49 Assessment of Knowledge about Childhood Autism among Pharmacists and Doctors in Miri Hospital
Mei Chi Lee1, Huei Erh Chin1, Kamarudin Ahmad1,2
1Miri Hospital Pharmacy Department
2Clinical Research Center Hospital Miri
Corresponding author name and email: Mei Chi Lee ([email protected])
ABSTRACT
Introduction: Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioural challenges.
Objectives: We aimed to assess the knowledge of pharmacists and doctors about childhood autism in Miri Hospital and investigate the association between age, gender, ethnicity, years of working and occupation with knowledge about childhood autism.
Methods: We conducted a cross-sectional study in Miri Hospital using Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire. A total of 62 participants recruited, which consisted of 31 pharmacists and 31 doctors. We analysed data by using descriptive statistics, Pearson’s correlation test and Independent t-test.
Results: The mean score on the KCAHW questionnaire of pharmacists and doctors was 12.26
± 2.435 and 13.42 ± 2.527 respectively. The knowledge on childhood autism was found to have no significant linear correlation with age (p=0.79) and years of working (p=0.942). We found the knowledge of childhood autism to have a significant association with gender (p=0.007) and occupation (p=0.07). There is no association between ethnicity and score on the KCAHW questionnaire (p=0.735).
50 Conclusion: Knowledge on childhood autism is crucial in facilitating early detection of ASD and implementation of interventions to improve prognosis in each ASD affected individuals.
Keywords: Childhood autism, Pharmacists, Doctors
51 INTRODUCTION
Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioural challenges with severe impacts in childhood (American Psychiatric Association, 2013). ASD is known as a "spectrum" disorder as there is a wide variation in the type, effects and severity of the symptoms in each affected individuals.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association used to diagnose mental disorders, stated that people with ASD have difficulty with communication and interaction with other person, restricted interests and repetitive behaviours and symptoms that hurt the person's ability to function properly in school, work, and other areas of life.
According to the Centre for Disease Control (CDC), about 1 in 59 children has been identified with ASD in the USA. A study done by the Ministry of Health Malaysia showed that the rate of autism is 1.6 in 1000 children or approximately 1 in 625, who aged from 18 to 26 months.
ASD can occur in all racial, ethnic, and socioeconomic groups. The risk of getting ASD in males is four times higher as compared to females (Baio et al., 2018). Signs of ASD usually appear by age 2 or 3. Some associated development delays can appear even earlier, as early as 18 months and typically lasts throughout a person's life (Johnson et al., 2007).
According to the National Health Service (NHS), the exact causes of ASD remain unknown.
However, research suggested that genes can act together with the environmental influences to affect the development in ways that lead to ASD (Chaste et al., 2012). Early diagnosis and interventions are essential to allow the child to grow as healthy as possible by learning new skills and thus improving the quality of life for those diagnosed with autism and their families (Igwe et al., 2011).
Several similar studies had been carried out in different countries to assess the knowledge about childhood autism among different health care providers such as doctors, pharmacists and nurses. Unfortunately, results from these studies revealed inadequacies in knowledge about childhood autism among health care workers (Rohanachandra et al., 2017). Knowledge on childhood autism is crucial in facilitating early detection of ASD and implementation of interventions in order to improve prognosis in each ASD affected individuals (Igwe et al., 2011). In this study, we assessed the knowledge about childhood autism among pharmacists
52 and doctors in Miri Hospital and investigated various factor that affecting those knowledge. By doing this, we hope can increase awareness in these two groups of health care providers. The objective in this study is to assess the knowledge of pharmacists and doctors about childhood autism in Miri Hospital and investigate the association between age, gender, ethnicity, years of working and occupation with knowledge about childhood autism.
METHODS
Study design and population
A cross-sectional study was carried out in Miri Hospital among pharmacists and doctors to assess their knowledge about childhood autism by using KCAHW (Knowledge about childhood autism among health workers) questionnaire (Bakare et al., 2008). A total of 62 participants recruited via convenience sampling method. Sixty-two questionnaires distributed to 31 pharmacists and 31 doctors in Miri Hospital over one month period. Our inclusion criteria included the pharmacists and doctors working in Miri Hospital, which were literate in English.
