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New-Material

Joseph T.F. Lau^l, Jacky C.K. Cheung^l, S.S. Lee²

1: Centre for Clinical Trials and Epidemiological Research, The Chinese University of Hong Kong
2: Department of Health, Government of Hong Kong

Problems

Health care workers' (HCW) avoidance of persons with HIV/AIDS has been a common concern both in the field of medical services and in the research literature. Such an attitude is not uncommon in Western countries (Dworkin et al. 1991; Kunzel and Sadowsky 1993). The attitude is problematic because it undermines effective and non-discriminatory medical services, as well as being contradictory to the professional ethic of caring for AIDS patients (Kunzel and Sadowsky 1993). As a result, HCW's avoidance of AIDS patients will be detrimental to those who need the services (Dworkin et al. 1991). To assess and reduce the attitude among HCW in Hong Kong, the present study examines the plausible causes of the attitude of avoidance, including perceived susceptibility to HIV infection at work, lack of knowledge, training, and experience in caring for AIDS patients (Fishbein et al. 1993; Kunzel and Sadowsky 1993; Van der Velde and Van der Pligt 1991).

Objectives

Taking account of the aforementioned problem, the present investigation has objectives to: (1) assess levels of the avoidance attitude of various health care professions in Hong Kong, (2) scrutinize variation in the attitude due to professional groups, and (3) determine effects of perceived susceptibility at work, knowledge about AIDS, confidence in providing services, training on AIDS, and endorsement of professional duty on the avoidance attitude. Through clarifying the role of knowledge, training, and other variables, this study offers useful implications for improving health care workers' services provided to persons with HIV/AIDS.

Methods

From March 1995 to July 1995*, the study employed a mail survey of 21,068 health care workers (HCW) in Hong Kong by sending them questionnaires and self-addressed and stamped return envelopes. The target HCW represented whole populations of HCW registered in the relevant professional bodies. There were 4,615 valid questionnaires returned. This sample represented an overall response rate of 21.9% and included 1,266 (27.4%) doctors (including 579 public doctors, 248 private doctors, and 92 medical students), 1949 (42.2%) nurses, 689 (14.9%) medical laboratory technicians, 191 (4.1%) occupational therapists, 247 (5.4%) radiographers, 216 (4.7%) physiotherapists, and 57 (1.2%) optometrists. Among them, 60.3% were female, 81.7% working in public institutions, 48.9% aged between 21 to 30 years, 34.6% aged between 31 to 40 years, 35.4% having 1 to 5 years of post-graduation experience, 24.3 % having 6 to 10 years, 20.7% having 11 to 20 years, and 10.5% having more than 20 years of post-graduation experience.

The measurement of the avoidance attitude involved seven five-point Likert-type items, The composite score of the these three dimensions attained a high level of reliability (a = .75 8). The measurement of knowledge about HIV transmission or lack of common misconceptions was a composite of six five-point Likert-type items (a = .540, with standardized scores). The measure of confidence in providing AIDS-related services was based on two five-point Likert-type items (a = .694). Measures of knowledge about management and the progression of AIDS, the perceived adequacy of knowledge, perceived susceptibility to HIV infection at work, endorsement of professional duty to care for AIDS patients, number of AIDS patient having been cared in the previous year, and the total length of training on AIDS were based on single items.

Results

About one-third (33.1%) of the HCW in the sample had taken care of some AIDS patients in the previous year (see Table 1). Among all HCW in the sample, one-fifth (20.6%) of HCW were not willing to take care of HIV/AIDS patients. Multiple comparison tests (by the Student-Newman-Keul test) showed that compared with public doctors, laboratory technicians (difference on the five-point scale = 0.55), nurses (0.50), optometrists (0.47), radiotherapists, and private doctors (0.22) were more unwilling to care for AIDS patients. Avoidance of AIDS patients was even higher in terms of their reluctance to have physical contact with AIDS patients (25.8%) and likelihood to asking for a transfer to another unit due to the requirement to care for AIDS patients on a regular basis (24.1%).

