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A world-wide internet survey of public knowledge about tuberculosis
Vol. 96 (2002) 59^ 60
SHORT REPORT
A world-wide internet survey of public knowledge about tuberculosis J. A.CORLESS*, P. A. STOCKTONw, S. B. MYERSz AND P. D.O. DAVIESw *Aintree Chest Centre, University Hospital, Liverpool, wTeamTechnologyFwww.teamtechnology.co.uk and z Tuberculosis Research Unit, Cardiothoracic Centre, Liverpool, U.K. Abstract Four simple multiple-choice questions about tuberculosis (TB) were posted on a non-medical internet site for a 2-month period. Atotal of 564 responses were received. Sixty-two were excluded as individuals had made multiple attempts atthe questions. Sixty-¢ve per cent of responses were from North America,14?5% from Europe and12% from Australia and New Zealand, with only a small number of responses from Africa, the Indian subcontinent and South America.Of the respondents 49?5% correctly answered that cough is the commonest symptom of TB, 45% knew that TB was transmitted mainly by air-borne droplets, 37?8% knew that TB was caused by a bacterium.Only19?5% knew that the most important risk factor for developingTB was HIV infection and only 4% answered all questions correctly. This survey suggests that knowledge abouttuberculosisislimited in computer-literate individuals throughoutthe world.r2001 Harcourt Publishers Ltd doi:10.1053/rmed.2001.1205, available online at http://www.idealibrary.com on
Keywords tuberculosis; knowledge; internet.
INTRODUCTION Tuberculosis (TB) is a disease that has a major impact on a global scale. It is estimated that one in every three people alive is infected with Mycobacterium tuberculosis and it causes two million deaths annually. In 1993 the World Health Authority declared tuberculosis to be a global emergency. Over recent years, the internet has developed into a means of rapid communication between distant individuals. In this study we sought to use the internet as a means of investigating public knowledge regardingTB throughout the world. This study aimed to assess public knowledge about TB using an internet-based questionnaire.
METHODS Four multiple-choice questions about tuberculosis were incorporated into a personality questionnaire on a nonmedical web site at: www. teamtechnoIogy.co.uk. This Received 6 July 2001, accepted in revised form16 August 2001and published online 14 November 2001. Correspondence should be addressed to: Dr P. D. O. Davies, Tuberculosis Research Centre, The Cardiothoracic Centre, Thomas Drive, Liverpool L4 3PE, U.K. Fax: +44(0)151228 7688.
site would not have been found using the terms ‘tuberculosis’ or ‘TB’ in a search engine. Visitors to the site were told that their responses would be anonymous and may be used for the purpose of medical research.
RESULTS A total of 564 responses were received over a 2-month period. Sixty-two were excluded as individuals had made multiple attempts at the questionnaire. Thirty-¢ve per cent of respondents were male, 47% female and sex was not recorded by18%. Mean (SD) age was 33?4 (11?4) years. Most responses came from North and Central America (65%), with 14?5% from Europe, 12% from Australia and New Zealand, 3% from Asia, 1% from South America and 0?5% from Africa. In 4% the source of the response was unknown. Replies to the questions are outlined inTable 1. Four per cent of respondents answered all questions correctly.
DISCUSSION In this survey we have found that a majority of respondents did not know the answer to four simple
60
RESPIRATORY MEDICINE
TABLE 1. Replies to the questions abouttuberculosis Question
Answer
Responses (%)
Cough (correct) Chest pain Weight loss Sweating Don’t know
49?5 14?4 15?2 8?3 12?6
Air-borne dropletsFlike the common cold (correct) Contaminated foodFlike salmonella Contaminated drinksFlike cholera Sexual relationsFlike HIV Don’t know
45?0 9?2 15?8 15?4 14?4
Virus Bacterium (correct) Parasite None of the above Don’t know
19?0 37?8 16?7 10?6 16?0
Diabetes HIV infection (correct) A family history Heavy alcohol consumption Don’t know
7?1 19?5 25?4 3?5
1.The commonest symptom of TB is?
