https://www.um.edu.mt/library/oar/handle/123456789/33691 2026-04-15T20:19:33Z 2026-04-15T20:19:33Z https://www.um.edu.mt/library/oar/handle/123456789/41414 2020-11-11T05:44:55Z 2009-01-01T00:00:00Z

Title: Health behaviour counselling in primary care : general practitioner-reported rate and confidence. Abstract: Aims The main aim of the study was to identify variables associated with GPs' self-reported rate of health behaviour change counselling and confidence in counselling abilities. The study also tried to elucidate the association of doctors' personal health behaviours with self-reported rate of health behaviour counselling and confidence in counselling abilities. Methodology A repetition of a study done at the Mayo Clinic, Rochester, USA, by Vickers, et al., (2007) was done using the same tool which was a self-filled questionnaire. 326 questionnaires were mailed to all GPs on the specialist register. The survey was completely anonymous. Self-reported items assessed rate of health behaviour change counselling, perceived importance of counselling, extent of counselling training, confidence in counselling abilities, and GP personal health behaviours. Comparison of the results of the 2 studies was made. Using the same questionnaire a semi-qualitative approach was used to identify GPs' barriers to and perceptions about health behaviour counselling. Results The response rate was 70 per cent. The male doctors were slightly overweight and their exercise frequency on a regular basis was low. Almost 74 per cent of the doctors never smoked. Quantitative analysis showed that perceived importance of counselling and confidence in counselling were associated with GP self-reported rate of health behaviour counselling. Years in practice, extent of training, and importance of counselling were significantly associated with confidence in counselling in a multiple regression model. Qualitative analysis revealed that the main perceived barriers to counselling were insufficient time, patients' non-compliance and patients not ready to change. Further analysis revealed that most of the doctors believed that counselling in health behavior change in primary care was very important and that they had to be role models for their patients as regards health behaviour. Discussion & Limitations Objective, validated measurement of health behaviour and counselling behaviour is preferable to the single self-reported items developed for use in this study. Only the general confidence in abilities to deliver health behaviour change counselling was assessed and not the confidence in overcoming the specific barriers to counselling. Additional research is needed to understand the relationship between doctor personal health behaviour, perception of patient opinion regarding doctor's health behaviour, and how these issues interact and impact doctor-patient communication about health behaviour. Further research in this area is needed to determine if multi-disciplinary training could improve the rate or impact of health behaviour counselling in primary care. Conclusions Perceived importance of counselling and confidence in counselling were associated with GP self-reported rate of health behaviour counselling. But extent of training in health behaviour counselling was not associated with GP self-reported rate of health behaviour counselling. This could be due to the lack of training for GPs in health behaviour counselling. Years in clinical practice, extent of training, and perceived importance of counselling were significantly associated with confidence in health behaviour counselling. One third of GPs reported difficulty counselling patients on behaviours that they struggled with themselves. Recommendations Doctors should be trained in motivational interviewing and the trans-theoretical method, which are so important in helping patients recognise the need for a change in their health behaviours. Description: M.SC.FAMILY MEDICINE

2009-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/38721 2020-11-06T11:26:54Z 2009-01-01T00:00:00Z

