The assessment of knowledge and attitudes of health legislation (HL) among private family practitioners (FP) working in a defined geographical area.

Abstract

Introduction Since the 1994 change in power in South Africa, there have been many necessary changes in health legislation (HL), in accordance with the principles enshrined in the Constitution, Such changes have been recognized as being both complex and fraught with stakeholder interests. There is a perception that private family practitioners (FP) generally harbour negative attitudes towards HL that has been brought into effect in recent years. It is also possible that FP, in general, lack knowledge regarding HL. The aim of the study was to assess the knowledge and attitudes of private family practitioners (FP) to health legislation (HL) within a localized geographical area of the eThekweni Metro, KwaZulu-Natal Province. The specific objectives were: To determine family practitioners’ knowledge of health legislation. To determine family practitioners’ attitudes towards health legislation. To assess the correlation between family practitioners’ knowledge and attitudes. To compare the self-reported knowledge of health legislation with the objective assessment of knowledge and attitudes. To establish practitioners’ perceptions of the future of the profession, and of family practice in particular. Methods A cross-sectional descriptive and analytical study was performed, using a pre-tested, validated, structured questionnaire. This instrument was personally hand-delivered to each of a group of private family practitioners practising within a confined geographical area. The sample comprised of 101 family practitioners. Data were analysed using SPSS version 15.0 (SPSS Inc., Chicago, Illinois). Results The study revealed that private FP possess limited knowledge about HL and have a negative attitude in general towards HL. The mean knowledge score was 55% (standard deviation 12.2%). The mean score for attitudes towards health legislation was 46,3% (standard deviation 4.2%). The correlation coefficient between knowledge and attitudes was 0.244 (p=0.022). Therefore, there was a weak positive, but statistically significant, correlation between knowledge and attitudes. Thus, in general, as knowledge increased, so did attitudes improve and become more positive. The self reported knowledge and attitudes of FPs seemed to show some unexpected though non-statistically significant anomaly, in that FPs who considered themselves “well aware” of certain parts of HL, together with those who were “not aware”, reporting a more negative attitude towards HL than those who considered themselves to be “aware”. FPs’ perceptions of the future of the profession, and of family practice in particular, were generally reported as being reasonable to poor. Financial viability and sustainability of FP, in particular, were reported as being reasonable to poor. The attractiveness of the profession to the youth of today was reported as being poorer than in the past. However, the majority of FP held the perception that medicine as a profession was distinct as it responds to a calling to serve society at large, giving this aspect of the question a ranking of “reasonable to good”. Conclusion and Recommendations The study revealed that this group of FPs attained an overall mean knowledge score of 55% with respect to HL. FPs’ knowledge of HL requires improvement, which can be achieved through effective education and training programmes. Private FPs need to embrace the change process, but also need to be more pro-active in vocalizing their opinions. The Health Ministry and relevant authorities and policymakers need to play a greater role in creating an atmosphere that embraces and facilitates change by involving iii relevant stakeholders. Lastly, it is recommended that this study serve as a template for a broader research project involving larger numbers of participants and a wider geographical area. In addition, an intervention tool should be devised. Such a tool could take the form of a structured education programme on HL, with an associated monitoring and evaluation aspect, which would enable an assessment of the intervention programme in terms of its value and the influence it has on improving knowledge and attitudes.