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Knowledge and attitudes of pharmacy students towards human immunodeficiency virus (HIV)
Available online at www.sciencedirect.com
Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
Opinion
http://www.pharmacyteaching.com
Knowledge and attitudes of pharmacy students towards human immunodeficiency virus (HIV) Michelle Jarvis, PharmDa, Jennifer Beall, PharmDb,*, Thomas Woolley, PhDc a Hume Pharmacy, Louisville, KY Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL c Department of Economics Finance and Quantitative Analysis, Brock School of Business, Samford University, Birmingham, AL b
Abstract Knowledge about human immunodeficiency virus (HIV) can impact attitude towards patients with HIV by health care providers and the level of confidence the provider has in their ability to care for patients with HIV. A survey of general knowledge of HIV and feelings about providing care to patients with HIV was administered to pharmacy students at the McWhorter School of Pharmacy (MSOP) at Samford University. The survey was re-administered to the third-year students after the HIV lecture series in their Therapeutics course. There were misconceptions among students regarding routes of transmission of HIV. Those students who had these misconceptions also thought that patients with HIV should be treated separately from others. MOP students also report a lack of confidence in treating HIV patients and worried that they would contract the virus from a patient. Third-year students reported they had a better ability to provide care to a patient with HIV after their lecture series. Even among pharmacy students, there is some lack of knowledge and misconceptions about HIV. Further education is warranted to develop knowledge and change attitudes. r 2014 Elsevier Inc. All rights reserved.
Keywords: Pharmacy; Students; Knowledge; Attitude; HIV
Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS) and is characterized by profound immunosuppression, leading to opportunistic infections and associated complications.1 Since AIDS was first recognized by the medical community in 1981, researchers and clinicians have been diligently working on new or improved pharmacological therapies and ways to reduce transmission rates of HIV.2 From 1984 to 2006, the transmission rate of HIV in the United States has significantly declined by approximately 89% (from 44 transmissions per 100 people to five transmissions per 100 people). During this same time, the annual number of new HIV infections has also decreased from 130,000 new * Corresponding author: Jennifer Beall, PharmD, Department of Pharmacy Practice, McWhorter School of Pharmacy, 800 Lakeshore Drive, Birmingham, AL 35209. E-mail: [email protected] http://dx.doi.org/10.1016/j.cptl.2014.09.002 1877-1297/r 2014 Elsevier Inc. All rights reserved.
infections per year to roughly 56,300. In addition, transmission of HIV from mother to child has decreased from 1000 to 2000 per year in the early 1990s to 138 per year in 2004. Between 1988 and 2006, HIV infections among injection drug users have declined by approximately 80%. This dramatic decline in incidence is likely due to increased knowledge of the disease and how it is transmitted, both by those living with HIV and those who care for HIV-infected patients. The CDC acknowledges that health care professionals are responsible for ensuring people have the information, motivation, and skills necessary to reduce their risk of either acquiring or transmitting HIV. Previous studies have shown that a lack of knowledge of HIV in health care professionals may lead to lack of confidence in treating this patient population, and therefore, somewhat of an unwillingness to treat.3,4 A lack of knowledge about HIV has also been associated with negative attitudes towards the treatment of those infected. We wanted
63 (98.4) 1 (1.6) 0 Bold values represent correct responses. a Some surveys not answered completely, so percentages may not total 100%.
13 (48.1)
0
(11.4)
0
0
0 66 (100) 25 (92.6) 2 (7.4)
23 (35.9) 36 (56.3) 5 (7.8) 28 (42.4) 30 (45.5) 8 (12.1) 13 (48.1) 1 (3.7)
0 7 (10.9) 56 (87.5) 58 (87.9) 1 (1.5) 0 3 (11.1) (6.8)
24 (88.9)
6 (9.1)
0 63 (98.4) 0 65 (98.5) 1 (1.5) 0 0 27 (100) 0 (6.8)
No
49 (76.6) 15 (23.4) 63 (98.4) 0 50 (75.8) 15 (22.7) 0 63 (95.5) 2 (3) 1 (1.5) 7 (25.9) 0 0 2 (7.4) 20 (74.1) 25 (92.6) 0 (4.5)
Do you know your HIV status? 40 (90.9) 4 (9.1) 41 (93.2) 1 (2.3) 2 Can HIV be transmitted from infected mother to child? Can HIV be transmitted via air and contact with 0 41 (93.2) 3 water? Can HIV be transferred through social contacts such 3 (6.8) 37 (84.1) 3 as sharing cups/utensils/shaking hands/kissing? Can HIV be transmitted through contact with feces, 19 (43.2) 20 (45.5) 5 urine, or saliva? Can HIV be completely cured with antiretroviral 1 (2.3) 43 (97.7) therapy?
