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Matching the Message to the Process The Relative Ordering of Knowledge, Attitudes, and Practices in Behavior Change Research
Abstract
PIP
The authors empirically investigated the relative ordering of knowledge, attitudes, and practices in behavior change models and its relation to communicating health-related information. Considerable research has been conducted in the area of behavior change to identify and measure the presence of knowledge, attitudinal, and practice levels for many behaviors. The literature is reviewed. The authors' investigation consisted of interviewing 1680 men and women in Lima, Cusco, Huaraz, Puno, and Chimbote--5 large Peruvian cities--in 3 urban probability household surveys conducted in August 1994, January 1995, and January 1996. Six possible knowledge, attitude, and practice permutations are developed with regard to contraception in Peru. People may use contraceptive methods before they become fully knowledgeable about their chosen methods. In so doing, these users may become misinformed about contraceptive practice and become dissatisfied contraceptive users who discontinue contraceptive use. Media campaigns designed to inform the public can help produce a more satisfied and sustainable contraceptive user base. The informed choice approach can be the basis for effective communication strategies.
... The finding of a high mean score for practices against geo-disasters is supported by a study conducted by Choukolaei et al. [17], who stated that the behavior domain scores of male and female students were higher. Valente et al. [24] stated that positive practices result from high involvement in a situation. This situation shows that the form 3 students of three schools in the Cameron Highland district have a high level of practice regarding geo-disasters. ...
... If a person's knowledge increases, their attitudes and practices will also change positively. Valente et al. [24] stated that high involvement in a situation causes positive attitudes and behavior (practice). ...
... Nasir et al. [1,2] state that increased knowledge causes behavioral changes. This statement is also supported by Valente et al. [24], who asserts that when a person has more knowledge, this knowledge will cause them to change their attitude towards a more positive direction towards the environment, which in turn can reduce the potential of geo-disaster Furthermore, many research findings show that students' level of knowledge and attitude towards the environment is at a high level and can be said to be very good [1,2,8]. This result also aligns with the opinion of Ibrahim [5], who states that most students are aware of the environment. ...
... KAP surveys are representative studies of specific populations designed to collect data on what is known, believed, and done concerning a particular topic [11]. The KAP surveys originated from learning theory and the diffusion of innovation and were widely used in marketing, consumer research, and the evaluation of health communication campaigns [12]. The KAP model was often considered a learning hierarchy, as it posited that individuals first learned about a new idea, developed a positive attitude towards it, and then tried it out [13]. ...
... Chaffee and Roser suggested that the classical learning stages of knowledge, attitudes, and behaviors occurred among highly engaged individuals [14]. The classic KAP model was used to design and evaluate the outcomes of various health-related activities as part of behavior change communication [12], covering topics such as HPV vaccination [15], tobacco control [16], nutritional diets [17], HIV prevention and treatment [18,19], cancer prevention [20,21]. ...
... The KAP model suggests a linear relationship between knowledge, attitudes, and practice [12,23]. Several previous studies have demonstrated that a higher level of knowledge is associated with positive attitudes and practices [12,23,33]. ...
... Pendedahan terhadap maklumat yang baru boleh meningkatkan pengetahuan. Hal ini turut dipersetujui oleh Valente et al. (1998) dan Mahadevan (2009) apabila pengetahuan seseorang bertambah, maka pengetahuan ini akan menjadi pendorong kepada perubahan sikap. ...
... Komponen yang mempengaruhi sikap (attitude) ialah kognitif yang mengandungi pengetahuan dan kepercayaan terhadap sesuatu isu atau maklumat. Menurut Valente et al. (1998), perasaan kasih dan sayang yang mengandungi emosi dan perasaan seseorang terhadap sesuatu isu atau maklumat dan komponen kognitif yang mempunyai kecenderungan untuk bertindak mengikut cara yang tertentu. Valente et al. (1998) juga menyatakan bahawa proses untuk berfikir (kognitif) akan mempengaruhi seseorang untuk bertindak mengikut perasaan terhadap sesuatu isu atau maklumat yang diperolehnya. ...
... Menurut Valente et al. (1998), perasaan kasih dan sayang yang mengandungi emosi dan perasaan seseorang terhadap sesuatu isu atau maklumat dan komponen kognitif yang mempunyai kecenderungan untuk bertindak mengikut cara yang tertentu. Valente et al. (1998) juga menyatakan bahawa proses untuk berfikir (kognitif) akan mempengaruhi seseorang untuk bertindak mengikut perasaan terhadap sesuatu isu atau maklumat yang diperolehnya. Mahadevan (2009) menyatakan komponen pengetahuan memainkan peranan yang penting untuk membantu manusia bagi melihat persekitaran dengan lebih fokus. ...
Kajian ini bertujuan untuk mengetahui tahap pengetahuan, sikap dan amalan fardu ‘ain dalam kalangan pelajar di sekolah menengah sekitar di negeri Perlis. Kajian ini dilakukan rentetan daripada kajian-kajian lepas mengesahkan bahawa faktor lemah pegangan agama adalah punca utama penglibatan remaja Islam dalam masalah sosial. Rekod statistik juvana dalam kalangan remaja semakin meningkat saban tahun, sedangkan remaja adalah generasi pelapis dan modal insan negara.
Kajian ini telah dijalankan terhadap para pelajar tingkatan lima di sekolah menengah sekitar di negeri Perlis. Sebanyak enam kategori pendidikan menengah menjadi populasi kajian melibatkan 347 pelajar. Data yang diperoleh dianalisis menggunakan perisian Statistical Package for the Social Sciences (SPSS) Statistics versi22. Dapatan kajian menunjukkan tahap amalan pelajar sekolah menengah tingkatan lima mengenai fardu ‘ain berada pada tahap tinggi dengan min sebanyak 3.89.
Demikian juga pengetahuan responden terhadap fardu ‘ain berada pada tahap tinggi dengan nilai min 3.94. Manakala sikap responden terhadap fardu ‘ain berada pada tahap rendah dengan min 2.57. Dapatan kajian juga menunjukkan bahawa ujian Kolerasi Pearson secara keseluruhan menunjukkan bahawa tahap amalan pelajar berkaitan fardu ‘ain mempunyai hubungan yang signifikan (r = .74, p
<.01) dengan tahap pengetahuan pelajar. Ujian Kolerasi Pearson secara keseluruhan menunjukkan bahawa tahap sikap pelajar berkaitan fardu ‘ain tidak mempunyai hubungan yang signifikan (r = .308, p > .01) (r = .258, p >.01) terhadap tahap amalan dan pengetahuan pelajar. Implikasi kajian ini mendapati bahawa sikap negatif di kalangan pelajar boleh menatijahkan tingkah laku negatif hingga boleh membawa kepada masalah sosial yang meruncing.
... Over time, this causes a change in practice that is in agreement with the attitude (13). The legitimacy of the KAP approach in the health field, although not entirely free from criticism (15)(16)(17), is largely supported by the scientific literature (13, [18][19][20] and has formed the basis for many successful public health interventions (21)(22)(23)(24)(25). Within this article context, according to the KAP framework, improved knowledge of human rights and how to apply rights-based, person-centered approaches among mental health professionals and other stakeholders would lead to positive attitudinal changes toward people with mental health conditions or psychosocial disabilities as rights holders. This would also lead, over time, to reduced human rights violations and improved practices consistent with a human rights-based approach. ...
... 13 People with intellectual disabilities have the right to make their own decisions, even if I do not agree with them 14 Controlling people using mental health services is necessary to maintain order 15 The use of seclusion and restraint is needed if people using mental health services become threatening 16 People at risk of harming themselves or others should be isolated in a locked room. ...
Background
Instruments to assess the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals’ practices related to substitute decision-making and coercion are either missing or lack evaluation of their validity and reliability.
Aim
The aim of this study is to evaluate the validity and reliability of three instruments developed to fill this gap in the literature, the World Health Organization’s QualityRights (WHO QR) Knowledge questionnaire, the WHO QR Attitudes questionnaire, and the WHO QR Practices questionnaire.
Methods
A sample of participants was recruited and completed an online survey. Content validity and face validity were assessed for the three questionnaires. Based on the characteristics of the questionnaires, different approaches were used to assess their construct validity (confirmatory factor analysis, known group validity, and convergent and divergent validity). Internal consistency was evaluated using Cronbach’s alpha and test re-test reliability using Pearson’s and Spearman’s r coefficients.
Results
The analyses conducted indicate that the three questionnaires are valid and reliable instruments to evaluate the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals’ practices related to substitute decision-making and coercion.
Conclusion
This finding lends support to the use of these instruments both within mental health services and in the general population for a better understanding of current knowledge, attitudes, and practices related to a human rights–based approach to mental health in mental health services and the community.
... Combining these models with financial literacy, emotions, and intuition, Hauff et al. (2016) attempted to investigate the reasons for heterogeneity in household savings behavior. The mental accounting of financial products Theory Discipline Findings Exemplar studies Theory of Planned Behavior (Ajzen 1991) Organizational Psychology Investment intention influencing investment behavior, explained by attitude and behavioral factors Shim et al. (2012), Griffin et al. (2012), Ruefenacht et al. (2015), Tang and Baker (2016), Kimiyaghalam et al. (2017), Sivaramakrishnan et al. (2017), Nga and Yeoh (2018) Learning Theory (Valente et al. 1998) Psychology ...
... According to this theory, individuals develop an ideal image for their future and try hard to achieve it. A recent work by Hoffmann and Plotkina (2020b), studying retirement planning intentions converging into actual behavior, used a learning theory by Valente et al. (1998). The theory states that learning is a cognitive process that starts with learning about the behavior, developing a positive attitude towards the behavior, resulting in an intention to behave, and finally, culminating in actual behavior. ...
Rising life expectancy and an aging population across nations are leading to an increased need for long-term financial savings and a focus on the financial well-being of retired individuals amidst changing policy framework. This study is a systematic review based on a scientific way of producing high-quality evidence based on 191 articles from the Scopus and Web of Science databases. It adopts the Theory, Context, Characteristics, and Method (TCCM) framework to analyze literature. This study provides collective insights into financial decision-making for retirement savings and identifies constructs for operationalizing and measuring financial behavior for retirement planning. Further, it indicates the need for an interdisciplinary approach. Though cognitive areas were studied extensively, the non-cognitive areas received little attention. Qualitative research design is gaining prominence in research over other methods, with the sparse application of mixed methods design. The study’s TCCM framework explicates several areas for further research. Furthermore, it guides the practice and policy by integrating empirical evidence and concomitant findings. Coherent synthesis of the extant literature reconciles the highly fragmented field of retirement planning. No research reports prospective areas for further analysis based on the TCCM framework on retirement planning, which highlights the uniqueness of the study.