We excluded those who have a severe mental illness which affects their daily function. All subjects consented to participate. Each respondent was required to answer the questionnaire within 30 minutes without references. The questionnaires were collected immediately after that.
Study instrument
This survey used the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire. This was a self-administered questionnaire that was developed by a team of psychiatrists and clinical psychologists in 2008 at Enugu Nigeria (Bakare et al., 2008). The questionnaire has good test-retest reliability, overall internal consistency and culturally valid (Bakare et al., 2008). It contains a total of nineteen item questions that are divided further into four domains. There are three options for each question, with only one of them are correct. The correct option of each item question attracts a score of one while the other two options that are incorrect attract a score of zero each. Therefore, the maximum and minimum total score is nineteen and zero, respectively.
Sample size determination
In the current study, the sample size was determined based on each of the objectives of the study to ensure sufficient sample obtained to answer all the objectives. Objective 1 do not require sample size estimation. Objective 2, the sample size was based on the variables of age
53 and years of working experience using the Sample Size Calculator for Correlation Analysis (version 3.0), whereas Power and Sample Size (PS software version 3.1.6) was used to determine the sample size of the variables gender, ethnicity and occupation. The largest sample size obtained was for occupation with the standard parameters for p-value and study power, 1and other parameters based on Igwe et al. (2011). Based on a power of 0.8, p-value (α) of 0.05, detectable difference (δ) of 3, standard deviation within-group (σ) of 3.5 and standard deviation (m) of 1, the calculated sample size for each group was 22 by taking into consideration of dropout rate of 30%. The required sample size was 31 participants per group.
Statistics analysis
The demographic profile of respondents described as frequencies and percentages for categorical variables. Numerical variables, for example, age, was described as mean and standard deviation (SD). We used Independent T-test for comparison of mean score between gender and occupations; while comparison between ethnicity analysed by using ANOVA. We considered the level of significance if p < 0.05.
RESULTS
Sixty-two participants (100% response rate) had agreed to participate in this study. Table 1 summarised the details of the sociodemographic characteristics of study participants. The age of the study population ranged from 23 to 36 years old. The years of working as doctors and pharmacist ranged from 1 to 12 years. Most of the participants are females (75.8%). Majority of the participant were Chinese (67.7%).
Table 1: Sociodemographic characteristics of study participants (n=62)
Variables Frequency (%) Mean (SD)
Age (years) 28.16 (0.58)
Years of working (years) 3.69 (2.72)
Gender
Male 15 (24.2)
Female 47 (75.8)
Ethnicity
Malay 10 (16.15)
Chinese 42 (67.7)
Others 10 (16.15)
Occupation
Pharmacist 31 (50)
Doctor 31 (50)
54 There is no significant linear correlation between age and score on the KCAHW questionnaire (p=0.79). The observed correlation coefficient (r) is 0.034, which suggests a very weak, positive correlation between age and score on the KCAHW questionnaire.
Figure 1: Association between age and score on the KCAHW questionnair
There is no significant linear correlation between years of working and score on the KCAHW questionnaire (p=0.942). The observed correlation coefficient (r) is 0.009, which suggests very weak, positive correlation between years of working and score on the KCAHW questionnaire.
Figure 2: Association between years of working and score on KCAHW questionnaire
We attempted to evaluate the difference between groups. The mean score on the KCAHW questionnaire between the two genders was significantly different (Table 2).
Table 2. Comparing the mean score on the KCAHW questionnaire between male and female
Variable
Mean (SD)
Mean diff.
(95% CI)
t statistic
(df) a p-value a Male
(n=15)
Female (n=47) Total score 11.33
(2.845)
13.32 (2.247)
-1.98
(-3.4, -0.3) -2.79 (60) 0.007
a Independent t-test
55 However, there is no significant difference in the score between different occupation (Table 3) and ethnicity groups (Table 4).