Table 2 Responses to questions pertaining to knowledge about human immunodeficiency virus (HIV) [number (%)]a
I don't know
Third-year students (n ¼ 66)
Some surveys not answered completely, so percentages may not total 100%.
to determine students’ knowledge and attitudes about HIV and their willingness to treat patients with HIV infection. We surveyed students in all four years of the McWhorter School of Pharmacy (MSOP) curriculum at Samford University using a 17-question online survey. Survey questions included their general knowledge of the virus, thoughts and attitudes towards treating patients with HIV, and were similar to those asked in other published studies.3–5 Thirdyear students were re-assessed following a five-day HIV/ AIDS Therapeutics lecture series that is part of the required pharmacy curriculum to further evaluate whether a better understanding of the disease state changes attitudes, risk perception, or willingness and confidence to treat. We had an overall response rate of 40.6% with the initial survey and a 31.5% response rate from the third-year students after their HIV/AIDS lecture series. Demographic information by class is presented in Table 1. Results for questions about knowledge of HIV and attitudes towards HIV are presented in Tables 2 and 3, respectively. The results for third-year students’ knowledge of HIV and attitudes towards HIV before and after the lecture series are presented in Tables 4 and 5, respectively. We found that students who believed that HIV can be transmitted through feces, urine, or saliva also thought that patients with HIV infection should be treated separately from other patients. These students also reported that they did not feel confident in safely providing patient care to those infected with HIV and worried that they will contract HIV from an infected patient. Students who did not believe that patients infected with HIV look unhealthy also did not feel that patients with HIV infection should be treated separately. Previous studies have linked a lack of knowledge of HIV among health care professionals to an unwillingness to treat these patients. Although we did not find an unwillingness to treat in MSOP students, it did uncover some areas where pharmacy students were less knowledgeable. Specifically, 41.3% of students surveyed believed that HIV can be transmitted through feces, urine,
Yes I don't know
a
No
15 (23.4) 48 (75)
Yes
20 (30.3) 46 (69.7)
No
8 (29.6) 18 (66.7)
Yes
2 (3.1) 57 (89.1) 5 (7.8) 0
I don't know
0 59 (89.4) 4 (6.1) 2 (3)
No
1 (3.7) 23 (85.2) 3 (11.1) 0
Yes
Fourth-year students (n ¼ 64)
Fourth-year students (n ¼ 64)
Third-year students (n ¼ 66)
Second-year students (n ¼ 27)
Age o22 14 (31.8) 22–28 26 (59.1) 29–35 3 (6.8) Z35 0 Gender Male 9 (20.5) Female 35 (79.5)
Second-year students (n ¼ 27)
First-year students (n ¼ 44)
First-year students (n ¼ 44)
I don't know
Table 1 Demographics of respondents [number (%)]a
0 0
M. Jarvis et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
Survey question
138
5 (7.8) 3 (4.7) SA/A ¼ strongly agree/agree; SD/D ¼ strongly disagree/disagree; NS ¼ not sure. a Some surveys not answered completely, so percentages may not total 100%.