... The Knowledge, Attitudes, and Practices (KAP) framework theorizes that an individual learns about a topic (knowledge), develops some affective response (attitude), and engages in a behavior (practice)-often these factors influence one another in multidirectional ways [16,17]. The KAP framework addresses the relationship between knowledge and behavior, theorizing that attitudes may affect the relationship [16]. ...
... The Knowledge, Attitudes, and Practices (KAP) framework theorizes that an individual learns about a topic (knowledge), develops some affective response (attitude), and engages in a behavior (practice)-often these factors influence one another in multidirectional ways [16,17]. The KAP framework addresses the relationship between knowledge and behavior, theorizing that attitudes may affect the relationship [16]. KAP tools are often used to assess health behaviors, including the behaviors of health workers during the provision of care. ...
Background
Female genital mutilation or cutting (FGM/C) is a social norm driven practice associated with numerous adverse health complications. Existing assessment tools for health workers are limited by lack of a clear framework for what constitutes the critical knowledge, attitudes, and practices that impact FGM/C prevention and care. The aim of this study was to explore expert opinion of the knowledge, attitudes, and practices for FGM/C-related prevention and care that can be used to inform the development of future KAP measurement tools.
Methods
We conducted 32 semi-structured individual interviews with global clinical and research experts on FGM/C from 30 countries including participants from Africa, Australia/ New Zealand, Europe, the Middle East, and North America. Interview questions explored areas of knowledge, attitudes, and practices that influence FGM/C-related prevention and care activities. We used the directed content analysis methodology for the qualitative data analysis.
Results
We identified six categories of knowledge, six of practice, and seven of attitudes that contribute to FGM/C-related prevention and care. Areas of knowledge included: general knowledge about FGM/C; who is at risk for experiencing FGM/C; support for FGM/C; female genital anatomy/ physiology; health complications of FGM/C; management of health complications of FGM/C; ethical and legal considerations for the treatment and prevention of FGM/C, and patient-health worker communication. Areas of practice included: clinical procedures and protocols; management of complications; defibulation; other surgical procedures for FGM/C; pediatric care (including prevention); and patient-centered care. Participants described health worker attitudes that may affect how prevention and care activities are delivered and/or received including attitudes toward: the perceived benefits of FGM/C; harms of FGM/C; ethical considerations related to FGM/C medicalization, prevention, and treatment; providing care for FGM/C-affected clients; women and girls who have experienced FGM/C; communities that practice FGM/C; and affective response to FGM/C. We also present participant perspectives on the ways in which knowledge, attitudes, and practice interact impacting the type and quality of care provided to those affected by FGM/C.
Conclusions
This study identified specific areas of knowledge, attitudes, and practices in FGM/C prevention and care that are important to include in future evaluation metrics. Future KAP tools should be theoretically informed using the framework we present, and assessed for validity and reliability using psychometrically rigorous methods. Developers of KAP tools should consider the hypothesized relationships between knowledge, attitudes, and practices.
... Here, it is suggested that response to advertising will follow the affinity model (i.e., ACB: affect → cognition → behavior). Valente et al. (1998) explored how media campaigns create behavioral change through the affinity model and specified that liking a promotion drives interest or purposive information seeking which initiates a desired action. Thus, a favorable response to the brand's advertisement will be related to increased interest and a higher likelihood of brand use. ...
... Third, while past research mentions that the separate dimensions of brand response (Speed & Thompson, 2000) are likely to be hierarchical in nature with the ability to influence each other, this study extends prior work by formally developing a process approach to consumer evaluations of an ad based on the affinity model (i.e., ACB: affect → cognition → behavior; Valente et al., 1998). The current research finds that brand favorability is positively associated with brand interest, which then subsequently increases brand use intentions. ...
Consumer‐brand relationships vary with regard to their degree of psychological connection to the brand. Some individuals may have a weak connection to the brand (e.g., general consumers), while others may possess a strong connection to the brand (e.g., brand community members). Marketers have yet to distinguish between the types of advertising appeals that are most effective for these different individuals. Hence, this research utilizes construal level theory to posit that consumers with a stronger [weaker] psychological sense of brand community will think about the brand more concretely [abstractly] and be more persuaded by utilitarian [symbolic] advertising appeals. Three original experiments reveal that a match between the degree of psychological sense of brand community and the type of advertising appeal directly influences favorable consumer attitudes, and subsequently consumer cognitions and behaviors. Furthermore, message elaboration is the process mechanism driving the effect of the match on favorable consumer attitudes, while relationship‐oriented cultural values attenuate this effect. This research contributes to both theory and practice by providing new knowledge regarding which advertising appeals are the most effective for consumers with strong versus weak consumer‐brand relationships.
... The lack of knowledge among adolescent girls is important to address since most girls are cut between the ages of 10 and 14, interventions specifically designed to improve knowledge about the practice specifically the short and long term impacts of the practice among girls is likely to help them truly understand what FGM and provoke critical thinking around benefits or sanctions related to being cut, instead of simply expressing disapproval of the practice in an effort to appear politically correct. These results also support findings presented by Valente et al. (50) questioning the linear ranking of knowledge, attitudes, and practices in promoting behavior change and instead promoting six different permutations examining the cause and effect relationships between knowledge, attitudes, and practices (50). ...
... The lack of knowledge among adolescent girls is important to address since most girls are cut between the ages of 10 and 14, interventions specifically designed to improve knowledge about the practice specifically the short and long term impacts of the practice among girls is likely to help them truly understand what FGM and provoke critical thinking around benefits or sanctions related to being cut, instead of simply expressing disapproval of the practice in an effort to appear politically correct. These results also support findings presented by Valente et al. (50) questioning the linear ranking of knowledge, attitudes, and practices in promoting behavior change and instead promoting six different permutations examining the cause and effect relationships between knowledge, attitudes, and practices (50). ...
Female Genital Mutilation (FGM) is a harmful practice with no benefits and considerable harm to girls and women who undergo it. In 2016, the United Nations Joint Program to Eliminate FGM, funded the development and subsequent validation of a monitoring and evaluation framework to understand the relationship between social norms and practicing FGM. Evidence on the framework was gathered through a pilot study in Ethiopia. This paper uses cross-sectional quantitative data from the pilot to operationalize the framework and determine what factors are associated with practicing FGM. A total of 554 and 481 participants answered the question “Have you undergone FGM?” and “Do you know a family member who has undergone FGM?” respectively. Overall, 65% of participants said they had undergone FGM and 32% said they knew someone in their family who had undergone FGM. Predictors of not undergoing FGM included most progressive attitudes vs. less progressive attitudes about FGM and relationship to identity [OR: 1.9 (95% CI: 1.1–3.3)]; region [Afar vs. Addis Ababa: OR: 0.09 (95% CI: 0.02–0.5); Southern Nations Nationalities and People's Regions vs. Addis Ababa: OR: 0.1 (95% CI: 0.05–0.3)], being 36 years old and above vs. 10–19 years (OR: 0.2 (95% CI: 0.1 to 0.7)) and being single, never married vs. married or engaged (OR: 2.8 (95% CI: 1.1–7.0)]. Predictors of knowing a family member who has not undergone FGM included: Higher knowledge vs. lower knowledge [OR: 0.3 (95% CI: 0.1–0.5)]; if the family expected you to abandon FGM, you had a greater odds of knowing a family member who had not undergone FGM [43.6 (95% CI: 2.7–687.8)]; coming from Southern Nations, Nationalities and People's Region was associated with a lower odds of knowing a family member who had not undergone FGM [0.3 (95% CI: 0.1–0.6)]. Being a female influential vs. female caregiver was associated with a higher odds of knowing a family member who had not undergone FGM [2.9 (95% CI: 1.01–5.2)]. This paper has allowed us to validate a theory and research based social norms framework, specifically examining how social and behavior change communication can be used as a mechanism for shifting norms around a given harmful practice. Now that this model has been developed and validated, it is likely to provide a foundation to study the direct and indirect impacts of social norms programming on changing harmful practices, such as FGM.
... Therefore, increasing knowledge about EEHV, including its symptoms, transmission, and preventive measures, is essential. Improved understanding among elephant owners/caretakers can lead to better practices related to the KAP model, which represents the interconnection among knowledge, attitudes, and practices that can lead to changes in individual behaviors [33][34][35]. This model demonstrated that knowledge and attitude influence practice, even if they are not necessarily correlated [36]. ...
Surin, situated in the northeastern region of Thailand, has earned the reputation of being an "elephant village" due to its high captive elephant population and unique tradition of elephant rearing. However, the continuous occurrence of elephant endotheliotropic herpesvirus (EEHV) infection poses a significant threat to elephants, particularly the young ones. This study investigated various aspects of EEHV-related elephant care among ninety-two mahouts at the Surin Elephant Kingdom Project. This study used semi-structured interviews and observations to assess the mahouts’ knowledge, attitude, and practice (KAP scores) toward EEHV transmission, prevention, and management. The result revealed knowledge and practice scores below expectations, indicating an insufficient understanding the nature of disease and preventive measures. However, the mahouts exhibited awareness of the severity of the disease and factors contributing to transmission risk. Regarding the relationship among KAP scores, a positive correlation was observed at a low level (p < 0.05) between the knowledge and practice scores. Interestingly, approximately 55% of the survey respondents were confident that their elephants would not receive EEHV, leading to inadequate prevention measures. From the result, it is crucial to provide comprehensive knowledge about the nature of the disease and preventive measures to all mahouts. This education should emphasize the importance of early monitoring signs, appropriate weaning age, and preventing viral transmission practices. The KAP survey offers valuable insights that can identify areas requiring improvement and guide the development of effective and targeted disease prevention programs within the specific population. Therefore, it is recommended that the KAP survey should be employed in other parts of the country where the elephant management system differs.
... KAP data can reveal knowledge gaps, behavioral patterns, and barriers to understanding, facilitating problem-solving (World Health Organization, 2008). Previous research emphasizes the connection between knowledge, attitudes, and practices (Valente et al., 1998), with education acting as a catalyst for increasing awareness and influencing attitudes. Kholi (2015) and Al-Naqbi and Alshannag (2018) found that enhanced environmental education raises public awareness and fosters positive attitudes toward sustainability. ...
Sustainability refers to both the planet’s health and humanity’s future well-being, encompassing actions humans take to prevent the depletion of natural resources. Education for Sustainable Development (ESD) plays a vital role in course curricula by helping students develop critical thinking, decision-making, socio-emotional, and behavioral skills. This study examined the awareness and behavior of BS Management Accounting (BSMA) students regarding the three pillars of sustainability as well as the relationship between sustainability education and their awareness and behavior. Using the Knowledge-Attitudes-Practices (KAP) and Knowledge-Attitude-Behavior (KAB) frameworks, this quantitative descriptive research collected data from 349 out of 399 BSMA students (87.47% participation rate) enrolled during SY 2023–2024 at the University of Saint Louis, Northern Philippines. The results revealed that students were generally aware of sustainability and exhibited positive attitudes toward sustainable practices. Enrollment in the SASA 1013 course significantly increased sustainability awareness, but neither year level nor course enrollment had a significant impact on actual sustainability behavior. This study offers insights into the relationship between students’ sustainability awareness and their behavior across the three sustainability pillars. The novelty of this research lies in its focus on BSMA students and the specific role of the SASA 1013 course in fostering sustainability awareness. The study concludes with recommendations for curriculum development and policy initiatives to further promote students’ long-term sustainability awareness and behavior.
