Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.
School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
BMC Prim Care. 2022 May 11;23(1):114. doi: 10.1186/s12875-022-01716-9.
General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China.
An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and practice was tested using the PROCESS model 4 macro with 5000 bootstrap samples through linear regression modelling.
A total of 1253 GPs completed the questionnaire, with an average score of 54.51 ± 18.18, 57.31 ± 7.43, and 50.05 ± 19.80 for knowledge, attitudes, and practice, respectively. More than 12% of respondents scored zero in knowledge, 28.4% tended not to consider MCI as a disease, and 19.1% completely rejected MCI screening. Higher levels of knowledge were associated with more favourable attitudes toward community management of MCI (AOR = 1.974, p < 0.001). Higher compliance with practice guidelines was associated with both higher levels of knowledge (AOR = 1.426, p < 0.01) and more favourable attitudes (AOR = 2.095, p < 0.001). The association between knowledge and practice was partially mediated by attitudes (p < 0.001). Training was associated with higher levels of knowledge (AOR = 1.553, p < 0.01), while past experience in MCI management was associated with more favourable attitudes (AOR = 1.582, p < 0.05) and higher compliance with practice guidelines (AOR = 3.034, p < 0.001). MCI screening qualification was associated with higher compliance with practice guidelines (AOR = 2.162, p < 0.05), but less favourable attitudes (AOR = 0.452, p < 0.05).
The MCI knowledge of GPs in Shanghai is low, and is associated with less favourable attitudes toward MCI management and low compliance with practice guidelines. Attitudes mediate the association between knowledge and practice. Training is a significant predictor of knowledge. Further studies are needed to better understand how the attitudes of GPs in Shanghai are shaped by the environments in which they live and work.
全科医生（GP）在社区发现和管理轻度认知障碍（MCI）方面具有独特的地位。然而，充分的知识、态度和实践（KAP）是履行这一角色的先决条件。本研究旨在评估中国上海全科医生的 MCI 相关 KAP。
2021 年 4 月至 5 月期间，采用在线问卷调查的方式，从上海市 56 家社区卫生服务中心（CHC）招募了 1253 名全科医生。采用多学科专家小组认可的量表评估知识（8 项）、态度（13 项）和实践（11 项）。计算平均总分，并将其转换为知识、态度和实践的得分，范围分别为 0 至 100。通过逻辑回归模型，使用 PROCESS 模型 4 宏，对潜在的 KAP 评分较高的因素（以平均值为临界值）进行调整，计算调整后的优势比（AOR）。通过线性回归模型，使用 PROCESS 模型 4 宏，对态度在知识和实践之间的关联的中介作用进行测试，使用 5000 个 bootstrap 样本进行 5000 次重复。
共有 1253 名全科医生完成了问卷，知识、态度和实践的平均得分分别为 54.51±18.18、57.31±7.43 和 50.05±19.80。超过 12%的受访者在知识方面得分为零，28.4%的人倾向于不将 MCI 视为一种疾病，19.1%的人完全拒绝 MCI 筛查。较高的知识水平与对 MCI 社区管理更有利的态度相关（AOR=1.974，p<0.001）。更高的实践指南依从性与更高的知识水平（AOR=1.426，p<0.01）和更有利的态度（AOR=2.095，p<0.001）相关。知识与实践之间的关联部分由态度介导（p<0.001）。培训与较高的知识水平相关（AOR=1.553，p<0.01），而 MCI 管理方面的过往经验与更有利的态度（AOR=1.582，p<0.05）和更高的实践指南依从性相关（AOR=3.034，p<0.001）。MCI 筛查资格与更高的实践指南依从性相关（AOR=2.162，p<0.05），但与较不利的态度相关（AOR=0.452，p<0.05）。
上海全科医生的 MCI 知识水平较低，与对 MCI 管理的不利态度和实践指南依从性较低有关。态度在知识和实践之间的关系中起中介作用。培训是知识的重要预测因素。需要进一步研究，以更好地了解上海全科医生的态度是如何受到其生活和工作环境的影响。