Table 3. Comparing the mean score on the KCAHW questionnaire between pharmacist and doctor
Variable Mean (SD) Mean diff.
(95% CI) t statistic (df) b p-value b Pharmacist
(n=31)
12.26
(2.435) -1.16
(-2.4, 0.1) -1.842 (60) 0.07 Doctor
(n=31)
13.42 (2.527)
b Independent t-test
Table 4. Comparing the mean score on the KCAHW questionnaire between different ethnicity
Ethnicity N Total score,
Mean (SD) F-statistic (df)c p-value c
Malay 10 12.40 (2.50)
0.310 0.735
Chinese 42 12.83 (2.35)
Others 10 13.30 (3.40)
c One-way ANOVA test
DISCUSSION
Our study revealed that there is a significant difference in the score on the KCAHW questionnaire between male and female. Female participants scored a higher mark (13.3 ± 2.2) than male participants (11.3 ± 2.8). However, the outcome of a study done by Eseigbe et al.
(2015) is in contrast with our findings in terms of gender. Eseigbe et al. (2005) found that males have significantly good knowledge of KCAHW (p < 0.05). This might be due to male preponderance (71.3%) among participants in that study, while our study has more female subjects (75.8%).
We also found that doctors obtained a significantly higher score on the KCAHW questionnaire as compared to pharmacists. Doctors are more likely to be able to identify a child presenting with signs and symptoms of autism due to their nature of work — the frequent exposure of doctors to patients which gives them a chance to enhance their clinical knowledge. Doctors undergo more medical training which predisposes them to know more about autism as compared to other health care personnel, including pharmacists. Besides that, autistic
56 complains such as abnormal behaviours, intellectual delays and feeding difficulties are often necessitate visits to doctors that signify better knowledge of autism among doctors. No other similar studies were comparing KCAHW knowledge among different health care groups as what we did in this study. Thus, we are unable to compare our outcome with another article.
However, there was a study done by Igwe et al. (2011) which investigating childhood autism knowledge between specialised paediatric nurses and psychiatric nurses in Eboni state, Nigeria.
Igwe et al. (2011) found out that there was a significant association between the score on the KCAHW questionnaire and area of specialisation of nurses involved in the study. Those nurses who have experience in managing children with childhood autism scored better than those without experience.
Rohanachandra et al. conducted a study in 2017 showed that knowledge of childhood autism did not differ significantly with age and years of working. Another study carried out among medical students in Karachi reported that those who are older might not necessarily score higher on the KCAHW questionnaire (Shaukat et al., 2015). These findings are consistent with our study's outcomes. There was no significant difference in the score on the KCAHW questionnaire among different ethnicity groups.
Early diagnosis and prompt interventions are crucial to improve adaptive behaviour, language and intelligence in children with autism. The deficits in knowledge about childhood autism among health care providers can lead to misdiagnosis, delayed diagnosis and delayed treatment. The quality of life of patients and caregiver will worsen if childhood autism is left untreated (Rohanachandra et al., 2017).
LIMITATIONS
The limitation of this study is that it was a single centre study. The findings of this study might not reflect that in other settings. Furthermore, the KCAHW questionnaire is a self-administered questionnaire and collected immediately upon completion. This questionnaire only serves as a point assessment of knowledge.
57 CONCLUSION
Adequacy in knowledge on childhood autism is the key factors in facilitating early detection of ASD in order to improve prognosis in each ASD affected individuals (Igwe et al., 2011).
Continuous education on childhood autism is necessary to increase knowledge and awareness of all health care personnel.
ACKNOWLEDGEMENTS
The authors wish to extend our gratitude to all of the hospital pharmacists who voluntarily participated in this study. We would like to express our appreciation also to Clinical Research Centre colleagues who have generously provided expertise and insight on statistical analysis during the writing of this manuscript.
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