... The findings of our study, which indicate medium levels of perception and knowledge about climate change in agronomy, can be contextualized within the broader framework of Knowledge, Attitude, and Perception (KAP) models. These models are particularly relevant in public health [67,68], environmental education [69,70], and behavioral change studies [71,72]. They provide a structured way to examine the interrelations between these three dimensions. ...
The Intergovernmental Panel on Climate Change has confirmed that climate change is an unequivocal fact, presenting significant challenges due to its adverse impacts. Understanding climate change is crucial for agricultural students, as climate variability and extreme weather events directly affect agriculture. This study examined agronomy students’ perceptions and knowledge of climate change at a technical university in Cotopaxi, Ecuador. An online structured questionnaire was used to gather data on students’ perceptions and knowledge. The questionnaire had two sections, i.e., perception and knowledge. The perception section employed a Likert scale covering the following six components: skepticism, perceived benefit, economy, environmentalism, perceived risk, and negative effects. The knowledge section included true/false questions across four dimensions, i.e., causes, effects, concepts, and human relationships. The results indicated that most students had a medium level of perception (55.85%) and knowledge (54.25%) regarding climate change. A low but significant correlation was found between perception and knowledge (rs = 0.12, p = 0.02). Based on these findings, the researchers recommend incorporating specific climate change courses to better prepare students for sustainable agricultural development in a changing climate.
... With the goal of helping individuals establish positive attitudes and beliefs and shifting towards correct behavior based on the reception and mastery of relevant knowledge, the theory has been widely applied in predicting health-related behaviors and implementing practice-improvement programs [26]. However, few studies have integrated the KAP model into death education for older adults, though it has the potential to communicate essential information, achieve reasonable life and death cognition, facilitate the maintenance of a positive attitude, and encourage the development of death-coping strategies [27]. Therefore, this study aimed to develop a KAP-based narrative life education program and explore its feasibility and effects on attitudes toward death and sense of meaning of life in older community-dwelling adults. ...
Background
The global aging population presents challenges that are particularly acute in China. Older Chinese adults’ attitudes towards death significantly impact their quality of life. Death education is crucial for promoting positive perspectives on life and death. Narrative education offers a promising approach to facilitating death education. Integrating the Knowledge-Attitude-Practice (KAP) model into death education will enhance the feasibility and acceptability of death education programs.
Methods
This mixed-methods feasibility study included a quasi-experimental trial and semi-structured interviews. Older adults in the intervention group (N = 27) received a 6-week KAP-based narrative life education program in addition to standard community health education; participants in the control group (N = 20) received only the normal community health education. In both groups, attitudes toward death and the meaning of life were assessed at baseline and immediately after the intervention. A post-intervention semi-structured interview and satisfaction survey were also conducted for the intervention group.
Results
Forty out of 47 older adults completed the program for an 85.1% retention rate. All of the older adults in the experiment were very satisfied and satisfied with the life education program, and no adverse events were reported. Compared to the control group, participants in the intervention group had a significant decrease in the fear of death (P = 0.028), and substantial improvement in their value of life (P = 0.031), goal of life (P = 0.035), freedom of life (P = 0.003), and the total score for purpose in life (P = 0.017). The qualitative results yielded four themes: profound recognition of life and death, contradiction between thoughts and action, conflict between one’s acceptance and others’ avoidance, and evaluation of the life education program.
Conclusions
The KAP-based narrative life education program is feasible and acceptable for older Chinese community-dwelling adults. It is also potentially effective in improving attitudes toward death attitudes and the meaning of life in this cohort.
Trial registration
This study was retrospectively registered at China Clinical Trial Registry as ChiCTR2300069551 on 2023-03-20. URL of registration: https://www.chictr.org.cn/showproj.html?proj=183176.
... Th e idea of the learning model of behavior modifi cation states that people's thoughts, attitudes, and intentions have an impact on their outer conduct (Smollan, 2015). Similar ordering of the attitude components may be seen in the learning model of behavior modifi cation created by Valente et al. (1998), with cognition coming before emotion and emotion infl uencing conduct. ...
This study examines the influence of change leadership on employee support for an intentional organizational change in the Delta State Ministry of Education Asaba, Nigeria. The study employed a cross-sectional research methodology and a self-administered Likert-type questionnaire. Data for the study were obtained from employees who were undergoing through significant upheaval. The data collected was evaluated using structural equation model. The study found that essential change leadership qualities including communication and involvement aid in building employee support for change initiatives. The cognitive and behavioral reactions of the employees to the planned change was influenced by change leadership. Employees' cognitive assessments of and emotional reactions to the planned change event served as a mediating factor in the relationship between change leadership and behavioral intentions to support the planned change. When assessing planned organizational transformation efforts, leaders frequently pay more attention to how employees respond to the change than to the causes of those reactions. The significance of addressing employee attitudes as the first step toward desired change activities was emphasized by this study. This study adopted a multidimensional approach to attitudes and examined their hierarchy of impacts in order to more accurately describe the influence of change leadership on employee support for change. The study makes a number of suggestions, one of which is that leaders should boost employee morale prior to initiating change projects in order to increase the likelihood of success. In a world of rapid change and cultivation of adaptable mindsets, change leadership is essential.
... Numerous connections between knowledge, attitudes, and practices have been found in earlier research (e.g., Valente et al. 1998). The Knowledge, Attitudes, and Practices (KAP) model was created and is currently regarded as one of the most well-liked survey tools in the field of social research. ...
This study explored farmers’ knowledge, practice, and attitude towards Climate Services (weather information) in the West African state of Benin. Primary data were collected randomly from 540 smallholder farm households across five municipal areas. Seemingly Unrelated Regression (SUR) models were employed to analyze the socio-economic factors that explain the Knowledge, Attitude, and Practice (KAP) scores. The empirical results suggest that most farmers are unaware of Climate Services (CS) but show positive attitude and willingness to adopt them. The average KAP scores are 4.13 (± 3.77) against a maximum of 10; 7.20 (± 3.64) against a maximum of 14; and 2.78 (± 3.50) against a maximum of 16 for Knowledge, Attitude, and Practice respectively. Socio-economic factors such as level of education, gender, household size, membership in an organization, and access to credit have different effects that policymakers should consider to improve farmers’ KAP towards the adoption of Climate Services.
... First, our DA significantly improved knowledge on prostate cancer screening, which is often the initial step toward changes in both intention and behavior for individuals. 28 a manner that neither guaranteed complete detection of prostate cancer nor assured morality reduction. This possibly incited confusion among the participants, leading to a decrease in accurate response rates. ...
Background:
Prostate-specific antigen-based routine screening is not recommended for the general population due to conflicting results with mortality reduction. We aimed to develop a web-based decision aid (DA) for informed decision making for prostate cancer screening.
Methods:
Using the International Patient Decision Aid Standards (IPDAS) development process model, we developed our DA based on patient and clinician interviews and multidisciplinary expert discussions. The prototype consisted of predicting individual prostate cancer risk and informed decision-making, including knowledge, risk and benefit, cost, personal value, and decision making. We conducted a pilot study on 101 healthy men, evaluating the effectiveness of DA by measuring knowledge, attitude, and intention to screen before and after using the DA, as well as decisional conflict and usefulness after using the DA.
Results:
Of the 101 participants (median age 60 [50-69] years), 84% had not undergone screening for prostate cancer in the past two years. After using the DA, knowledge on prostate cancer screening increased (mean score [of 10] before versus after: 6.85 ± 1.03 versus 7.57 ± 1.25; P < 0.001), and intention to not screen increased from 27.7% to 51.5% (P < 0.001), but attitude toward screening did not change (P = 0.564). After use of the DA, 79 participants reported no decisional conflict, and the usefulness score was high (mean score [of 100] 77.35 ± 7.69), with 85% of participants reporting that the DA helped with decision making.
Conclusion:
Our web-based DA yielded increased knowledge, decreased screening intention, and high perceived usefulness. These findings indicate potential clinical relevance, especially among younger individuals.
... The KAP model has been widely used to examine the transmission of knowledge, attitudes, and practices in areas, such as health, pain management, nutrition, accident prevention, and amoral health (see, e.g., Smyth et al., 2007;Alzghoul and Abdullah, 2015;Wan et al., 2016;Liu et al., 2018). Although various researchers have proposed different existing theoretical models of the knowledgeattitude-practice relationship, the most frequently applied ordering of the KAP variables is the cognitive model (Valente et al., 1998). This theoretical model "argues that individuals first learn about a practice, then develop a positive attitude toward it, and after passing through these stages, engage in the behavior" (p. ...
Pesticides are widely used by vegetable growers in Bangladesh, however the health consequences of these chemicals in relation to non-communicable diseases (NCDs) is largely unknown. NCDs have emerged as a major health concern in recent decades and cause deaths, chronic illnesses, and psychosomatic suffering for people worldwide. In Bangladesh, a lack of health literacy among other reasons contributes to the occurrence and prevalence of NCDs. This study interprets and evaluates the status of key health literacy forming components, such as knowledge, attitude, and practices (KAP) of vegetable growers with respect to the use of pesticides. The study was carried out in six districts of Bangladesh. A multistage sampling procedure was used to obtain a survey sample of 334 farmers who grow vegetables and use pesticides. The results revealed that the level of knowledge of the farmers is poor. They are also not very aware of the relationship between pesticide use and potential vulnerability to NCDs. Such knowledge, along with attitude and practices developed through long-held beliefs and perceptions are not helpful for the safe and appropriate use and application of pesticides. To redress such KAP situations among vegetable growers, we posit that policy actors and stakeholders across public health and agricultural sectors, and developmental agencies must strive to improve health literacy in terms of KAP. Large-scale programmatic interventions in the knowledge, attitude, and practices of vegetable growers through training, education, or mass promotion could enhance their literacy and diminish the unabated use of pesticides.
... The KAP model has been widely used to examine the transmission of knowledge, attitudes, and practices in areas, such as health, pain management, nutrition, accident prevention, and amoral health (see, e.g., Smyth et al., 2007;Alzghoul and Abdullah, 2015;Wan et al., 2016;Liu et al., 2018). Although various researchers have proposed different existing theoretical models of the knowledgeattitude-practice relationship, the most frequently applied ordering of the KAP variables is the cognitive model (Valente et al., 1998). This theoretical model "argues that individuals first learn about a practice, then develop a positive attitude toward it, and after passing through these stages, engage in the behavior" (p. ...