2 (4.5) 4 (9.1) 34 (77.3) 0
3 (11.1) 19 (70.4) 5 (18.5) 7 (10.6) 45 (68.2) 12 (18.2) 6 (9.4) 49 (76.6) 21 (77.8) 1 (3.7) 5 (18.5) 52 (78.8) 3 (4.5) 11 (16.7) 61 (95.3) 0
2 (3.1) 3 (4.7) 59 (92.2) 4 (6.1) 3 (4.5) 3 (11.1) 59 (89.4) 2 (7.4) 22 (81.5) 1 (2.3) 2 (4.5)
5 (7.8) 23 (35.9) 34 (53.1) 5 (7.6) 9 (33.3) 7 (25.9) 25 (37.9) 36 (54.5) 6 (13.6) 11 (40.7) 32 (72.7)
23 (52.3) 10 (22.7) 4 (14.8) 16 (59.3) 7 (25.9) 11 (16.7) 27 (40.9) 26 (39.4) 13 (20.3) 38 (59.4) 12 (18.8) 9 (20.5) 15 (34.1) 11 (40.7) 7 (25.9) 9 (33.3) 33 (50) 7 (10.6) 25 (37.9) 42 (65.6) 11 (17.2) 10 (15.6)
8 (12.1) 54 (81.8) 3 (4.5) 0 60 (93.8) 1 (1.6) 8 (12.1) 32 (48.5) 23 (34.8) 20 (31.3) 29 (45.3) 10 (15.6) 22 (81.5) 4 (14.8) 16 (59.3) 8 (29.6) 1 (3.7) 2 (7.4) 39 (88.6) 3 (6.8) 22 (50) 14 (31.8)
Most people who have HIV look unhealthy. 0 I feel I am competent enough to provide treatment and 6 (13.6) counseling to HIV patients Patients with HIV should be cared for separately. 9 (20.5) I am confident that I can safely work with and care for 20 (45.5) HIV patients. As a health care professional, I worry about acquiring HIV 6 (13.6) through infected patients. Health care professionals should be told when a patient 41 (93.2) has HIV. I would prefer not to care for patients infected with HIV. 7 (15.9) I am willing to care for patients infected with HIV. 40 (90.9)
SD/D SA/A SD/D SA/A SD/D SA/A Survey question
SA/A
SD/D
NS
Second-year students (n ¼ 27) First-year students (n ¼ 44)
Table 3 Responses to questions pertaining to attitudes about human immunodeficiency virus (HIV) [number (%)]a
NS
Third-year students (n ¼ 66)
NS
Fourth-year students (n ¼ 64)
NS
M. Jarvis et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
139
and saliva. Furthermore, students that were misinformed on this mode of transmission also believed that patients with HIV infection should be cared for separately, did not feel that they could safely treat HIV patients, and worried about their risk of becoming infected when caring for this patient population. There was a lack of knowledge, specifically regarding modes of transmission that may have led to an overall uneasiness when treating HIV patients. Unlike previous studies, we did not find that students who had misconceptions about modes of transportation also had a lack of willingness to treat. We did, however, find that students lacked confidence in safely treating this patient population. The group of students who actually seemed to have the best responses regarding knowledge of HIV was the second-year students. They had no training on the topic during that academic year and were further removed from any training in the pre-pharmacy curriculum than the first-year students. In terms of the pre- and post-lecture surveys in the third-year students, we did find an improvement in knowledge of HIV after the lecture series. Studies have shown that improvement in educational programs is warranted in order to optimize patient care for HIV-infected individuals.3 In surveying the third-year class a second time following the HIV lecture series, we found more students who felt that they were competent enough to provide patient care and counseling to patients with HIV than felt competent in the first survey. There were also more students who felt that they could safely treat patients with HIV following the lecture series. There are several limitations to our study. First, our survey was developed from other published studies, but it was not a validated survey instrument. Also, there may be differences in responses from MSOP students than there would be from others in different regions of the country or those not in a private university. Another limitation to this study is that it only surveyed pharmacy students instead of those of other health professions. There were also fewer responses from the third-year students after the lecture series than there were prior to the lectures. We did not determine if any of the fourth-year students who responded had further experiential training with a focus on patients with HIV, which could influence their responses. Our study provided a one-time look at students’ knowledge and attitudes instead of trending these throughout their pharmacy education. We were midway through a curricular change when this study took place, and the first- and second-year students participated in the new curriculum, while the third-and fourth-year students participated in the previous curriculum. The results of this survey also may provide an opportunity for future research into curricular planning and teaching of topics such as HIV where misconceptions or stigmata exist. Understanding that the kind of care we provide to HIV patients reflects our knowledge and attitudes
140
M. Jarvis et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
Table 4 Third-Year student responses to questions pertaining to knowledge of human immunodeficiency virus (HIV) before and after lecture series [number (%)]a Before (n ¼ 66) Survey question
Yes
No
After (n ¼ 40) Don't know Yes
Do you know your HIV status? 50 (75.8) 15 (22.7) Can HIV be transmitted from infected mother to child? 63 (95.5) 2 (3) 1 Can HIV be transmitted via air and contact with water? 0 65 (98.5) 1 Can HIV be transferred through social contacts such as 6 (9.1) 58 (87.9) 1 sharing cups/utensils/shaking hands/kissing? Can HIV be transmitted through contact with feces, urine, or saliva? 28 (42.4) 30 (45.5) 8 Can HIV be completely cured with antiretroviral therapy? 0 66 (100)
No
Don't know
0 (1.5) (1.5) (1.5)
32 (80) 7 (17.5) 40 (100) 0 0 40 (100) 5 (12.5) 34 (85)
0 0 0 0
(12.1) 0
22 (55) 0
18 (45) 40 (100)
0 0
Bold values represent correct responses. a Some surveys not answered completely, so percentages may not total 100%.
