapy students represent a group of young-adults expected to have a good knowledge of physical activity. We evaluated physical activity levels of undergraduate physiotherapy students of University of Colombo, Sri Lanka and determined their motives and barriers for participation in physical activity.MethodsAll physiotherapy undergraduates studying at the University of Colombo, Sri Lanka in 2013 were invited for the study. Phase one was a quantitative study to evaluate the physical activity levels and phase two was a qualitative study to identify motives and barriers for physical activity and sports in the same cohort. Physical activity levels (phase 1) were assessed using the interviewer administered International Physical Activity Questionnaire (long-version). The qualitative study (phase 2) was conducted in the same population using Focus Group Discussions (n = 3) and individual In-depth Interviews (n = 5).ResultsSample size in phase 1 and phase 2 were 113 (response rate = 98%; [N-115]) and 87 (response rat = 97%; [N-90]) respectively. Mean age (±SD) of participants was 23.4 ± 1 years. The mean weekly total MET minutes (±SD) of the study population was 1791.25 ± 3097. According to the IPAQ categorical score a higher percentage of participants were ‘inactive’ (48.7%), while only 15.9% were in the ‘Highly active’ group. Lack of support and encouragement received during childhood to engage in sports activity seem to have played an important role in continuing their exercise behavior through to the adult life. Academic activities were given priority by both parents and teachers. The environment and support from teachers, family and friends were important to initiate and adhere to sports and physical activity.ConclusionsA higher percentage of participants were ‘inactive’, in spite of belonging to a group which is presumed to be knowledgeable regarding the benefits of physical activity. A significant negative attitude towards physical activity was observed in this cohort of young-adults. This seems to stem from earlier in life, due to lack of support and motivation for physical exercise and sports, received during primary and secondary schooling. This negative attitude has become a significant ‘internal’ barrier, which has not been changed in spite of their education.Electronic supplementary materialThe online version of this article (doi:10.1186/s13102-016-0063-8) contains supplementary material, which is available to authorized users.