The overall level of avoidance seemed to be high and inconsistent with the high proportion of HCW who endorsed professional duty to care for AIDS patients (89.8%). Multiple comparison tests showed that compared with public doctors, laboratory technicians (difference on the five-point scale = 0.48), optometrists (0.42), radiographers (0.42), nurses (0.38), and private doctors (0.18) expressed higher avoidance. Moreover, compared with private doctors, laboratory technicians (difference on the five-point scale = 0.30), radiographers (0.27), and nurses (0.20) showed higher avoidance. Besides, laboratory technicians displayed more avoidance than nurses (difference on the five-point scale = 0.10), physiotherapists (0.35), and occupational therapists (0.41).

Although most HCW (80.2%) were knowledgeable about the low chance of HIV transmission through daily contact, they were less knowledgeable about management of AIDS (see Table 1). Regarding the latter, less than half of HCW knew about the function of antiretroviral drug treatment (24.3%), the progress of AIDS (43.1%), and the chance of being infected by an HIV-contaminated needle-stick injury (45.8%). Even fewer HCW (12.6%) perceived their knowledge about AIDS as good. Their confidence in providing AIDS-related services was not high, in terms of managing AIDS patients and giving advice to their families. In fact, the majority (71.2%) of HCW had attended less than 3 hours of training on AIDS (see Table 2),

Correlates of avoidance attitudes

Correlation analysis showed that higher avoidance and unwillingness to care for AIDS patients were associated with higher perceived susceptibility, not having cared for AIDS patients, less knowledge about HIV transmission, less knowledge about management of AIDS, and poorer self-perceived knowledge, less confidence in providing AIDS-related services, and having attended less training on AIDS (see Table 3). Perceived susceptibility displayed the strongest association with the avoidance attitude among the correlates. Next came knowledge about HIV transmission or lack of common misconceptions.

Conclusion

Considerable proportions of HCW in Hong Kong expressed avoidance attitudes toward caring for AIDS patients. The avoidance attitude appears to correlate with insufficient knowledge, especially knowledge about management of AIDS, training, inadequate self-perceived knowledge, low confidence in providing AIDS-related services, and perceived susceptibility, to the avoidance attitude. To reduce avoidance among HCW, it is necessary to change the preceding factors leading to the attitude by removing the anxiety of self-perceived susceptibility. This effort should be achieved by providing training to promote knowledge about management of AIDS and HIV transmission, their self-confidence in managing HIV/AIDS. Special attention should also be paid to particular groups of HCW, such as nurses and laboratory technicians.

References

Dworkin, Joan, Gary Albrecht, and Judith Cooksey. 1991. "Concern about AIDS among Hospital Physicians, Nurses, and Social Workers." Social Science and Medicine 33(3):239248.

Fishbein, Martin, Susan E. Middlestadt, and Penelope J. Hitchcock. 1994. "Using Information to Change Sexually Transmitted Disease Related Behaviors: An Analysis Based on the Theory of Reasoned Action." Pp.61-93 in Preventing AIDS Theories and Methods of Behavioral Interventions, edited by Ralph J. DiClemente, and John L. Peterson. New York: Plenum Press.

Kunzel, Carol, and Donald Sadowsky. 1993. "Predicting Dentists' Perceived Occupational Risk for HIV Infection." Social Science and Medicine 36(12):1579-1586.

Van der Velde, Frank W., and Joop Van der Pligt. 1991. "AIDS-Related Health Behavior: Coping, Protection Motivation, and Previous Behavior." Journal of Behavioral Medicine 14(5):429-451.

Table 1: Avoidance, susceptibility, and knowledge about AIDS (%)

*: significantly different among professional types at the 2-tailed .05 level by Kruskal-Wallis's test

Table 2: Self-perceived adequacy of knowledge about AIDS, training, and the number of AIDS patients cared (%)

*: significantly different among professional types at the 2-tailed .05 level by Kruskal-Wallis's test

Table 3: Significant correlates (p < .001) with avoidance and unwillingness to take care of AIDS patients