2.TB is transmitted mainly by
3. TB is caused by a
4. The most important risk factor for tuberculosis is?
questions about tuberculosis. It has previously been shown that low levels of knowledge exist in newly diagnosed patients with TB in Malaysia (1), in high-risk populations (2,3) and in some healthcare workers (4,5). Not surprisingly, given that we used the internet as a platform for this study, the overwhelming majority of replies were received from more wealthy countries where the incidence of tuberculosis is much lower than in Africa and the Asian subcontinent. One could argue that a high level of knowledge about the features of tuberculosis would not be expected in such a population. We do however, ¢nd the results of this survey salutatory given the global impact of the disease and the fact that by de¢nition each respondent was relatively well educated as they were able to use the internet via a computer. We found it particularly surprising that so few people recognized the link between HIV infection and tuberculosis. Although this survey is brief and con¢ned to a speci¢c population, it suggests that knowledge about tuberculosis is poor in computer-literate individuals in relatively wealthy continents such as the North America
44?5
and Europe. The use of the internet as a potential research tool is also highlighted.
REFERENCES 1. Liam CK, Lim KH, Wong CM,Tang BG. Attitudes and knowledge of newly diagnosed tuberculosis patients regarding the disease, and factors a¡ecting treatment compliance. Int J Tuberc Lung Dis 1999; 3: 300 ^309. 2. Marinac JS, Willsie SK, McBride D, Hamburger SC. Knowledge of tuberculosis in high-risk populations: survey of inner city minorities.Int J Tuberc Lung Dis 1998; 2: 804 ^ 810. 3. Salomon N, Perlman DC, Friedmann P, et al., Knowledge of tuberculosis among drug users. Relationship to return rates for tuberculosis screening at a syringe exchange. J Subst Abuse Treat 1999; 16: 229^235. 4. Singla N, Sharma PP, Jain RC. Awareness about tuberculosis among nurses working in a tuberculosis hospital and in a general hospital in Delhi, India.Int J Tuberc Lung Dis 1998; 2: 1005^1010. 5. Lai KK, Fontecchio SA, Kelley AL, Melvin ZS. Knowledge of the transmission of tuberculosis and infection control measures for tuberculosis among healthcare workers.Infect Control Hosp Epidemiol 1996; 17: 168 ^170.
SHORT REPORT
A world-wide internet survey of public knowledge about tuberculosis J. A.CORLESS*, P. A. STOCKTONw, S. B. MYERSz AND P. D.O. DAVIESw *Aintree Chest Centre, University Hospital, Liverpool, wTeamTechnologyFwww.teamtechnology.co.uk and z Tuberculosis Research Unit, Cardiothoracic Centre, Liverpool, U.K. Abstract Four simple multiple-choice questions about tuberculosis (TB) were posted on a non-medical internet site for a 2-month period. Atotal of 564 responses were received. Sixty-two were excluded as individuals had made multiple attempts atthe questions. Sixty-¢ve per cent of responses were from North America,14?5% from Europe and12% from Australia and New Zealand, with only a small number of responses from Africa, the Indian subcontinent and South America.Of the respondents 49?5% correctly answered that cough is the commonest symptom of TB, 45% knew that TB was transmitted mainly by air-borne droplets, 37?8% knew that TB was caused by a bacterium.Only19?5% knew that the most important risk factor for developingTB was HIV infection and only 4% answered all questions correctly. This survey suggests that knowledge abouttuberculosisislimited in computer-literate individuals throughoutthe world.r2001 Harcourt Publishers Ltd doi:10.1053/rmed.2001.1205, available online at http://www.idealibrary.com on
Keywords tuberculosis; knowledge; internet.
INTRODUCTION Tuberculosis (TB) is a disease that has a major impact on a global scale. It is estimated that one in every three people alive is infected with Mycobacterium tuberculosis and it causes two million deaths annually. In 1993 the World Health Authority declared tuberculosis to be a global emergency. Over recent years, the internet has developed into a means of rapid communication between distant individuals. In this study we sought to use the internet as a means of investigating public knowledge regardingTB throughout the world. This study aimed to assess public knowledge about TB using an internet-based questionnaire.