... Therefore, the findings from the subgroup analysis can be generalized to situations and settings that resemble these studies (21)(22)(23)(24). Our results also show that strategies adopted in the intervention arms could not address the knowledgepractice gap highlighted by many public health practitioners previously ( 39,40). They argued that knowledge and attitudes towards FIGURE 2 Odds of a person to answer malaria-related questions correctly between intervention and control group. ...
Introduction
Malaria health education intervention is a community-directed approach that has long been considered important in preventing malaria in sub-Saharan Africa. However, its effectiveness is being questioned due to a lack of strong evidence. We aim to synthesize the evidence of the impact of health education on malaria knowledge and insecticide-treated nets (ITN) usage. Specifically, we analyzed the odds of correctly answering malaria-related questions and the odds of using ITN between the intervention and control groups.
Methods
Experimental and observational studies conducted in sub-Saharan Africa between 2000 and 2021 which had quantitatively evaluated the impact of health education interventions on malaria knowledge and ITN usage were included in the review.
Results
A total of 11 studies (20,523 participants) were included. Four studies used educational interventions to teach appropriate ITN strategies and promote ITN usage. Two others focused on improving knowledge of malaria transmission, prevention, treatment, and its signs and symptoms. The remaining five studies assessed both ITN use and malaria knowledge. Of these, 10 were eligible for meta-analysis. On average, the odds of a person in the intervention group reporting better malaria knowledge (odds ratio 1.30, 95% CI: 1.00 to 1.70, p = 0.05) and higher ITN usage (odds ratio 1.53, 95% CI: 1.02 to 2.29, p = 0.004) increased significantly after receiving health education interventions compared to those in the control group. The odds of ITN usage also substantially increased when the interventions were based on a theory or model (odds ratio 5.27, 95% CI: 3.24 to 8.58, p = 0.05).
Discussion
Our review highlights sub-Saharan Africa’s various health education strategies to curb malaria over the past two decades. Meta-analysis findings show that health education interventions are moderately effective in improving malaria knowledge and ITN usage and have contributed to the effort of global malaria strategy.
... 17,18 Various health behavior modelsdsuch as the transtheoretical modeldinform our understanding of behavior change and help practitioners develop strategies to address obstacles. 34,35 For example, regulations such as a sugar tax and banning junk food sales in and near schools promotes the practice of "Drink fewer SBBs." 14,23 Providing families free toothbrushes and fluoride toothpaste may encourage oral hygiene and reduce caries. 14 Identifying execution barriers and implementing strategies to overcome obstacles should be a health education priority. ...
Background/purpose:
This study examined the practice rate of Anticipatory Guidance (AG) and the gap between knowledge and practice among caregivers.
Methods:
We retrospectively collected data from caregivers who brought their children for seven age-based well-child visits (birth to 7 years old) and seven corresponding AG checklists for practice (each ranged from 16 to 19 guidance items, 118 items in total) between 2015 and 2017. Practice rates of guidance items and their association with children's sex, age, residence, and body mass index were collected and analyzed.
Results:
We enrolled 2310 caregivers (330 per well-child visit). Average practice rates of guidance items in the seven AG checklists were 77.6%-95.1%, generally without significant differences between urban/rural or male/female children. However, lower (<80%) rates were observed for 32 items, including dental check-ups (38.9%), use of fluoride toothpaste (44.6%), screen time (69.4%), and drinking less sugar-sweetened beverages (SSBs) (75.5%), with corresponding knowledge-to-practice gap rates of 55.5%, 47.9%, 30.3%, and 23.8%, respectively. "Drinking less SSBs" was the only item with a higher obesity rate in the non-achieved group versus the achieved group (16.7% vs. 7.4%, p = 0.036; odds ratio: 3.509, 95% CI: 1.153-10.677, p = 0.027).
Conclusions:
Caregivers in Taiwan practiced most AG recommendations. However, dental check-ups, fluoride toothpaste use, drinking less SSBs, and limiting screen time were less executed items. A higher obesity rate was found among 3-7-year-old children whose caregivers failed to practice the "Drink less SSBs" guidance. Strategies to overcome the gap between knowledge and practice are needed to improve these less-achieved guidance items.
... 5,9,[14][15][16][17][18][19][20][21][22][23][24] Studies show early discontinuation is specifically high among users who practice contraception without sufficient knowledge that may result in considerable misinformation and, in turn, dissatisfaction. 25,26 And, the discontinuation of LARCS for reasons other than wanting to become pregnant is a public health concern as it contributes to unplanned pregnancies, unwanted births, and unsafe abortions. [27][28][29] On the other hand, comprehensive information about contraception shapes women's contraceptive decision making abilities and behaviors. ...
Background:
Discontinuation of contraception for reasons other than wanting to become pregnant is a public health concern as it affects women's autonomy in sexual and reproductive health decision making as well as gender equality. Studies identified various factors, including community perception and users' dissatisfaction that limited the reach and impact of contraceptives, primarily LARCs, on women's wellbeing. In Ethiopia, however, the reasons for early discontinuation of LARCCs are not adequately explored. Against this backdrop, this study explores the main reasons for the early discontinuation of LARCs among Ethiopian women in selected public health facilities.
Methods:
This study used an institution-based qualitative study design and covered selected university hospitals and health centers in Addis Ababa, Gondar, Mekelle, and Jimma. It involved in-depth interviews with 29 women aged 15-49 to gather data and explore the decision-making processes involved in the early discontinuation of LARCs. It used description, narration and thematic interpretation as data analysis procedures.
Results:
Interviewees reported several reasons for early discontinuation of LARCs, including side effects (eg, weight gain/loss, heavy menses, tiredness, and reduced libido), desire to conceive, and husbands' disapproval. This study found that women were sufficiently aware of alternative contraceptives, including LARCs. Many reported experimenting before deciding on an option. Conversely, others' reports reveal the influences of gender roles and community misconceptions on women's decisions to discontinue LARCs.
Discussion and implications:
The common threads in interviewees' narratives highlight the significance of traditional values, gender roles, community perception, and experience with side effects to women's early discontinuation of LARCs. This study concludes with remarks on how to improve the effectiveness of family planning programming by adopting the gender transformative approach (GTA) in their design and implementation.
... Thus, this study aims to address the unclear status of the delirium subtype assessment among hospital departments. Based on several delirium guidelines (12,13,41,42), this research focused on the current KAP status regarding delirium subtypes among the nursing staff of different departments with high delirium rates using a selfadministered questionnaire with the theoretical guidance of the Knowledge-Attitude-Practice Model (43). We also explored the influencing factors of KAP status, which could provide suggestions for future studies related to delirium and delirium subtypes. ...
Background
Delirium, a confused transient state of consciousness, can be divided into hyperactive, hypoactive, mixed, and no motor subtypes, according to different clinical manifestations. Several studies have investigated delirium subtypes in the knowledge dimension, but few studies have investigated delirium subtype in the attitude and practice dimensions. The barriers, knowledge sources, and practice details regarding subtype assessment are unclear.
Objectives
This study had three objectives. First, we planned to investigate the KAP status regarding delirium and subtypes for nurses. Second, we wanted to identify factors affecting clinical nurses' KAP scores. Third, this study expected to explore more details regarding delirium and subtypes assessment, including assessment barriers, assessment instruments, and knowledge sources.
Methods
This multicentre cross-section study was conducted in 10 tertiary hospitals in three provinces, China, from January to April 2022. We investigated 477 nurses from six departments with a high prevalence. The self-developed KAP questionnaire regarding delirium and subtypes assessment had four parts: knowledge, attitude, practice, and source. Its reliability and validity were verified effectively by 2-round Delphi expert consultation.
Results
A total of 477 nurses from the general intensive care unit (ICU), specialty ICU, orthopedics, thoracic surgery, operating room, and geriatrics were 28.3, 22.4, 22.2, 10.5, and 5.2%, respectively. The total KAP score regarding delirium and subtypes assessment was 60.01 ± 6.98, and the scoring rate was 73.18%. The scoring rate for knowledge, attitude, and practice was 58.55, 83.94, and 51.70%, respectively. More than half (54.1%) were unaware of the delirium subtypes assessment instruments. A total of 451 (94.6%) participants recognized the importance of nursing work for delirium prevention. A total of 250 (52.4%) nurses occasionally or sometimes assessed delirium subtypes, and 143 (30.0%) never assessed for delirium subtypes. We found that age, department, technical title, familiarity with delirium, familiarity with delirium subtypes, delirium training, and subtype training affected the total KAP scores. ICU nurses achieved the highest scores.
Conclusion
Chinese nurses' KAP status regarding delirium and subtypes assessment were barely acceptable, and the attitude score was positive, but knowledge and practice needed improvement. Meanwhile, the department was one of the significant KAP factors, and ICU nurses did better in delirium and subtype assessment in knowledge and practice dimension than other departments. Systematic and scientific training processes including subtype content and assessment tools are required. Experience still drives nurses' assessments of delirium and subtype. Adding the delirium assessment into routine tasks should be considered.
... N 1722 1154 * * * p < 0.001; * * p < 0.01; * p < 0.05. VALENTE et al., 1998). Or analyses of policy and behavior diffusion progressing through the knowledge, persuasion, decision, trial, and implementation stages (Rogers, 2003;Valente et al., 2019). ...
Studies that collect multi-outcome data such as tobacco and alcohol use are becoming increasingly common. In principle, multi-outcomes studies investigate the correlations between outcomes, including, causal links and/or joint distributions. Although there are many methods for studying multivariate outcomes, significant limitations regarding scale and interpretation persist. Here we introduce a model based on the exponential-family for discrete binary outcomes that provides a flexible framework for hypothesis testing of multiple binary outcomes in a computationally efficient fashion.
... In deductive analysis, a theory aligned with the researchers' interest drives the data analysis [26]. Examples of theories used in deductive analysis include the transtheoretical model [27], and the knowledge, attitudes and practices model [28]. We used the intermediate outcomes of the CASCADA model [29] to identify themes of change in the stories. ...
Background
Cultural safety training is not yet standard in Colombian medical education. If incorporated, it could address currently adversarial interactions between health professionals and the 40% of people who use traditional medicine practices. In 2019, a randomised controlled trial tested the impact of cultural safety training for medical students using participatory serious game design. The quantitative evaluation showed improved cultural safety intentions of Colombian medical trainees. We report here a qualitative evaluation of the most significant change perceived by trial participants.
