د محمد الوصيفي تحت اشراف أد/هاله البرعي Attitudes د محمد الوصيفي تحت اشراف أد/هاله البرعي

Definition An attitude is a tendency to behave in a preferential manner. It denotes certain constant traits in an individual’s ways of feeling and thinking, and his predispositions towards action with regard to another person such as, a patient Attitudes are our expressions of likes and dislikes towards the people and objects.

components • Cognitive what a person knows and his belief about the attitude object. • Affective how he feels about the attitude object. • Conative behavioural tendency towards the object, both verbal and nonverbal.

Components of attitude:

A distinction is commonly made between attitude and opinion A distinction is commonly made between attitude and opinion. An opinion is a belief that one holds about some object in his environment. It differs from attitude, being relatively free of emotion.

Importance of the assessment of attitudes for doctors can be related to the following factors: Patient care: Any negative attitude towards race, community or disease results in a prejudicial behavior that affects patients. Formation of attitudes of peers or juniors Senior doctors has a significant impact on the students for the formation of opinions concerning health related issues.

Acceptance of new technology: In the present times, many new innovations in techniques, equipment and methods of health care delivery are taking place. Our attitudes can bias acceptance of new technology and high profile specialities. Interpersonal skills: Studies have shown that during training of undergraduate students there is a gradual decline in their interpersonal skills. This affects skills of history taking and elicitation of information from the patient.

Curriculum planning: While planning a new curriculum or revising the existing curriculum in educational courses, one needs to identify the attitudes of the students and teachers. Effects of attitudes on meaningful learning and retention: Attitudinal bias has a differential effect on the learning of controversial things. With a favourable attitude, one is highly motivated to learn, puts greater effort and concentrates better. Negative attitude leads to close-minded view to analyse new material and hence, learning is impaired.

Effect of attitudinal bias on training/ learning: Attitudinal bias often causes loss of objectivity in a clinical setting. This is encountered in situations where either a relative patient is being examined or a patient revealing a history resembling the student’s own life.

responses that reveal attitudinal biaswhile examining the patients. 1. Premature closure and dogmatic response— an early referral is made prior to taking a complete history, a simplistic solution may be provided in the initial contact. 2. Evasion—student misses the patient’s history and directs the conversation under his control. 3. Premature reassurance—here the student negates the concerns of the patient and reassures the patient without having substantial evidence.

4. Rejection—student may avoid conflict areas and reject patient’s concerns by neglect. 5. Condescension—Value-laden language is used so as to shame, embarrass or humiliate the patient. 6. Too many technical jargons are used by the student that confuses the patient.

Developments of Attitudes

Family Family is the first place for formation of attitudes. Parents begin the information flow that forms beliefs and attitudes about things. Categories are formed in our head on the basis of early information.

Peers Just as we learn from family in the early childhood, later our peer group has a tremendous influence on the development of attitudes. One may form very different or opposing attitudes in the company of friends, e.g. attitudes towards patients with AIDS or addictions, etc.

Conditioning in Sociocultural Environment There are ample examples in our sociocultural environment, which are responsible for conditioning our attitudes. One such example is words, which have acquired effective meaning. They can create positive or negative attitudes. Many attitudes developed on the basis of classical conditioning are found to be irrational, as they have been paired with an emotion producing unconditioned stimulus either accidentally or in a quite extraneous situation. Similarly the appropriate attitudes can be developed through classical conditioning.

How to Facilitate Development of Attitudes? Providing Information: Information can bring changes in attitudes. For example, information about smoking as a cause for cancer and heart diseases is likely to bring about changes in attitudes towards smoking. Providing Examples or Models Most advertising is designed to change attitudes. A common technique is to show an ideal person using a certain product. The advertiser aims to provide a model or an example, which will be followed by the reader.

Providing Experience Medical training provides a number of experiences, which shape the attitudes of the students. They may see patients with sores that have not been treated and that have become septic and possibly disabling. This direct experience of seeing the patient’s suffering will have far more impact on shaping students attitudes than a whole lot of theoretical information about the need for early treatment of sores and superficial wounds.

Discussions Discussions in small groups are generally thought to be helpful in shaping student’s attitudes. It is helpful for students to describe and discuss the experiences that they have had with their patients. During the discussion, they can share their experiences with other members of the group. Discussions also help to change students’ attitudes by the process in which a student gives his opinion and sees the reactions of other students.

Role-play Role-playing is an exercise in which the students play roles of suffering patients, doctors, paramedicals, etc. and begin to experience different kind of behavioural attributes. In a role-play, the participants exaggerate a situation or an incidence so that the audience can better appreciate the gravity of the situation.

Attitudes to be Developed by Undergraduate Medical Students 1. Eliciting psychosocial aspects of the illness. 2. Giving due respect to the patient’s age; communicating patiently with older patients. 3. Examination of female patients in privacy. 4. Informing the relative about the patient’s condition.

5. Breaking the news of death to the relatives. 6 5. Breaking the news of death to the relatives. 6. To elicit history concerning very personal aspects of patient’s life, like sexual history. 7. Informing the patient before giving an injection or doing a procedure. 8. Understanding individual differences and reactions to illness.

Methods to Change Attitudes a. Source or the communicator should be very effective and highly credible. He should be trustworthy and an expert to produce the change. b. Content of communication has also been subjected to research. The findings are that communications, which discuss both the pros and cons to the point, are more effective in situations where there is initial resistance to accept.

c. Personality characteristics of the audience Committing the audience to take challenges or do something has proven to be an effective technique for attitude change. General susceptibility or suggestibility of an individual will also determine their tendency to accept/ reject new information.

Methods to change attitudes

ASSESSMENT OF ATTITUDES Assessment of attitudes seems to be ignored because of the following reasons: 1. Attitudes are often vague and ill-defined entities. 2. The teachers frequently differ on what attitudes are really desirable. 3. Our instruments for measuring attitudes are not really good.

ASSESSMENT OF ATTITUDES Rating Scales *Likert scale, an attitudinal object is assessed on a five point scale ranging from extremely positive to extremely negative. *Osgood scale: two opposite adjectives are given with gradations. Example: Useful --------- Not useful. Observational Rating Scales This requires repeated and standardised direct observation of student’s behaviour (activity) over a long period and in natural professional situations such as in the ward with older patients, outpatient clinic or in primary health centre.

Indirect Methods based on the principle that people remember better the things that they Consider to be important. steps in construction of an attitude scale: 1. Specify attitude variable that is to be measured. 2. Collect wide variety of statements. 3. Edit the statements. 4. Sort out the statements into (an imaginary) scale. 5. Calculate the scale value.

Reliability and validity: 1. The statements should be brief. 2. Each statement should convey one complete thought. 3. The statement should belong to the attitude variable that is to be measured. 4. Care should be taken on language: - use simple sentences - avoid double negatives - avoid “all, always, none or never” - use with care “only, just, merely” - avoid words with more than one meaning.

5. The statements should cover the entire range of the effective scale of interest. 6. Statements should be such that they can be endorsed or rejected (agreed/disagreed). 7. Acceptance and rejection should indicate something about the attitude measured.