Title: Attitude of Maltese medical students towards family medicine. Abstract: Description: The attitude of Maltese medical students towards family medicine has been examined through a cross-sectional study at two important stages in the history of the medical school in Malta. In 1991/92 Dr Denis Soler created, validated and published a questionnaire to explore this subject. He came to the conclusion then, that family medicine was seen as comparatively important to medical students, but was not necessarily their first choice of career. It should be noted that most other medical schools around the world have also identified the same problem and are trying to find solutions to it. The issue is obvious. If the qualification system does not produce replacements for the general practitioners who exit (through retirement etc) and too many young doctors choose to specialize in other areas, the pressures increase unnecessarily on the secondary and tertiary health care sectors. Methods: Almost twenty years after his original questionnaire, we repeated Dr Soler's survey to find out if there had been any changes in the trend in Malta, not least because the Department of Family Medicine has been founded in the interim. The questionnaire was repeated in 2008 with all the students in the clinical years at the medical school at the University of Malta (n=200). Young doctors in Malta now have the opportunity to follow a course in post-graduate training over five years. Problem finding: Malta's traditional problem has always been the loss of young doctors to the United Kingdom. Young doctors have seen their best chance for the future in migrating to the UK to complete their post-graduate training there before returning to Malta as a specialist - not necessarily in family medicine. The current problems in the primary health sector can be traced back to that source. The issue that Dr Soler and his colleagues from other countries identified almost twenty years ago are still, if not more, relevant today. Aims: The issue we have to resolve is straightforward: are we training enough family doctors for the future? Considering the results of the current study is worrying. Today's students are simply not seeing family medicine as the first option in their career. All current efforts to get more students interested do not seem to be working. They compare the situation in Malta with the UK or Germany where family doctors are given much more importance, especially in management matters such as registration systems and IT health records. Malta therefore has to take positive action not only from the educational point of view, but also to meet the need to finance management issues, such as those identified in the previous paragraph. There is also a clear question to resolve - how the public health system interacts with the private health system, such as health insurance, at the general practitioner level. What Malta must address is the fact that family medicine still has a negative image compared to specific sectors such as surgery, gynaecology, dermatology and so on. Students see the financial issue of such specialities as offering a great advantage compared to, for example, the family doctor. The importance of the general practitioner, who has to work and, indeed, survive within the community, has to be accorded appropriate recognition and support. Description: M.SC.FAMILY MEDICINE

2009-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/35049 2020-11-06T07:57:41Z 2009-01-01T00:00:00Z

Title: Validation of the Maltese version of the EUROPEP instrument for patient evaluation of general practice care Abstract: It is now accepted, both by the medical profession and by government and non government organisations dealing with health care, that patient evaluations can make an important contribution towards the improvement of health care services. EUROPEP is an internationally validated 23-item questionnaire that has been used successfully throughout Europe in national, regional and local surveys for measuring patient evaluations in primary health care. The aim of this thesis is the validation of the Maltese version of the EUROPEP instrument for patient evaluation of general practice care. It will attempt to measure patient satisfaction using a methodology that has been specifically developed for this purpose. This is the first such study in Malta. In addition, the thesis aims to establish a reliable, verifiable and unambiguous Maltese text of the 23-item questionnaire of the EUROPEP instrument. It will also seek to establish the validity of the translation and the reliability of the EUROPEP questionnaire when applied to Maltese patients by conducting a pilot study for this purpose. Finally, the thesis will attempt to prove the reliability and consistency of the Maltese version of the EUROPEP instrument by comparing the results obtained from its application in Malta with those obtained from EUROPEP's application in other European countries. This comparison is extended to the results obtained by the European Health Interview Survey carried out in Malta in 2008. The EUROPEP questionnaire was translated, forward and backward, by two independent professional translators. The Maltese version was then tested for possible ambiguities and misunderstandings using a pilot group of fifteen persons. The final Maltese version was agreed and validation of the translation was completed. The reliability of the Maltese EUROPEP questionnaire was tested using the Intra Class Correlation Coefficient test. All questions scored 0.8 or more on this scale. The reliability of the Maltese EUROPEP was also tested with a group of twenty-three persons. These were interviewed by telephone individually, on two occasions with an interval of four weeks between each interview. Transcripts of the replies to both interviews were compared and found to correspond perfectly. Taking into account the objectives of the study and various statistical assumptions, the sample population was established at 239 randomly selected Maltese nationals over the age of eighteen. The sample was obtained from the latest edition of the Maltese electoral register. Telephone interviews were carried out by five professionally trained public relations officers, who were especially trained over a three- week period to conduct telephone interviews, and who had the objectives and contents of the EUROPEP instrument clearly explained to them. In addition to the 23-item questionnaire of EUROPEP, those interviewed were asked 9 additional questions concerning gender, age, health status, chronic illnesses, location and frequency of visits to general practitioner, in order to facilitate the analysis of the results. Once all the interviews were carried out, the results of the EUROPEP were pooled together and compared using the Cronbach α (alpha). This revealed internal consistency of the scales. The response rate was 74.45%, which compares well with the response rates obtained by EUROPEP in various European countries, and with the response rate of the European Health Interview Survey that was carried out in Malta between June and August 2008. The gender distribution of the respondents, their educational attainment, their perceived health status, their chronic condition, and the distribution by general health care provider, were analysed. The results obtained by the Maltese version of EUROPEP were found to tally with corresponding distributions in the Health Interview Survey 2008. There was also a high level of correlation between these results and those obtain by EUROPEP in ten other European countries. These results confirmed the reliability of the Maltese version of EUROPEP. The scores obtained by the Maltese version of EUROPEP for patient evaluation in the five dimensions of primary health care covered by the EUROPEP questionnaire could be confirmed by comparisons with the scores for similar dimensions in ten European countries where the EUROPEP questionnaire was used. These results could also be confirmed by comparisons with the statistics provided by the Health Interview Survey 2008. Thus the study confirmed the validation of the Maltese version of EUROPEP. Description: M.SC.FAMILY MEDICINE