Methods
This qualitative descriptive study used the most significant change technique. We invited the trial participants engaged in clinical settings to describe stories of change in their supervised clinical practice that they attributed to the intervention. Using a deductive thematic analysis based on a modified theory of planned behaviour, two independent reviewers coded the stories and, by consensus, created themes and sub-themes.
Results
From 27 stories of change, we identified seven themes and 15 subthemes: (a) Conscious knowledge: benefits of cultural safety training, consequences of culturally unsafe behaviour, cultural diversity and cultural practices; (b) Attitudes: respect and appreciation for cultural diversity, openness, and self-awareness; (c) Subjective norms: positive perception of cultural practices and less ethnocentrism; (d) Intention to Change; (e) Agency to accept cultural diversity and to prevent culturally unsafe actions; (f) Discussion; and (g) Action: better communication and relationship with patients and peers, improved outcomes for patients, physicians, and society, investigation about cultural health practices, and efforts to integrate modern medicine and cultural health practices.
Conclusion
The narratives illustrated the transformative impact of cultural safety training on a results chain from conscious knowledge through to action. Our results encourage medical educators to report other cultural safety training experiences, ideally using patient-related outcomes or direct observation of medical trainees in clinical practice.
Trial registration
Registered on ISRCTN registry on 18/07/2019. Registration number: ISRCTN14261595.
... The KAB model has received much attention due to earlier research finding that knowledge alone is insufficient to cause behavioural changes (Valente et al., 1998;Worsley, 2002). Attitude is a necessary mediator to mitigate the cognitive dissonance between knowledge and action. ...
Recent studies on the pandemic have focused on the DOs and DON’Ts of recovery remedies, but few have investigated the pandemic-spawned fundamental internal problems of the enterprises in order to diminish the impacts of the mega-crisis and relieve the need for recovery efforts. It is incontestable that employees are one of the major victims of the pandemic crisis; their negative emotions caused by the increasing career and financial instability have heightened the challenges of their enterprises that are striking for survival. This research has identified a breakthrough that extends the effect of CSR efforts from the traditional societal focus to internal employees, to whom CSR is found to mediate the undesirable escape habits and anti-crisis behaviours resulted from crises. This strengthens the understanding and value of CSR, while presents management with a novel mixed strategy to stabilize employee emotions and assemble their competence to get through a crisis.
... The KAB model has received much attention due to earlier research finding that knowledge alone is insufficient to cause behavioural changes (Valente et al., 1998;Worsley, 2002). Attitude is a necessary mediator to mitigate the cognitive dissonance between knowledge and action. ...
A multitude of studies have suggested potential factors that influence internet security awareness (ISA). Some, for example, used GDP and nationality to explain different ISA levels in other countries but yielded inconsistent results. This study proposed an extended knowledge-attitude-behaviour (KAB) model, which postulates an influence of the education level of society at large is a moderator to the relationship between knowledge and attitude. Using exposure to a full-time working environment as a proxy for the influence, it was hypothesized that significant differences would be found in the attitude and behaviour dimensions across groups with different conditions of exposure and that exposure to full-time work plays a moderating role in KAB. To test the hypotheses, a large-scale survey adopting the Human Aspects of Information Security Questionnaire (HAIS-Q) was conducted with three groups of participants, namely 852 Year 1–3 students, 325 final-year students (age = 18–25) and 475 full-time employees (age = 18–50) in two cities of China. MANOVA and subsequent PROCESS regression analyses found a significant negative moderating effect of work exposure, which confirmed the proposed model. However, the effect was more pervasive than expected and moderation was found in the interaction between work exposure and all three ISA dimensions. The social influence does not only reshape the cybersecurity attitude of the highly educated, but also knowledge and behaviour. Findings contribute theoretically, methodologically and practically, offering novel perspectives on ISA research and prompting new strategies to respond to human factors.
... However, KAP has been studied crosssectionally because it is believed that a causal relationship exists between knowledge and attitudes because before an attitude can be formed, knowledge of the topic must occur first. 33 Physicians are seeing a rise in patients who use cannabis but only consulting on a limited number of patients with suspected cannabis allergy except for the members of CSACI who saw more patients with suspected cannabis allergy; this could be because of the federal legality of cannabis and increase in occupational exposure in addition to increased use in Canada. 34,35 The Canadians are also performing the most testing for cannabis sensitization, also presumably owing to looser federal regulations and greater access to cannabis testing materials, which are scarce in the United States and European Union. ...
Background
Increased cannabis consumption world-wide challenges allergists due to an upsurge in cannabis allergy and need to discuss cannabis with patients.
Objective
We determined the knowledge, attitudes, and practices (KAP) regarding cannabis amongst allergists and their approach to recognizing and diagnosing suspected cannabis allergy.
Methods
The International Allergist Canna KAP Survey was completed by members from three International Allergy Societies. Survey questions included: 13 on cannabis attitudes, 7 on cannabis knowledge, and 4 on real-world allergy practices. Knowledge level was dichotomized and SPSS Two-Step cluster analysis grouped participants by attitudes. Multivariate analysis determined the relationship of knowledge and attitude to practice delivery.
Results
Of 570 eligible surveys started, 445 (78.0%) were completed. Participants were 49.7%% female, 80% ages 34-57 years, about 70% in practice for ≥9 years, and 29.0% practicing in an area where cannabis use is illegal. 51% reported consulting on patients with suspected cannabis allergy and 58.1% of respondents had undertaken skin prick testing and/or in vitro cannabis testing. Significant differences were found between the three societies for most variables analyzed. Analysis of attitudes revealed 3 clusters named Traditional, Progressive, and Unsure. Those with more progressive attitudes toward cannabis and who had more knowledge were more comfortable speaking to patients about cannabis, more often asked patients how often and how they used cannabis (all p<0.001).
Conclusion
Varying knowledge and attitudes toward cannabis impacting comfort communicating with patients about cannabis were seen in members of three allergy societies supporting the need for more cannabis research and education.
... Previous studies have identified many interconnections among knowledge, attitudes, and practices (e.g., Valente et al., 1998). In terms of knowledge-practices relationship, Hungerford and Volk (1990) proposed that knowledge of issues and possession of skills are required for behavioral change. ...
Sustainable agriculture plays an important role in achieving sustainable development goals with regard to food security and environmental conservation. Sustainable agriculture relies on sustainable farming practices that reduce greenhouse gas production, the wise use of local natural resources, and reductions in negative impacts on the environment and human health. Sustainable farming practices can be driven by various factors, such as the socio-environmental setting, socio-cognitive factors, agricultural institutions, and policy. This study used the knowledge, attitude, and practice (KAP) model to examine farmers’ knowledge, attitudes, and practices in the area of sustainable agriculture. It also considered the factors affecting farmers’ knowledge, attitudes, and practices. Two different socio-environmental contextual settings in Surin Province (a Thai-Cambodian border province) of Thailand are considered. The results show that there are differences between the two different socio-environmental contextual settings with regard to farmers’ sustainable agricultural practice perceptions, knowledge, and attitudes. Farmers’ perceptions of environmental degradation, the number of years of agricultural experience, and agricultural policy drive farmers’ attitudes and individual sustainable practices. Another major result of the study is that individual farmers’ attitudes and practices promote collective sustainable agricultural behaviors. The implication of these findings is that it is necessary to improve the learning ability of individual farmers on the environment and sustainable agricultural practices through social learning and scientific knowledge dissemination, so as to produce sustainable collective development behaviors.
... To illustrate the underlying mechanism through which theory is transformed into action, we follow the KAP model that assumes a hierarchical model that posits a learning model of behavior change in which knowledge precedes attitudes, which in turn influences behavior. Thus, this model presumes a relative ordering of knowledge, attitudes, and practices (KAP) (Valente et al., 1998), suggesting that causality follows a transmission from lower to higher dimensions of environmental commitment. These dimensions in turn encompass increasing levels of individuals' environmental commitment. ...
Environmental education is regarded as a key instrument for promoting pro-environmental behavior in early childhood. In this paper, we analyze the transmission process within a personal value system including knowledge, attitudes, and practices (KAP) regarding the consumption and disposal of plastics among school children, and the extent to which parents play a role in mediating that transmission. The study gathers data from a sample of 1,521 children in southern Chile. Results evidence that the transmission of value systems is a recursive and hierarchical process, where knowledge mediates attitudes, and attitudes (and knowledge) mediate practices. We also find evidence that parents' behavior significantly explains children's behavior in all domains of KAP, with stronger connections among practices where children and parents interact more closely (e.g., packing a lunch box) and in those that are more visible to children (e.g. recycling).
... According to the theory of knowledge, attitudes, and practices (KAP) in behavior change models, knowledge is the foundation, attitude is the motivation and behavior is the goal. Knowledge improvement and attitude change contribute to the formation of individual behavior and skills [46]. It is suggested that the training of knowledge and attitude of adolescence and knowledge and skills of peer education activities can help peer educators to develop a healthy lifestyle and develop their ability to carry out peer education activities. ...
Background
An increasing number of children and adolescents have reported mental health problems, and resilience is a protective factor against these problems. Therefore, the aim of the study is to verify the effect of peer education based on adolescent health education on adolescent resilience.
Method
A cluster randomized controlled trial was conducted including 1,613 students who were divided into an intervention group (19 classes, 732 participants) and a control group (24 classes, 881 participants). One-year peer education was performed in the intervention group, and the control group had no interventions. The Resilience Scale for Chinese Adolescents by Yueqin Hu and a self-designed basic information questionnaire were used to collect data. Chi-square test and rank-sum test were used to compare the differences of demographic characteristics between the two groups. A linear mixed model was used to compare the changes of resilience between the two groups after intervention, and the intra-cluster correlation coefficient (ICC) was calculated. A generalized linear mixed model (GLMM) was used to verify the effect of peer education on adolescent resilience. The significance was set at P < 0.05.
Results
After intervention, compared with the control group, the intervention group showed significant improvement in target focus, emotion adjustment, interpersonal assistance and total resilience (P < 0.05). The ICC range was 0.003 to 0.034. The GLMM results indicated that peer education based on adolescent health education had significant effects on adolescents’ target focus (β = 0.893, P = 0.002), emotional adjustment (β = 1.766, P < 0.001), interpersonal assistance (β = 1.722, P = 0.016) and total mental resilience (β = 5.391, P < 0.001), and the effect was greater for boys than for girls.
Conclusions
Peer education based on adolescent health education is effective for improving adolescents’ target focus, emotional adjustment, interpersonal assistance, and total resilience, especially for males. Future research should devote more attention to positive cognition and family support as well as gender differences.
... more positive attitudes towards or perceptions of reporting may have actively 347 sought out information or were better able to recall it(Valente et al., 1998). In support of this 348 interpretation, we observed no improvement in attitudes in the short term despite widespread 349 dissemination of information. ...