Table 5 Third-year student responses to questions pertaining to attitudes about human immunodeficiency virus (HIV) before and after lecture series [number (%)]a Before (n ¼ 66) Survey question Most people who have HIV look unhealthy. I feel I am competent enough to provide treatment and counseling to HIV patients. Patients with HIV should be cared for separately. I am confident that I can safely work with and care for HIV patients. As a health care professional, I worry about acquiring HIV through infected patients. Health care professionals should be told when a patient has HIV. I would prefer not to care for patients infected with HIV. I am willing to care for patients infected with HIV.
SA/A
After (n ¼ 40)
SD/D
NS
SA/A
SD/D
NS
8 (12.1) 8 (12.1)
54 (81.8) 32 (48.5)
3 (4.6) 23 (34.9)
1(2.5) 22 (55)
36 (90) 0
0 12 (30)
11 (16.7) 33 (50)
27 (40.9) 7 (10.6)
26 (39.4) 25 (37.9)
11 (27.5) 30 (75)
21 (52.5) 5 (12.5)
8 (20) 8 (20)
25 (37.9)
36 (54.6)
5 (7.6)
12 (30)
24 (60)
3 (7.5)
59 (89.4) 7 (10.6) 52 (78.8)
3 (4.6) 45 (68.2) 3 (4.6)
4 (6.1) 12 (18.2) 11 (16.7)
35 (87.5) 6 (15) 32 (80)
2 (5) 23 (57.5) 1 (2.5)
3 (7.5) 10 (25) 7 (17.5)
SA/A ¼ strongly agree/agree; SD/D ¼ strongly disagree/disagree; NS ¼ not sure. a Some surveys not answered completely, so percentages may not total 100%.
towards the disease is an important part of developing awareness and improving the way we treat these patients. Understanding HIV is imperative in order to care for these patients confidently, effectively, and without discriminatory attitudes so that we may ultimately decrease transmission rates and improve patient awareness and compliance. References 1. Anderson PL, Kakuda TN, Fletcher CV. Human immunodeficiency virus infection. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey JM, eds. Pharmacotherapy: A Pathophysiologic Approach, 8th ed., New York, NY: McGrawHill; 2011:2169–2170.
2. Centers for Disease Control and Prevention Web site. CDC’s H. I.V prevention progress in the United States. 〈http://www.cdc. gov/hiv/pdf/dhap_cdcPrevention.pdf〉; Accessed September 20, 2014. 3. Ahmed SI, Hassali MA, Aziz NA. An assessment of the knowledge, attitudes, and risk perceptions of pharmacy students regarding HIV/AIDS. Am J Pharm Educ. 2009;73(1): Article 15. 4. Reis C, Heisler M, Amowitz LL, et al. Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Med. 2005;2(8):743–752. 5. Wertz DC, Sorenson JR, Liebling L, Kessler L, Heeren T. Knowledge and attitude of AIDS health care provider before and after education programs. Public Health Rep. 1987;102(3): 248–254.
Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
Opinion
http://www.pharmacyteaching.com
Knowledge and attitudes of pharmacy students towards human immunodeficiency virus (HIV) Michelle Jarvis, PharmDa, Jennifer Beall, PharmDb,*, Thomas Woolley, PhDc a Hume Pharmacy, Louisville, KY Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL c Department of Economics Finance and Quantitative Analysis, Brock School of Business, Samford University, Birmingham, AL b
Abstract Knowledge about human immunodeficiency virus (HIV) can impact attitude towards patients with HIV by health care providers and the level of confidence the provider has in their ability to care for patients with HIV. A survey of general knowledge of HIV and feelings about providing care to patients with HIV was administered to pharmacy students at the McWhorter School of Pharmacy (MSOP) at Samford University. The survey was re-administered to the third-year students after the HIV lecture series in their Therapeutics course. There were misconceptions among students regarding routes of transmission of HIV. Those students who had these misconceptions also thought that patients with HIV should be treated separately from others. MOP students also report a lack of confidence in treating HIV patients and worried that they would contract the virus from a patient. Third-year students reported they had a better ability to provide care to a patient with HIV after their lecture series. Even among pharmacy students, there is some lack of knowledge and misconceptions about HIV. Further education is warranted to develop knowledge and change attitudes. r 2014 Elsevier Inc. All rights reserved.
Keywords: Pharmacy; Students; Knowledge; Attitude; HIV
Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS) and is characterized by profound immunosuppression, leading to opportunistic infections and associated complications.1 Since AIDS was first recognized by the medical community in 1981, researchers and clinicians have been diligently working on new or improved pharmacological therapies and ways to reduce transmission rates of HIV.2 From 1984 to 2006, the transmission rate of HIV in the United States has significantly declined by approximately 89% (from 44 transmissions per 100 people to five transmissions per 100 people). During this same time, the annual number of new HIV infections has also decreased from 130,000 new * Corresponding author: Jennifer Beall, PharmD, Department of Pharmacy Practice, McWhorter School of Pharmacy, 800 Lakeshore Drive, Birmingham, AL 35209. E-mail: [email protected] http://dx.doi.org/10.1016/j.cptl.2014.09.002 1877-1297/r 2014 Elsevier Inc. All rights reserved.
infections per year to roughly 56,300. In addition, transmission of HIV from mother to child has decreased from 1000 to 2000 per year in the early 1990s to 138 per year in 2004. Between 1988 and 2006, HIV infections among injection drug users have declined by approximately 80%. This dramatic decline in incidence is likely due to increased knowledge of the disease and how it is transmitted, both by those living with HIV and those who care for HIV-infected patients. The CDC acknowledges that health care professionals are responsible for ensuring people have the information, motivation, and skills necessary to reduce their risk of either acquiring or transmitting HIV. Previous studies have shown that a lack of knowledge of HIV in health care professionals may lead to lack of confidence in treating this patient population, and therefore, somewhat of an unwillingness to treat.3,4 A lack of knowledge about HIV has also been associated with negative attitudes towards the treatment of those infected. We wanted
63 (98.4) 1 (1.6) 0 Bold values represent correct responses. a Some surveys not answered completely, so percentages may not total 100%.
13 (48.1)
0
(11.4)
0
0
0 66 (100) 25 (92.6) 2 (7.4)
23 (35.9) 36 (56.3) 5 (7.8) 28 (42.4) 30 (45.5) 8 (12.1) 13 (48.1) 1 (3.7)
0 7 (10.9) 56 (87.5) 58 (87.9) 1 (1.5) 0 3 (11.1) (6.8)
24 (88.9)
6 (9.1)
0 63 (98.4) 0 65 (98.5) 1 (1.5) 0 0 27 (100) 0 (6.8)
No
49 (76.6) 15 (23.4) 63 (98.4) 0 50 (75.8) 15 (22.7) 0 63 (95.5) 2 (3) 1 (1.5) 7 (25.9) 0 0 2 (7.4) 20 (74.1) 25 (92.6) 0 (4.5)
Do you know your HIV status? 40 (90.9) 4 (9.1) 41 (93.2) 1 (2.3) 2 Can HIV be transmitted from infected mother to child? Can HIV be transmitted via air and contact with 0 41 (93.2) 3 water? Can HIV be transferred through social contacts such 3 (6.8) 37 (84.1) 3 as sharing cups/utensils/shaking hands/kissing? Can HIV be transmitted through contact with feces, 19 (43.2) 20 (45.5) 5 urine, or saliva? Can HIV be completely cured with antiretroviral 1 (2.3) 43 (97.7) therapy?