2009-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/33901 2020-11-03T11:30:13Z 2009-01-01T00:00:00Z

Title: Translating and testing the reliability of the adult primary care assessment toll into Maltese Abstract: Translating and Testing the Reliability of the Adult Primary Care Assessment Tool into Maltese. Fabrizia Azzopardi MD. General Practice Trainee Master's student in Family Medicine University of Malta Medical School Faculty of Medicine and Surgery Department of Family Medicine fabriziaazzopardi@gmail.com Aim: To translate and test the reliability of the Primary Care Assessment Tool in Maltese. The Adult Primary Care Assessment Tool (PCAT) is a Validated Tool originating from Johns Hopkins School of Public Health and Hygiene in the University of South Carolina, Columbia. Method: Permission to use the Adult Primary Care Assessment Tool (PCAT) was obtained from the Johns Hopkins School of Public Health and Hygiene. Forward and backward translations were then carried out by bilingual persons proficient in translations. The translated versions of the PCAT were then reviewed so that a final consensus translation in Maltese was obtained. Pilot testing was carried out on 3 patients by convenience sampling. The tool was then administered to a random sample of sixty-eight patients. All interviews were conducted by telephone. Re-test administration of the tool was carried out 2 to 4 weeks later. Test-Retest Reliability was established by working out Cronbach alpha and Intraclass correlation coefficient (ICC) for each item between initial and retest administration results. Cronbach alpha together with Spearman-Brown coefficient and Guttman Split-Half Coefficient were worked out to study Internal Consistency. Results: Out of a total of 68 randomly identified individuals a total of 45 (66.2%) answered the tool on both test and retest administration. The average number of days between test and retest administration was 12.58days. First time interviews took an average of 23.50 minutes to carry out. Retest administration of the tool took an average of 12.58 minutes. Results showed that most questions were reliable on testretest administration with a Cronbach alpha result above 0.7 however sections G and H dealing with Comprehensiveness of Services A vailable/Provided had low Cronbach alpha results. Internal consistency results showed that Family Centeredness and Community Orientation had low Cronbach alpha results of 0.495 and 0.616 respectively. Despite this, Cronbach's alpha for the primary care score was 0.784 suggesting that a good level of internal consistency reliability was achieved. Conclusions: Further changes to the Maltese version of the PCAT are necessary. Changes required reflect cultural differences and not translation problems. Re-pilot testing of the questionnaire will be necessary to confirm that changes are adequate. Description: M.SC.FAMILY MEDICINE

2009-01-01T00:00:00Z