Social networks are critical to the success of behavioral interventions in conservation because network processes such as information flows and social influence can enable behavior change to spread beyond a targeted group. We investigated these mechanisms in the context of a social marketing campaign to promote a wildlife poisoning hotline in Cambodia. With questionnaire surveys we measured a social network and knowledge and constructs from the theory of planned behavior at 3 points over 6 months. The intervention initially targeted ∼11% (of 365) of the village, but after 6 months ∼40% of the population was knowledgeable about the campaign. The likelihood of being knowledgeable nearly doubled with each additional knowledgeable household member. In the short term, there was also a modest, but widespread improvement in proconservation behavioral intentions, but this did not persist after 6 months. Estimates from stochastic actor‐oriented models suggested that the influences of social peers, rather than knowledge, were driving changes in intention and contributed to the failure to change behavioral intention in the long term, despite lasting changes in attitudes and perceived norms. Our results point to the importance of accounting for the interaction between networks and behavior when designing conservation interventions.
... Eighth, behavior. The communication process not only changes the knowledge of the communicant, but also changes attitudes and behavior (Hartmann et al., 2012;Valente et al., 1998). Empowerment is the process of making objects/ targets capable or empowered (Hennestad, 1998). ...
This study aims to describe the empowerment-based da'wah approach among the deaf in the Lampung region. This research also identifies the elements of persuasive da'wah in the process of the empowerment process. This study used a descriptive qualitative method by collecting data through interviews and observations and searching literature sources that were considered relevant. The results showed that empowerment has two functions, first as an instrument to build economic independence, which is carried out through providing skills based on hobby development. Secondly, empowerment becomes a persuasive da'wah instrument. The process of preaching uses sign language with an orientation to change the dimensions of religiosity, so that there is a change in understanding, experience and appreciation of religion towards a positive direction and an increase in the confidence of members of the deaf community. ABSTRAK Penelitian ini bertujuan mendeskripsikan pendekatan dakwah berbasis pemberdayaan pada kalangan tunarungu di wilayah Lampung. Penelitian ini juga sekaligus mengidentifikasi unsur-unsur dakwah persuasif dalam proses pemberdayaan yang dimaksud. Penelitian ini menggunakan metode kualitatif deskriptif dengan mengumpulkan data melalui wawancara dan observasi serta penelusuran sumber pustaka yang dipandang relevan. Hasil penelitian menunjukkan pemberdayaan memiliki dua fungsi: pertama sebagai instrumen membangun kemandirian ekonomi, yang dilakukan melalui pembekalan keterampilan berbasis pengembangan hobi. Kedua pemberdayaan menjadi instrumen dakwah persuasif. Proses dakwah menggunakan bahasa isyarat dengan orientasi perubahan dimensi-dimensi religiusitas, sehingga terjadi perubahan pemahaman, pengalaman dan penghayatan kegamaan kearah positif dan peningkatan rasa percaya diri para anggota komunitas tunarungu. Kata-kata kunci; Pendekatan da'wah; tunarungu; ekonomi kreatif.
... Psychological factors may also affect the other 2 influencing factors, including physiological and situational factors. Knowledge is the foundation of behavioral change (Bettinghaus, 1986;Valente et al., 1998) and might help patients adopt more appropriate self-care strategies, such as maintaining oral hygiene (a situational factor). In addition, dietary guidance is an important element of the intervention, which might facilitate patients' eating and improve their nutritional status (a physiological factor). ...
Purpose
This study aimed to test the feasibility and estimate the effectiveness of a theory-driven and evidence-based educational intervention program to manage the nutrition impact symptom cluster in patients undergoing radiotherapy for nasopharyngeal carcinoma (NPC).
Methods
A pilot randomized controlled trial was performed. Forty patients were divided equally into the intervention and control groups. The patients in the intervention group attended 2 face-to-face individual instructional sessions to enhance their knowledge and skills in managing the cluster. The study outcomes were the severity of the nutrition impact symptom cluster, body weight, symptom interference, and quality of life (QOL). A generalized estimating equation model was used to compare the differences in the outcome variables between the groups over 3-time points.
Results
The consent rate for the study was 95.2%, and the attrition rate was 5.0%. Although no significant differences between the groups were detected from T1 to T3, favorable effects on relieving the cluster itself (B [95% confidence interval (CI)] = -0.844 [-2.261, 0.572], p = 0.243, Cohen's d [95% CI] = -0.37 [-1.00, 0.28]) and improvements in physical well-being (B [95% CI] = 0.833 [-3.965, 5.632], p = 0.734, Cohen's d [95% CI] = -0.15 [-0.78, 0.49]) and in head and neck cancer–specific QOL (B [95% CI] = 0.061 [-4.061, 4.182], p = 0.977, Cohen's d [95% CI] = -0.05 [-0.68, 0.59]) were observed in the intervention group compared with the control.
Conclusions
The educational intervention program is feasible and has promising effects on relieving the cluster.
... A KAP survey is a method that provides access to quantitative and qualitative information (6). KAP questions tend to reveal characteristic traits in knowledge, attitude, and behaviors about different topics, including education and training (7). ...
Objective: A national program on providing comprehensive social and mental health services, entitled “SERAJ”, was developed and piloted in three districts of Iran. The present study aims to thoroughly explain the educational needs for implementing the provision of comprehensive mental and social health services in districts of Iran (SERAJ).
Method: In this study, we have interviewed service providers, held focused group discussions (FGDs) and used the knowledge, attitude, and practices (KAP) model for analyzing the duties of the service providers.
Results: To implement SERAJ, Mental and Social Health Professionals and Healthcare professionals should be trained on various contents in the fields of mental health, social health, and addiction to provide primary care services in Iran. Such training materials and schedules are necessary for providing secondary, and community action care services as well.
Conclusion: The educational program resulting from this study should be piloted and after removing the barriers and solving the limitations, it should be expanded throughout the country.
... 16 The KAP framework theorizes that an individual learns about a topic (knowledge), develops some affective response (attitude), and engages in a behavior (practice)-often these factors influence one another in multidirectional ways. 37 Existing studies assessing health care providers' KAP have typically reported their results as purely descriptive, without exploring the relationships between knowledge, attitudes, and practices or considering health care provider characteristics, such as demographics or past experiences with FGM/C, as confounders to these relationships. 16,17 The purpose of this study was to explore the relationship between provider characteristics, including awareness of the health complications of FGM/C (knowledge), and their attitudes toward FGM/C and confidence in their ability to care for patients affected by FGM/C (practice). ...
Background: Female genital mutilation/cutting (FGM/C) is a cultural practice that includes procedures that intentionally alter or cause harm to female genital organs for nonmedical reasons, affecting ∼200 million women and girls globally. Health care providers in the United States often lack confidence to provide appropriate FGM/C-related care, and experience attitudes that may negatively impact quality of care for FGM/C.
Methods: We conducted a cross-sectional survey of health care providers to explore the associations between health care provider characteristics, awareness of health complications of FGM/C, attitudes, and confidence for FGM/C care.
Results: Factors associated with more Confidence for Clinical FGM/C Care include awareness of health complications, ever cared for a woman with FGM/C, being a woman or person of color, and more than 5 years of clinical practice. Increased Confidence in Communication Skills for FGM/C Care was associated with awareness of more health complications for FGM/C. Women endorsed significantly less Negative Attitudes toward FGM/C compared with men; no other factors were associated with health care provider attitudes.
Conclusion: Future research should further investigate factors associated with health care provider attitudes toward FGM/C and those affected by the practice to promote quality care. Health providers require adequate training for clinical FGM/C care and in the communication skills that promote patient/provider communication cross-culturally.
Trial Registration: Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649
The study aims to examine the relationship between Sustainable Development Goals (SDGs) knowledge, sustainability attitudes, sustainable entrepreneurship, and sustainable behaviors among students enrolled in business-related courses at Spanish universities. Employing the Knowledge-Attitude-Behavior (KAB) model, this study innovatively disaggregates the attitude variable into attitudes toward sustainability and sustainable entrepreneurship. The findings affirm the direct and indirect effects posited in the model, indicating that familiarity with SDGs positively impacts attitudes toward sustainability, subsequently influencing sustainable behaviors. Moreover, positive attitudes toward sustainable entrepreneurship also directly influence sustainable behaviors. Additionally, the study examines the moderating influence of receiving a scholarship; results indicate that attitudes toward sustainability and sustainable entrepreneurship significantly shape behavior, with the scholarship variable altering the relationship between attitudes toward entrepreneurship and behavior. These outcomes underscore the significance of enhancing SDGs awareness and nurturing favorable attitudes toward sustainability and sustainable entrepreneurship among university students to stimulate sustainable behaviors and advance SDGs objectives.
Environmental education provides people with the information they need to understand the causes and consequences of environmental issues, helping to promote positive attitudes toward nature. This paper uses a multivalued treatment effects model to evaluate the effects of a green school certification program on children’s pro-environmental behavior in Chile. Pro-environmental behavior is measured by knowledge, attitudes, and practices related to the consumption and disposal of plastics. Results evidence a positive effect of schools’ higher certification level on children’s plastic waste behavior. This effect seems stronger in practices where children have more decision-making power (e.g., packing a lunch box). The observed reverse effect when switching from basic to intermediate level of certification is in line with the potential non-linear effects of environmental education on pro-environmental behavior regarding the consumption and disposal of plastic. To improve the design of the program, it is important to redefine incentives in the certification system to differentiate better the benefits of reaching each level of environmental certification.
Understanding the elements that affect people's compliance with preventative measures has become essential for public health activities in the aftermath of the global Covid-19 epidemic. This study looks into how readers' compliance behaviours with Covid-19 preventive measures are influenced by newspaper coverage. The study adopts a quantitative research approach, using surveys and statistical analyses to assess the link between newspaper coverage and readers' compliance with Covid-19 prevention guidelines, using both Agenda Setting theory and the KAP model. The questionnaire was used to test participants' understanding of preventative measures, exposure to Covid-19 news coverage, and compliance with suggested guidelines. The study discovered that during the pandemic, newspapers had a substantial influence on readers in preventing the virus's spread. The findings shed light on the role of newspapers in shaping public behaviour during a health crisis and inform communication strategies to promote effective preventive practices. Ultimately, the study provided actionable insights for policy-makers, journalists, and health professionals to enhance public health outcomes and mitigate the spread of infectious diseases. The results provide insight into how newspapers affect public behaviour during a health emergency and provide guidance for communication methods to support successful preventative measures.
Background:
The prevention of unplanned endotracheal extubation (UEE) is significant for the critical care of intensive care unit (ICU) patients.
Aim:
To develop a questionnaire to assess the knowledge, attitude, and practice (KAP) of the nurses regarding of the prevention of UEE in ICU patients with transoral endotracheal intubation (TEI) and to test the validity and reliability of the questionnaire.