Table 2 Responses to questions pertaining to knowledge about human immunodeficiency virus (HIV) [number (%)]a
I don't know
Third-year students (n ¼ 66)
Some surveys not answered completely, so percentages may not total 100%.
to determine students’ knowledge and attitudes about HIV and their willingness to treat patients with HIV infection. We surveyed students in all four years of the McWhorter School of Pharmacy (MSOP) curriculum at Samford University using a 17-question online survey. Survey questions included their general knowledge of the virus, thoughts and attitudes towards treating patients with HIV, and were similar to those asked in other published studies.3–5 Thirdyear students were re-assessed following a five-day HIV/ AIDS Therapeutics lecture series that is part of the required pharmacy curriculum to further evaluate whether a better understanding of the disease state changes attitudes, risk perception, or willingness and confidence to treat. We had an overall response rate of 40.6% with the initial survey and a 31.5% response rate from the third-year students after their HIV/AIDS lecture series. Demographic information by class is presented in Table 1. Results for questions about knowledge of HIV and attitudes towards HIV are presented in Tables 2 and 3, respectively. The results for third-year students’ knowledge of HIV and attitudes towards HIV before and after the lecture series are presented in Tables 4 and 5, respectively. We found that students who believed that HIV can be transmitted through feces, urine, or saliva also thought that patients with HIV infection should be treated separately from other patients. These students also reported that they did not feel confident in safely providing patient care to those infected with HIV and worried that they will contract HIV from an infected patient. Students who did not believe that patients infected with HIV look unhealthy also did not feel that patients with HIV infection should be treated separately. Previous studies have linked a lack of knowledge of HIV among health care professionals to an unwillingness to treat these patients. Although we did not find an unwillingness to treat in MSOP students, it did uncover some areas where pharmacy students were less knowledgeable. Specifically, 41.3% of students surveyed believed that HIV can be transmitted through feces, urine,
Yes I don't know
a
No
15 (23.4) 48 (75)
Yes
20 (30.3) 46 (69.7)
No
8 (29.6) 18 (66.7)
Yes
2 (3.1) 57 (89.1) 5 (7.8) 0
I don't know
0 59 (89.4) 4 (6.1) 2 (3)
No
1 (3.7) 23 (85.2) 3 (11.1) 0
Yes
Fourth-year students (n ¼ 64)
Fourth-year students (n ¼ 64)
Third-year students (n ¼ 66)
Second-year students (n ¼ 27)
Age o22 14 (31.8) 22–28 26 (59.1) 29–35 3 (6.8) Z35 0 Gender Male 9 (20.5) Female 35 (79.5)
Second-year students (n ¼ 27)
First-year students (n ¼ 44)
First-year students (n ¼ 44)
I don't know
Table 1 Demographics of respondents [number (%)]a
0 0
M. Jarvis et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
Survey question
138
5 (7.8) 3 (4.7) SA/A ¼ strongly agree/agree; SD/D ¼ strongly disagree/disagree; NS ¼ not sure. a Some surveys not answered completely, so percentages may not total 100%.
