This pre-post interventional study was conducted to assess the KAP of FPs on well-child care for children under five in the Suez Canal area before and after the implementation of pre-post intervention. Participants’ KAP on well-child care was significantly improved after the intervention, but their attitudes and practices about risk assessment and screening, as well as practices of chemoprevention and counseling, require further improvement.
Prior to this intervention, poor knowledge, poor attitudes, and poor practice levels were detected in the pre-intervention survey on well-child care. These poor pre-intervention phase results may be the result of inadequate training and practice on well-child care, inadequate equipment, deficiency of well-child care issues in undergraduate and postgraduate curriculums, out-of-date national guidelines, and weak systems in providing well-child care with the exception of the provision of vaccination and screening for congenital hypothyroidism and phenylketonuria.
The current intervention effectively improved the participants’ KAP on growth monitoring. Service training of FPs on growth monitoring, especially plotting and interpretation of growth charts in addition to appropriate management of the growth problems, is needed to acquire them an acceptable level of knowledge and skills toward this subject [7].
Participants’ KAP on developmental monitoring was also improved after participating in the present study. These findings are congruent with the findings of the Brazilian study, which revealed that PHC professionals’ knowledge and practices about child development were improved after participation in continuing education programs [9].
After this intervention, participants became more knowledgeable about the interpreting of growth on the 2006 WHO growth charts’ z-score, estimation of gestational age for premature babies, diagnosis of global developmental delay, identifying of the appropriate age milestones, physicians’ concern for children’s speech and language, and indication of referral for children’s motor development. There was no similar interventional study to make a sound comparison with.
After this intervention, nearly four out of five participants asked about parents’ concerns for development. This finding was higher than the finding of the National Survey of Children’s Health, USA, which revealed that more than half of the physicians or other health care providers asked about parents’ concerns for development of children aged 10-47 months [25]. This might be due to the fact that this current study was based on an observational checklist while the survey’s result was based on parents reporting their questions they asked physicians regarding concerns for their children’s learning, development, or behavior.
In the pretest of the current study, the clinical assessment of risk factors for child development needed to have improved results, especially through assessing family as well as socioeconomic risk factors due to the fact that some physicians are less knowledgeable regarding the family risk factors’ effect on developmental difficulties, as they had less appreciation of socioeconomic risk factors for growth and development. These issues were improved after implementing the intervention.
Despite the fact that FPs should elicit any parents’ concerns about their children’s speech and language [20], none of the participants elicited these concerns prior to the current intervention. After the intervention, less than two-fifths of the participants inquired about parents’ concerns for language and hearing. This poor practice might have been due to some participants thinking that parents would complain if their children had language or hearing problems; in addition, some physicians relied on their clinical judgment for early detection of hearing loss.
The suboptimal level of knowledge and attitudes toward hearing screening among participants in the pretest might be due to a lack of adequate training and the absence of the national program for early detection and intervention of hearing impairment.
Participants’ practices toward vision screening/examination in the present study needed to be improved; it could be because of a lack of adequate training and equipment (e.g., direct ophthalmoscope or torches). This reflected that re-training is needed for vision screening and examination in addition to the availability of the required equipment. In another Turkish study, FPs were shown to also need educational seminars on this topic. Just as well, infrastructure in FPCs should be established to implement detailed eye screening like those in developed countries [26].
The pretest of the current study revealed that the participants’ KAP toward developmental dysplasia of the hip (DDH) needed to be changed. While there was a significant improvement of the tested knowledge and attitudes toward this issue after training, only a little more than a quarter of the participants actually examined hips for developmental dysplasia. This might be due to a lack of training on this issue, and most of the participants might have felt they should not do it because of DDH screening having insufficient evidence.
In the pretest of the present study, about more than one-eighth of the participants examined teeth for caries in contrast to more than two-fifths of them in the posttest. This poor practice reflected that participants did not appreciate one of the most significant health problems for children. There was a lack of training, and this problem might not have been addressed enough in the intervention.
In the current study, participants inquired about one micronutrient supplementation (iron supplements) or two (iron and vitamin D supplementations). Inquiring about vitamin A supplementations was a rare practice; this should be improved by reviewing children’s cards for this issue.
Prior to the present intervention, about one out of every twenty participants counseled parents regarding ≥ 2 anticipatory guidance topics, in contrast to one-third of them after this intervention. The provided anticipatory guidance can be improved by involving nurses, the use of brochures and booklets, and re-training on oral health and child safety and development themes.
A previous survey regarding anticipatory guidance topics, which was discussed during health maintenance visits for children aged 2-11 years, revealed that about one-fifth of the providers reported discussing ≤ 4 topics during the well-care visit. More than half of providers reported discussing 5-8 topics, and nearly three out of every ten providers reported discussing ≥ 9 topics [27]. The discrepancy of findings between the current study and that study might be due to different health system deliveries of under-5 well-child care.
Affiliation with the Family Medicine Department at the FOM-SCU was the most powerful contributing variable of the posttest practices score. This could be attributed to most of the participants having a master’s degree in contrast to participants affiliated with MOHP who had only a bachelor’s degree. Also, some of them provide field training for undergraduates in different phases related to child health.
Based on our best knowledge, this is the first trial to evaluate family physicians’ KAP toward well-child care for children under five in Egypt. Well-child care issues in the family medicine curriculums for the postgraduate and undergraduate students at the FOM-SCU were both improved based on the results of this study. Only one trained evaluator assessed participants’ practices via a valid questionnaire, and this was in order to minimize observer bias. The Head of the Family Medicine Department at the FOM-SCU as well as the academic supervisors who hold a master’s degree and are part of the medical doctorate programs there are motivated to participate in this intervention to minimize response bias.
Limitations of the study
Recruitment of the participated FPs had many difficulties because most of them had multiple official duties. The generalization of the study’s result is limited by the lack of randomization. The study also suffered from a limited sample size.