Study design:
Items relevant to KAP were prepared following a literature review, and then screened using a Delphi expert consultation, pre-test, and factor analysis. The nursing staffs in four tertiary hospitals in Qinghai, Jiangsu, Gansu, and Shandong provinces were surveyed to test the reliability and validity of the questionnaire.
Results:
The questionnaire contained 76 items, including 10, 37, and 29 in the dimensions of knowledge, attitude, and practice, respectively. The scale-level content validity index (S-CVI) of the questionnaire was 0.96. The results of exploratory factor analysis (EFA) showed that the Kaiser-Meyer-Olkin value was 0.956, indicating that the sample was adequate and suitable for factor analysis. The result of the Bartlett spherical test was significant (p < .001), indicating that the questionnaire was suitable for further EFA. A total of six common factors were extracted by EFA with a cumulative variance interpretation rate of 85.52%, indicating that the questionnaire had good structural validity. The Cronbach's alpha was 0.981 for the whole questionnaire; and was 0.966, 0.996, and 0.981 for the dimensions of knowledge, attitude, and practice, respectively. The test-retest reliability for the questionnaire was 0.843.
Conclusions:
The developed questionnaire has good reliability and validity and can be used as a scientific tool for the nursing leaders to prevent UEE in ICU patients with TEI.
Relevance to clinical practice:
The instrument provides a theoretical reference for establishing preventive strategies and management programs in clinical practice.
Public relations researchers, theorists, and practitioners should integrate professional practice with research topics, themes, concepts, theories, contextual intelligences, strategic processes, moral judgment, and functional practices by addressing the end(s) that public relations serves in community. Disciplinary intelligences feature outcomes that yield to specialized knowledge-based, processually achievable, intellectually justifiable, strategically valuable, and morally serviceable practices that constitute culture, society, and community. In that communitarian spirit, this paper draws on established research streams and strategic process-to-ends paradigms to argue that unique knowledge serves to collaboratively assist the constitution of community as place in search for order. Public relations’ unique knowledge, constantly refined and critically guided, adds strategic, emergent force to human’s communitarian imperative. This communitarian rationale for the constitutive paradigm reasons that as individuals, organizations and communities engage to communicate they communicate to organize through narrative continuity. Organizations, individuals, and groups engage on the winding path of agonistic, emergently epistemological and ontological cultural and societal moments to seek order in the public interest. Reputations (identities), complexes of relationships (institutionalized identification) and textuality of narrative continuity empower community members co-manage resources in service of shared interests’ license to operate.
This study explores the university students’ awareness of the Circular Economy (CE) through the identification of knowledge, attitudes and behaviors (KAB). A quantitative method is applied by adopting the SDG survey questionnaire of Cifuentes-Faura that was developed using the 5Rs (Reduce, Reuse, Refurbish, Repair and Recycle) of the CE concept to measure the students’ KAB towards CE. A total of 110 students studying economics-related courses from two Indonesian universities participated in the survey and the statistical program SPSS 20.0 was used for data analysis. The study found that the students’ awareness of the circular economy is higher in terms of knowledge (85.5%) than attitude (55.5%) and behavior (68.2%). In a way, the results of attitude and behavior show that students tend to buy new things instead of reusing/renting or repairing them. The female students' knowledge of CE is higher than male students, whereas their attitude and behaviour show similar results. Additionally, there is a correlation between knowledge and attitude, attitude and behavior, and knowledge and behavior, which means that the variables influence each other.
Introduction: Knowledge, attitudes and practices (KAP) impact on cardiac disease outcomes, with noted cultural and gender differences. In this Asian cohort, we aimed to analyse the KAP of patients towards cardiac diseases and pertinent factors that influence such behaviour, focusing on gender differences. Materials and Methods: A cross-sectional survey was performed among consecutive outpatients from a cardiac clinic over 2 months in 2014. Results: Of 1406 patients approached, 1000 (71.1%) responded (mean age 57.0 ± 12.7 years, 713 [71.3%] males). There was significant correlation between knowledge and attitude scores (r = 0.224, P <0.001), and knowledge and practice scores (r = 0.114, P <0.001). There was no correlation between attitude and practice scores. Multivariate predictors of higher knowledge scores included female sex, higher education, higher attitude and practice scores and prior coronary artery disease. Multivariate predictors of higher attitude scores included higher education, higher knowledge scores and non-Indian ethnicity. Multivariate predictors of higher practice scores included male sex, Indian ethnicity, older age, higher knowledge score and hypertension. Males had lower knowledge scores (85.8 ± 8.0% vs 88.0 ± 8.2%, P <0.001), lower attitude scores (91.4 ± 9.4% vs 93.2 ± 8.3%, P = 0.005) and higher practice scores (58.4 ± 18.7% vs 55.1 ± 19.3%, P = 0.013) than females. Conclusion: In our Asian cohort, knowledge of cardiovascular health plays a significant role in influencing attitudes and practices. There exists significant gender differences in KAP. Adopting gender-specific strategies for future public health campaigns could address the above gender differences. Key words: Health behaviour, Health promotion, Public health
Objective
Noncompressible torso hemorrhage (NCTH) is a major challenge in prehospital bleeding control and is associated with high mortality. This study was performed to estimate medical knowledge and the perceived barriers to information acquisition among health-care workers (HCWs) regarding NCTH in China.
Methods
A self-administered and validated questionnaire was distributed among 11 WeChat groups consisting of HCWs engaged in trauma, emergency, and disaster rescue.
Results
A total of 575 HCWs participated in this study. In the knowledge section, the majority (87.1%) denied that successful hemostasis could be obtained by external compression. Regarding attitudes, the vast majority of HCWs exhibited positive attitudes toward the important role of NCTH in reducing prehospital preventable death (90.4%) and enthusiasm for continuous learning (99.7%). For practice, fewer than half of HCWs (45.7%) had heard of NCTH beforehand, only a minority (14.3%) confirmed they had attended relevant continuing education, and 16.3% HCWs had no access to updated medical information. The most predominant barrier to information acquisition was the lack of continuing training (79.8%).
Conclusions
Knowledge and practice deficiencies do exist among HCWs. Obstacles to update medical information warrant further attention. Furthermore, education program redesign is also needed.
KAP' study measures the knowledge, attitude and practices of a community. It serves as an educational diagnosis of the community. The main purpose of this knowledge, attitude and practices (KAP) study is to explore changes in knowledge, attitude and practices of the community. A KAP survey is a representative study of a specific population to collect information on what is known, believed and done in relation to a particular topic. In most KAP surveys, data are collected orally by an interviewer using a structured, standardized questionnaire. These data then can be analyzed quantitatively or qualitatively depending on the objectives and design of the study. Before beginning the process of creating awareness in any given community, it is first necessary to assess the environment in which awareness creation will take place. KAP study tells us what people know about certain things, how they feel and also how they behave.
Objective:
To assess knowledge, attitudes, and practices (KAP) related to antimicrobial resistance (AMR) among college students.
Participants:
Undergraduate students at a large public university in the United States.
Methods:
Anonymous online questionnaire completed in early 2020.
Results:
While 82% of participants knew that resistant pathogens can spread between people, 38% believed that antibiotics weaken the immune system and 32% believed that AMR is only a problem for people who take antibiotics often. Many undergraduates have or would stop taking antibiotics before completing a full course because of side effects (44%) or feeling better (38%), and some would take (23%) or share (13%) antibiotics that had not been prescribed to the recipient. Only 57% are worried about AMR, compared to 88% who are worried about global climate change.
Conclusions:
Health education about antimicrobial stewardship and other global health issues must improve knowledge, perceptions, health behaviors, self-efficacy, and social norms.
This study compared mass media and interpersonal influence during a reproductive health communication campaign in Bolivia using the following six behavior change steps: awareness, detailed knowledge, attitudes, intention, interpersonal communication, and family planning method use. The authors found that the main terms of mass media campaign and personal network exposure were associated with behavior change, whereas the multiplicative interaction term was not. Further analysis showed that the mass media campaign was associated with contraceptive adoption for individuals with personal networks composed of few contraceptive users (as perceived by the respondent) and not for individuals with personal networks containing a majority of users. These findings indicate that the mass media may substitute for personal network influences and speed social change by accelerating the behavior change process.
The proposition that consistency among people's knowledge (K), attitudes (A), and behaviors (B) is contingent on high levels of involvement was tested in a long-term health intervention campaign. Support varied depending upon the indicator of involvement used. Cognitive involvement with the health topic, as indicated by number of responses to an open-ended question about heart disease, produced the clearest support. Using LISREL procedures, high K-A, K-B, and A-B correlations were found only in the high cognitive response group. Affective indicators of involvement produced mixed support. Perceived risk of heart disease was related to K-A-B consistency in a direction opposite to the hypothesis, but extremity of affective response was associated with the predicted high K-B correlation. A behavioral indicator of involvement based on reading the campaign literature produced results consistent with the hypothesis, although less so as the campaign progressed. The experimental health education campaign produced no discernible effect on K-A-B consistency, despite gains in knowledge itself.
A descriptive analysis of contraceptive discontinuation, based on Demographic and Health Sur- vey data from six countries with high levels of contraceptive use, shows that about one-third of couples stop use of their method within 12 months and about half do so within 24 months. IUD users are the least likely to stop using their method, with 82-89% of users persisting after one year and 65-80% continuing at the end of two years. Levels of discontinuation of other modern meth- ods are similar to those of traditional methods, but the reasons for discontinuation vary. For hor- monal contraceptives and the IUD, health concerns (including side effects) are the most common reason. For withdrawal and periodic abstinence, accidental pregnancy is the dominant reason. Women using the pill or the IUD are more likely to continue use if they have attained their desired family size. However, analysis of pill data indicates that education and residence have little or no
According to data from Demographic and Health Surveys for nine Latin American countries, women with no education have large families of 6-7 children, whereas better educated women have family sizes of 2-3 children, analogous to those of women in the developed world. Despite these wide differentials in actual fertility desired family size is surprisingly homogeneous through-out the educational spectrum. While the least educated and the best educated women share the small family norm, the gap in contraceptive prevalence between the two groups ranges from 20-50 percentage points. Better educated women have broader knowledge, higher socioeconomic status and less fatalistic attitudes toward reproduction than do less educated women: Results of a regression analysis indicate that these cognitive, economic and attitudinal assets mediate the influence of schooling on reproductive behavior and partly explain the wide fertility gap between educational strata.
This study suggests that mass-media-generated interpersonal communication networks vary according to an individual's behavior-change stage. As people in Peru adopted modern family planning methods, they increasingly formed and perhaps relied on information from more technical interpersonal communication networks, which shifted from peers to doctors and other service providers. Moreover, information seeking and giving varied with adoption stages in unexpected ways. In collaboration with Apoyo a Programmas de Población (Advocacy for Population Programs) of Peru, we present a model of how interpersonal communication networks generated by mass media messages vary with stage of behavior change.
