Survey of parents' attitudes to the recommended Haemophilus influenzae type b vaccine program.

A survey was conducted in a general pediatric practice to determine parents'' attitudes to and compliance with the recommended Haemophilus influenzae type b vaccine program. Of 133 families surveyed 127 (95%) responded to the questionnaire. About one third of the parents did not have their children vaccinated. The decision against vaccination was made despite parent education, follow-up telephone contact and the pediatrician''s expressed support of the vaccine program. Most of the respondents (86%) had no previous knowledge of the vaccine. The factor of greatest concern was the possibility of an adverse reaction. This concern was significantly more common among the parents who decided not to have their children vaccinated than among those who had their children vaccinated (chi 2 = 6.52, p less than 0.025). One third of the parents who indicated that they intended to have their children vaccinated required a telephone reminder. The findings suggest a need for public education about the vaccine, with particular emphasis directed at allaying fears about side effects.     

A new approach to decision making in primary health care

The village health worker has two basic tasks: (1) to prevent health problems; (2) to identify and provide effective management of illness in the village. The village health worker has limited education and the length of basic health training is usually 12 weeks. This training can only be considered appropriate if it enables the village health worker to practise effectively within the cultural, social, economic and educational constraints of the village. How far does the training help this worker to work with other members of the village community to prevent illness? These others include mothers, children, school teachers, village leaders, religious leaders, traditional birth attendants, and traditional healers; training needs to be problem-oriented. The management decisions that have to be made in situations of shortage of resources are complex to analyse. A W.H.O. research project has been undertaken to determine the feasibility of developing and using flow charts to provide alternative and more appropriate methods to help the village health worker to provide optimal management in suboptimal situations. Some examples of these new methods are presented.     

Nurse practitioners in primary care II. Prior attitudes of a rural population

A household survey in a medically underserviced rural population of south-central Ontario was conducted in early 1971 to ascertain attitudes about nurses as providers of primary care. The population sampled had not been exposed to nurse practitioners or family practice nurses before the survey was concluded. The results demonstrate favourable views about nurses giving services in health maintenance and sickness surveillance situations. Personal primary care rendered in homes was highly acceptable to respondents. Physician services were preferred in worry-inducing situations.     

Nurse practitioners in primary care iv. Impact of an interdisciplinary team on attitudes of a rural population.

Attitudes toward the expanded role of nurse practitioners in primary care (family practice nurses) have been determined for persons from a semirural area who chose as their principal souce of care an interdisciplinary family medical centre (FMC) incorporating two nurse practitioners, and those for whom the FMC was not the usual source of care. Data were obtaine using"before-and-after" structured interviews of a random sample of persons living in a southern Ontario township. Slowly evolving, nonsignificant trends of greater acceptance were observed among patiens who had dealth with family practice nurses. The greatest change observed was an increased acceptance of the nnurse by FMC users as the person who would be contacted as a second choice if theirfirst choice, usually a physician, could not be reached in specific worrry-inducing situations. FMC users depended more on nurses to provide information. A conclusion of increased general acceptance of the family practive nurse by FMC users is supported by a 34 per cent higher use of nurses by FMC patients compared to other persons of comparable characteristics living in the same community.     

Doctors' attitudes to risk in difficult clinical decisions: application of decision analysis in hepatobiliary disease.

Twelve doctors with special training in hepatology independently reviewed two to five cases each from a group of seven cases of complicated hepatobiliary problems. A doctor''s willingness to take risks to improve his patients'' health was quantified by a wagering technique based on the probability of achieving a successful intervention. These probabilities were then used to calculate "utilities," which represented the average opinion of the doctors about the relative worth of each of six predefined states of health. The results showed that, in the context of risky decisions for severely ill patients, a year of life was considered by the doctors to be worth 44% of a full recovery; being mobile for that year increased this value to 57%. Survival for up to five years with restricted mobility was considered to be worth 70% of a full recovery and the ability to work during that period increased this value to 85%. It is concluded that in clinical decision making the uncertainty and preferences implicit in a course of action can be quantified and thus made explicit.