2 (4.5) 4 (9.1) 34 (77.3) 0
3 (11.1) 19 (70.4) 5 (18.5) 7 (10.6) 45 (68.2) 12 (18.2) 6 (9.4) 49 (76.6) 21 (77.8) 1 (3.7) 5 (18.5) 52 (78.8) 3 (4.5) 11 (16.7) 61 (95.3) 0
2 (3.1) 3 (4.7) 59 (92.2) 4 (6.1) 3 (4.5) 3 (11.1) 59 (89.4) 2 (7.4) 22 (81.5) 1 (2.3) 2 (4.5)
5 (7.8) 23 (35.9) 34 (53.1) 5 (7.6) 9 (33.3) 7 (25.9) 25 (37.9) 36 (54.5) 6 (13.6) 11 (40.7) 32 (72.7)
23 (52.3) 10 (22.7) 4 (14.8) 16 (59.3) 7 (25.9) 11 (16.7) 27 (40.9) 26 (39.4) 13 (20.3) 38 (59.4) 12 (18.8) 9 (20.5) 15 (34.1) 11 (40.7) 7 (25.9) 9 (33.3) 33 (50) 7 (10.6) 25 (37.9) 42 (65.6) 11 (17.2) 10 (15.6)
8 (12.1) 54 (81.8) 3 (4.5) 0 60 (93.8) 1 (1.6) 8 (12.1) 32 (48.5) 23 (34.8) 20 (31.3) 29 (45.3) 10 (15.6) 22 (81.5) 4 (14.8) 16 (59.3) 8 (29.6) 1 (3.7) 2 (7.4) 39 (88.6) 3 (6.8) 22 (50) 14 (31.8)
Most people who have HIV look unhealthy. 0 I feel I am competent enough to provide treatment and 6 (13.6) counseling to HIV patients Patients with HIV should be cared for separately. 9 (20.5) I am confident that I can safely work with and care for 20 (45.5) HIV patients. As a health care professional, I worry about acquiring HIV 6 (13.6) through infected patients. Health care professionals should be told when a patient 41 (93.2) has HIV. I would prefer not to care for patients infected with HIV. 7 (15.9) I am willing to care for patients infected with HIV. 40 (90.9)
SD/D SA/A SD/D SA/A SD/D SA/A Survey question
SA/A
SD/D
NS
Second-year students (n ¼ 27) First-year students (n ¼ 44)
Table 3 Responses to questions pertaining to attitudes about human immunodeficiency virus (HIV) [number (%)]a
NS
Third-year students (n ¼ 66)
NS
Fourth-year students (n ¼ 64)
NS
M. Jarvis et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
139
and saliva. Furthermore, students that were misinformed on this mode of transmission also believed that patients with HIV infection should be cared for separately, did not feel that they could safely treat HIV patients, and worried about their risk of becoming infected when caring for this patient population. There was a lack of knowledge, specifically regarding modes of transmission that may have led to an overall uneasiness when treating HIV patients. Unlike previous studies, we did not find that students who had misconceptions about modes of transportation also had a lack of willingness to treat. We did, however, find that students lacked confidence in safely treating this patient population. The group of students who actually seemed to have the best responses regarding knowledge of HIV was the second-year students. They had no training on the topic during that academic year and were further removed from any training in the pre-pharmacy curriculum than the first-year students. In terms of the pre- and post-lecture surveys in the third-year students, we did find an improvement in knowledge of HIV after the lecture series. Studies have shown that improvement in educational programs is warranted in order to optimize patient care for HIV-infected individuals.3 In surveying the third-year class a second time following the HIV lecture series, we found more students who felt that they were competent enough to provide patient care and counseling to patients with HIV than felt competent in the first survey. There were also more students who felt that they could safely treat patients with HIV following the lecture series. There are several limitations to our study. First, our survey was developed from other published studies, but it was not a validated survey instrument. Also, there may be differences in responses from MSOP students than there would be from others in different regions of the country or those not in a private university. Another limitation to this study is that it only surveyed pharmacy students instead of those of other health professions. There were also fewer responses from the third-year students after the lecture series than there were prior to the lectures. We did not determine if any of the fourth-year students who responded had further experiential training with a focus on patients with HIV, which could influence their responses. Our study provided a one-time look at students’ knowledge and attitudes instead of trending these throughout their pharmacy education. We were midway through a curricular change when this study took place, and the first- and second-year students participated in the new curriculum, while the third-and fourth-year students participated in the previous curriculum. The results of this survey also may provide an opportunity for future research into curricular planning and teaching of topics such as HIV where misconceptions or stigmata exist. Understanding that the kind of care we provide to HIV patients reflects our knowledge and attitudes
140
M. Jarvis et al. / Currents in Pharmacy Teaching and Learning 7 (2015) 137–140
Table 4 Third-Year student responses to questions pertaining to knowledge of human immunodeficiency virus (HIV) before and after lecture series [number (%)]a Before (n ¼ 66) Survey question
Yes
No
After (n ¼ 40) Don't know Yes
Do you know your HIV status? 50 (75.8) 15 (22.7) Can HIV be transmitted from infected mother to child? 63 (95.5) 2 (3) 1 Can HIV be transmitted via air and contact with water? 0 65 (98.5) 1 Can HIV be transferred through social contacts such as 6 (9.1) 58 (87.9) 1 sharing cups/utensils/shaking hands/kissing? Can HIV be transmitted through contact with feces, urine, or saliva? 28 (42.4) 30 (45.5) 8 Can HIV be completely cured with antiretroviral therapy? 0 66 (100)
No
Don't know
0 (1.5) (1.5) (1.5)
32 (80) 7 (17.5) 40 (100) 0 0 40 (100) 5 (12.5) 34 (85)
0 0 0 0
(12.1) 0
22 (55) 0
18 (45) 40 (100)
0 0
Bold values represent correct responses. a Some surveys not answered completely, so percentages may not total 100%.