PIP
Diffusion is the process by which an innovation is communicated through certain channels over time among members of a social system. The diffusion of innovations is a communication theory which has laid the groundwork for behavior change models across the social sciences, representing a widely applicable perspective. The diffusion of innovations paradigm began with the 1943 publication of the results of an hybrid seed corn study conducted by Bryce Ryan and Neal C. Gross, rural sociologists at Iowa State University. The diffusion paradigm spread among midwestern rural sociological researchers in the 1950s and 1960s, and then to a larger, interdisciplinary field of diffusion scholars. By the late 1960s, rural sociologists lost interest in diffusion studies, not because it was ineffective scientifically, but because of lack of support for such study as a consequence of farm overproduction and because most of the interesting research questions were thought to be answered. Since 1943, more than 4000 research publications have appeared and diffusion research became a widely practiced variety of scholarly study in sociology and other social sciences. This paper describes some of the history of rural sociological research on the diffusion of agricultural innovations with the goal of understanding how the research tradition emerged and to determine how it influenced the larger body of diffusion research conducted later by scholars in other disciplinary specialties. The authors describe how diffusion of innovations research followed and deviated from the Kuhnian concept of paradigm development.
This article summarizes findings from the 1994 Ecuador Demographic and Maternal-Child Health Survey. Fertility was 3.6 lifetime births/woman. Women with no formal education had 6.2 births compared with college-educated women who had 2.1 births. Rural fertility in the sierras where a large proportion of indigenous population live was 4.8 children. Women desired 2.7 children. 55% did not want any more children and 7% were menopausal or undecided. 69% of women with no education wanted no more children compared with 42% of women with a college education. 57% of married women currently use contraception: 20% of all married women relied on sterilization 12% used the IUD and 11% used traditional methods. 64% reported contraceptive use for limiting childbearing. 30% used contraception to space births. Prevalence was highest in Quito (70%). The lowest prevalence was in the rural areas of the sierra (42%). 74% of women with a college education used contraception compared with 26% of women with no education. Prevalence in rural areas doubled during 1989-94. Contraceptive use was initiated earlier in the marriage among women with a higher socioeconomic status. About 16% of women were sexually active fertile did not desire a pregnancy and were not using contraception. Infant and child mortality declined during 1989-94. Infant mortality remained high in the rural areas of the sierra and among women with no education. Maternal mortality was estimated to be 159/100000 live births during 1989-94 based on the surviving sisterhood method. Maternal mortality declined about 50% since 1981-87. In the 5 years preceding the survey prenatal care use increased. 8% of pregnancies in the 3 years preceding the survey resulted in a spontaneous or induced abortion. 53% received a Pap smear at least once in the 2 years preceding the survey. Although the average breast-feeding period was 16 months a very small percentage exclusively breast fed in the first 2 months.
Evidence from four Demographic and Health Surveys suggests that the KAP-gap (defined as currently married women who either want no more children or want to postpone the next birth, who are not intending to use contraception, and who are immediately exposed to the risk of pregnancy) is negligible. The reasons for nonuse among this small minority cover a range of considerations, including lack of contraceptive availability, health concerns, partner disapproval, and cost. The significance of the finding of a very small KAP-gap is not the absence of an unmet need for family planning services, but rather that the difficult problems of motivation, religious and other objections to contraceptive use, fatalism, and health concerns are not the serious problems that may have been presumed. The basic supply problem of contraceptive availability has been successfully met. -Author
In a recent meta-analysis of attitude-behavior research, the authors of this article found a strong overall attitude-behavior relationship (r = .79) when methodological artifacts are eliminated. The trend in A-B research, however, is to conceive of behavioral intentions (BI) as a mediator between attitudes (A) and behaviors (B). In this study, it is hypothesized that (a) A-BI correlation would be higher than A-B correlation, (b) BI-B correlation would be higher than A-B correlation, (c) A-BI correlation would be higher than BI-B correlation, (d) the variation in BI-B correlations would be greater than that of A-BI, and (e) attitudinal relevance would affect the magnitude of the A-BI correlation. A series of meta-analyses, integrating the findings of 92 A-BI correlations (N = 16,785) and 47 B-BI correlations (N = 10,203) that deal with 19 specified categories and a variety of miscellaneous topics was performed. The results were consistent with all five hypotheses. The theoretical and methodological implications are discussed.
An analysis of fertility transitions in 69 developing countries since 1960 finds that the relationship between development and pretransitional fertility, the timing of the onset of transitions, and the pace of fertility decline after transition onset deviate substantially from what would be the case if fertility and development, as measured by the Human Development Index, were closely linked. A few noteworthy empirical regularities were identified, including a shifting threshold of development necessary for the onset of transition. This implies that, once a few countries in a region enter the transition, other countries follow sooner than expected. Also, the pace of fertility decline is not related to the pace oi development, as might be expected, but rather to the level of development when the transition began. To explain these findings, the authors propose a key role for social interaction. Social interaction, they suggest, operates at three levels of aggregation. Personal networks connect individuals; national channels of social interaction such as migration and language connect social and territorial communities within a country; and global channels such as trade and international organizations connect nations within the global society. Through these channels, actors at all three levels exchange and evaluate information and ideas, and exert and receive social influence, thus affecting reproductive behavior. Development is important in understanding the timing and pace of fertility change, bur social interaction is likely to have an independent influence on fertility. Given current levels of development and the proliferation of channels of social interaction, it is likely that few countries will fail to experience a fertility transition over the coming three decades.
The purpose of this article is to examine research evidence on knowledge gaps and to ask how strong this evidence is, particularly when amount of mass media publicity is taken into account. Many varying characteristics of 58 studies with relevant data are analyzed. Theoretical and methodological differences among the studies are pointed out, and some conclusions drawn about media effects on knowledge disparities and conditions under which knowledge gaps may or may not occur. Some reasons for conflicting results in the literature are explained, and suggestions are made for future research on knowledge differentials.
Data from four types of research—news diffusion studies, time trends, a newspaper strike, and a field experiment—are consistent
with the general hypothesis that increasing the flow of news on a topic leads to greater acquisition of knowledge about that
topic among the more highly educated segments of society. Whether the resulting knowledge gap closes may depend partly on
whether the stimulus intensity of mass media publicity is maintained at a high level, or is reduced or eliminated at a point
when only the more active persons have gained that knowledge.
The difficulty of finding a relationship between attitudes and behavior is one of the greatest controversies in recent social science research. The purpose of this study was to determine whether attitudinal relevance substantially affects the magnitude of the correlation between attitudes and behavior, and whether the effects are content free. Using meta-analysis, we integrated findings from 138 attitude-behavior correlations with a total sample size of 90, 908. The behaviors we studied ranged over 19 different categories and a variety of miscellaneous topics. Our results showed a strong overall attitude-behavior relationship (r = 79) when methodological artifacts were eliminated. As predicted, the higher the attitudinal relevance, the stronger the relationship between attitudes and behavior. This effect held true across diverse content domains. Implications for communication theory and practice are discussed.
This classic text surveys a number of different theoretical approaches to the related phenomena of attitude and belief change. These theories are grouped into seven major approaches, each presented and evaluated in a separate chapter. Each contributes in an important way to a complete understanding of the persuasion process. Appropriate for both upper level undergraduates and graduates in the social sciences.
This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.
This article reviews the background to the current debates between advocates of population control and reproductive health as frameworks for national and international health policies. Population control has been a dominant metaphor in international family planning programs since the 1960s. Population control has frequently meant pursuing a single-minded goal of fertility limitation, often without sufficient attention to the rights of family planning clients. This narrow focus has led to some coercive policies, numerous ethical violations, and ineffective family planning programs. In the last decade there has been the beginning of a policy shift, advocated by a growing number of activists and researchers in women's health, from population control to reproductive health. A reproductive health framework would provide a broader programmatic focus that could bring needed attention to such issues as sexually transmitted diseases, infertility, abortion, reproductive cancers and women's empowerment generally.
Results of an ethnographic study suggest that, despite stereotypes to the contrary, urban Aymara women in Bolivia want to regulate their fertility, and sociocultural norms support fertility regulation. However, the norms also make such regulation difficult to achieve. One barrier is a deep suspicion of modern medicine and medical practitioners, who are not seen as reliable sources of information. This suspicion is reinforced when the quality of health services is inadequate. Among urban Aymara, the level of acceptability of most modern methods of contraception is low. Many would prefer to use traditional methods, even when use of these methods entails considerable sacrifice and risk of conflict with their partners, unwanted pregnancies, and recourse to unsafe abortion.
In 1986, the Demographic and Health Surveys project administered the first six-year calendar history of events that included women's contraceptive use and their reasons for discontinuation in experimental surveys in Peru and the Dominican Republic. In this report the experimental survey from Peru is examined to demonstrate how the calendar data can be used to calculate multiple increment-decrement life table rates of contraceptive discontinuation--including contraceptive failure, method switching, and abandonment of use--and of resumption of method use following discontinuation. These analyses reveal that nearly half of all Peruvian women who begin to use a method will stop using it within one year; 29 percent of women discontinue method use for nonpregnancy-related reasons within one year of initiating use. Women who switch methods do so frequently, and many will return to a method used previously, or move on to a third method. Women who become pregnant after abandoning contraceptive use have similar contraceptive-use patterns to women who experience a contraceptive failure.
Evaluating information-education-communication (IEC) programs forfamily planning and reproductive health: Final report of the IEC working group Social interactions and contemporary fertility transitions
- J T Bertrand
- D L Kincaid
Bertrand, J. T., & Kincaid, D. L. (1996). Evaluating information-education-communication (IEC) programs forfamily planning and reproductive health: Final report of the IEC working group. Chapel Hill, N C Carolina Population Center. Bongaarts, J., & Watkins, S. (1996). Social interactions and contemporary fertility transitions. Population and Development Review, 22,639-682.
The impact of women's education on fertility in Latin America: Searching for explanations. lnternational Family Planning Perspectives Involvement and the consistency of knowledge, attitudes, and behaviors
- T Castro-Martin
- F Juarez
Castro-Martin, T., & Juarez, F. (1995). The impact of women's education on fertility in Latin America: Searching for explanations. lnternational Family Planning Perspectives, 22(2), Chaffee, S. H., & Roser, C. (1986). Involvement and the consistency of knowledge, attitudes, and behaviors. Communication Research, 13,373-399.
The knowledge-behavior gap in public information campaigns: A devel-opment communication view Information campaigns: Balancing social values and social change
- R Homik
Homik, R. (1989). The knowledge-behavior gap in public information campaigns: A devel-opment communication view. In C. T. Salmon (Ed.), Information campaigns: Balancing social values and social change. Newbury Park, CA Sage.