METHODS Four multiple-choice questions about tuberculosis were incorporated into a personality questionnaire on a nonmedical web site at: www. teamtechnoIogy.co.uk. This Received 6 July 2001, accepted in revised form16 August 2001and published online 14 November 2001. Correspondence should be addressed to: Dr P. D. O. Davies, Tuberculosis Research Centre, The Cardiothoracic Centre, Thomas Drive, Liverpool L4 3PE, U.K. Fax: +44(0)151228 7688.
site would not have been found using the terms ‘tuberculosis’ or ‘TB’ in a search engine. Visitors to the site were told that their responses would be anonymous and may be used for the purpose of medical research.
RESULTS A total of 564 responses were received over a 2-month period. Sixty-two were excluded as individuals had made multiple attempts at the questionnaire. Thirty-¢ve per cent of respondents were male, 47% female and sex was not recorded by18%. Mean (SD) age was 33?4 (11?4) years. Most responses came from North and Central America (65%), with 14?5% from Europe, 12% from Australia and New Zealand, 3% from Asia, 1% from South America and 0?5% from Africa. In 4% the source of the response was unknown. Replies to the questions are outlined inTable 1. Four per cent of respondents answered all questions correctly.
DISCUSSION In this survey we have found that a majority of respondents did not know the answer to four simple
60
RESPIRATORY MEDICINE
TABLE 1. Replies to the questions abouttuberculosis Question
Answer
Responses (%)
Cough (correct) Chest pain Weight loss Sweating Don’t know
49?5 14?4 15?2 8?3 12?6
Air-borne dropletsFlike the common cold (correct) Contaminated foodFlike salmonella Contaminated drinksFlike cholera Sexual relationsFlike HIV Don’t know
45?0 9?2 15?8 15?4 14?4
Virus Bacterium (correct) Parasite None of the above Don’t know
19?0 37?8 16?7 10?6 16?0
Diabetes HIV infection (correct) A family history Heavy alcohol consumption Don’t know
7?1 19?5 25?4 3?5
1.The commonest symptom of TB is?
2.TB is transmitted mainly by
3. TB is caused by a
4. The most important risk factor for tuberculosis is?
questions about tuberculosis. It has previously been shown that low levels of knowledge exist in newly diagnosed patients with TB in Malaysia (1), in high-risk populations (2,3) and in some healthcare workers (4,5). Not surprisingly, given that we used the internet as a platform for this study, the overwhelming majority of replies were received from more wealthy countries where the incidence of tuberculosis is much lower than in Africa and the Asian subcontinent. One could argue that a high level of knowledge about the features of tuberculosis would not be expected in such a population. We do however, ¢nd the results of this survey salutatory given the global impact of the disease and the fact that by de¢nition each respondent was relatively well educated as they were able to use the internet via a computer. We found it particularly surprising that so few people recognized the link between HIV infection and tuberculosis. Although this survey is brief and con¢ned to a speci¢c population, it suggests that knowledge about tuberculosis is poor in computer-literate individuals in relatively wealthy continents such as the North America
44?5
and Europe. The use of the internet as a potential research tool is also highlighted.
REFERENCES 1. Liam CK, Lim KH, Wong CM,Tang BG. Attitudes and knowledge of newly diagnosed tuberculosis patients regarding the disease, and factors a¡ecting treatment compliance. Int J Tuberc Lung Dis 1999; 3: 300 ^309. 2. Marinac JS, Willsie SK, McBride D, Hamburger SC. Knowledge of tuberculosis in high-risk populations: survey of inner city minorities.Int J Tuberc Lung Dis 1998; 2: 804 ^ 810. 3. Salomon N, Perlman DC, Friedmann P, et al., Knowledge of tuberculosis among drug users. Relationship to return rates for tuberculosis screening at a syringe exchange. J Subst Abuse Treat 1999; 16: 229^235. 4. Singla N, Sharma PP, Jain RC. Awareness about tuberculosis among nurses working in a tuberculosis hospital and in a general hospital in Delhi, India.Int J Tuberc Lung Dis 1998; 2: 1005^1010. 5. Lai KK, Fontecchio SA, Kelley AL, Melvin ZS. Knowledge of the transmission of tuberculosis and infection control measures for tuberculosis among healthcare workers.Infect Control Hosp Epidemiol 1996; 17: 168 ^170.