Table 5 Third-year student responses to questions pertaining to attitudes about human immunodeficiency virus (HIV) before and after lecture series [number (%)]a Before (n ¼ 66) Survey question Most people who have HIV look unhealthy. I feel I am competent enough to provide treatment and counseling to HIV patients. Patients with HIV should be cared for separately. I am confident that I can safely work with and care for HIV patients. As a health care professional, I worry about acquiring HIV through infected patients. Health care professionals should be told when a patient has HIV. I would prefer not to care for patients infected with HIV. I am willing to care for patients infected with HIV.
SA/A
After (n ¼ 40)
SD/D
NS
SA/A
SD/D
NS
8 (12.1) 8 (12.1)
54 (81.8) 32 (48.5)
3 (4.6) 23 (34.9)
1(2.5) 22 (55)
36 (90) 0
0 12 (30)
11 (16.7) 33 (50)
27 (40.9) 7 (10.6)
26 (39.4) 25 (37.9)
11 (27.5) 30 (75)
21 (52.5) 5 (12.5)
8 (20) 8 (20)
25 (37.9)
36 (54.6)
5 (7.6)
12 (30)
24 (60)
3 (7.5)
59 (89.4) 7 (10.6) 52 (78.8)
3 (4.6) 45 (68.2) 3 (4.6)
4 (6.1) 12 (18.2) 11 (16.7)
35 (87.5) 6 (15) 32 (80)
2 (5) 23 (57.5) 1 (2.5)
3 (7.5) 10 (25) 7 (17.5)
SA/A ¼ strongly agree/agree; SD/D ¼ strongly disagree/disagree; NS ¼ not sure. a Some surveys not answered completely, so percentages may not total 100%.
towards the disease is an important part of developing awareness and improving the way we treat these patients. Understanding HIV is imperative in order to care for these patients confidently, effectively, and without discriminatory attitudes so that we may ultimately decrease transmission rates and improve patient awareness and compliance. References 1. Anderson PL, Kakuda TN, Fletcher CV. Human immunodeficiency virus infection. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey JM, eds. Pharmacotherapy: A Pathophysiologic Approach, 8th ed., New York, NY: McGrawHill; 2011:2169–2170.
2. Centers for Disease Control and Prevention Web site. CDC’s H. I.V prevention progress in the United States. 〈http://www.cdc. gov/hiv/pdf/dhap_cdcPrevention.pdf〉; Accessed September 20, 2014. 3. Ahmed SI, Hassali MA, Aziz NA. An assessment of the knowledge, attitudes, and risk perceptions of pharmacy students regarding HIV/AIDS. Am J Pharm Educ. 2009;73(1): Article 15. 4. Reis C, Heisler M, Amowitz LL, et al. Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Med. 2005;2(8):743–752. 5. Wertz DC, Sorenson JR, Liebling L, Kessler L, Heeren T. Knowledge and attitude of AIDS health care provider before and after education programs. Public Health Rep. 1987;102(3): 248–254.