|Year : 2019 | Volume
| Issue : 1 | Page : 66-69
Knowledge and attitude of dental students toward human immunodeficiency virus/acquired immunodeficiency syndrome patients: A cross-sectional study in Thodupzha, Kerala
P Abdul Saheer1, K Fabna1, PM Febeena1, S Devika1, G Renjith1, AM Shanila2
1 Department of Public Health Dentistry, Al Azhar Dental College, Thodupuzha, Kerala, India
2 Department of OMRD, Al Azhar Dental College, Thodupuzha, Kerala, India
|Date of Submission||14-Feb-2018|
|Date of Acceptance||24-Jan-2019|
|Date of Web Publication||15-Mar-2019|
Dr. P Abdul Saheer
B4/ALSA Palm Springs, RC Road, Kozhikode, Kerala
Source of Support: None, Conflict of Interest: None
Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a syndrome not only to deal with by the clinician, but also to understand the social implications with proper magnitude. Aim: To assess the knowledge and attitude regarding HIV/AIDS patients among dental students in Thodupuzha, Kerala. Materials and Methods: A cross-sectional study was carried out on 341 dental students studying at a dental college in South Kerala, India. The students completed a predesigned self-administered questionnaire assessing the knowledge, attitude, and willingness to treat HIV/AIDS patients. SPSS software version 20 was used for the analysis. The data were analyzed using Student's t-test and analysis of variance. P < 0.01 was considered statistically significant. Results: More than half of the students (58.67%) had positive knowledge. There was a significant difference in knowledge score between the first-, second-, third-, and final-year students (P < 0.001). The favorable attitude score was reported among 22.22% of the study participants. There was no significant difference in the attitude of the students between the 1st, 2nd, and 3rd years, whereas significant difference was observed between students of final year and remaining batches (P < 0.001). Conclusions: The findings suggest that, although the students had adequate knowledge about HIV/AIDS, their attitude toward this group of people was not favorable.
Keywords: Acquired immunodeficiency syndrome, attitude, dental students, human immunodeficiency virus, knowledge
|How to cite this article:|
Saheer P A, Fabna K, Febeena P M, Devika S, Renjith G, Shanila A M. Knowledge and attitude of dental students toward human immunodeficiency virus/acquired immunodeficiency syndrome patients: A cross-sectional study in Thodupzha, Kerala. J Indian Assoc Public Health Dent 2019;17:66-9
|How to cite this URL:|
Saheer P A, Fabna K, Febeena P M, Devika S, Renjith G, Shanila A M. Knowledge and attitude of dental students toward human immunodeficiency virus/acquired immunodeficiency syndrome patients: A cross-sectional study in Thodupzha, Kerala. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2020 Nov 28];17:66-9. Available from: https://www.jiaphd.org/text.asp?2019/17/1/66/254331
| Introduction|| |
Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are globally emerging public health problems. India alone accounts for over 25 million people living with HIV/AIDS (PLWHA). Their estimated prevalence is 0.91%, and this figure is expected to increase further. The success of antiretroviral therapy in bringing down the viral load and significantly improving the CD4 counts has improved the life expectancy of PLWHA. Oral health-care needs among PLWHA are proportionally higher because oral conditions occur in a large proportion of them. With improved survival rates, it is expected that more PLWHA will be seeking dental care in the near future. Because of the possible transmission of HIV virus through direct contact with blood, the risk of cross infection comes into particular focus in dental practice. The risk of occupational transmission of the virus from a patient to a health-care provider has been estimated at 0%–3% after a single percutaneous exposure to HIV-infected blood. Fear of HIV contagion and AIDS phobia among health-care providers are obstacles in the successful delivery of dental care to PLWHA. Dentists have a professional and ethical responsibility to provide oral health care to all individuals without discrimination. According to the World Health Organization, it is compulsory for all dentists to treat HIV-positive patients., It is unethical and unlawful for a dentist or a dental student to refuse to treat a HIV-positive patient; despite these recommendations, few dentists are reluctant or refuse to treat HIV/AIDS patients due to lack of knowledge and ignorance about the disease. Control of infectious diseases including HIV/AIDS and cross infection forms a part of curriculum of the dental course, and it is being taught from the third year of the BDS course. It is expected that HIV/AIDS education and knowledge eliminates the stigma and phobia among the students and prepares them to morally accept the responsibility to provide oral health care to PLWHA. A dentist is supposed to know the various aspects of cross infection and precautions to be taken before treating a HIV patient. A minor negligence in handling these patients poses potential risk to the dentist himself/herself. Furthermore, dentists could easily detect any early symptoms of deadly HIV and direct the suspected for further treatment, so the disease can be intervened at the very early stage. Hence, a positive and welcoming attitude of a dentist would definitely help those suspected patients to seek further treatment. Hence, understanding the dental students' knowledge regarding HIV/AIDS and their attitude toward the patients is important. Hence, the aim of this study was to assess dental students' knowledge of HIV/AIDS and their attitude toward PLWHA and willingness to treat PLWHA and also to compare the knowledge and attitude of preclinical and clinical dental students regarding HIV/AIDS patients.
| Materials and Methods|| |
A cross-sectional study was conducted in Thodupuzha city, Southern Kerala (during October 2017), among all the dental students to assess the knowledge and attitude toward HIV/AIDS patients. Approval was obtained from the Institutional Review Board (AAMC/2653/17), and permission was taken from college authorities. Informed consent from participants was obtained. The questionnaire was adapted from the survey questionnaire used by Sadeghi and Hakimi with some modifications. A pilot study was done to check the psychometric properties of the questionnaire and was found to be satisfactory (kappa = 0.80). Data collection was done by distributing questionnaire [Table 1] and [Table 2] among the students during the lecture time with prior permission. A brief introduction about the topic was given before the distribution of questionnaire. The questionnaire included 22 closed questions (first 11 questions to assess knowledge and the latter 11 to assess attitude). Participants had the options of “correct” and “incorrect” to answer the knowledge-related questions. For every correct answer (positive knowledge), a score of 1 was assigned and a score of 0 for every incorrect answer. Eleven questions evaluating the attitude toward PLWHA and willingness to treat were rated on a 5-point Likert scale using options of strongly agree, agree, neutral, disagree, and strongly disagree. Participants' responses of “agree” and “strongly agree” were considered as favorable attitude and all the other responses were ignored. SPSS software version 19.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. The comparison between the groups was performed by analysis of variance and Student's t-test. P < 0.01 was considered statistically significant.
|Table 1: Correct responses of students to questions about knowledge regarding human immunodeficiency virus/acquired immunodeficiency syndrome|
Click here to view
|Table 2: Favorable (strongly agree/agree) responses of students to questions about attitude toward human immunodeficiency virus/acquired immunodeficiency syndrome|
Click here to view
| Results|| |
The sample included 62 males and 279 females. The sample was divided into two sections, that is, preclinicals and clinicals, which included 216 and 125 students in the respective categories. Students with correct answer to the question “Needle stick injury as a cause of disease spreading” were 82% and 100% in the 1st and final years, respectively. Question “Medical and paramedical staff is more prone to HIV infection” was correctly answered by 21.4% final-year students as compared to 65% of the 1st-year students. Attitude-related questions showed some marked difference in responses between the batches. Question regarding “moral responsibility to treat HIV patients” was favorably answered by 0% of the first-year students as compared to 94.6% of the final-year students. Questions such as “One can safely treat HIV/AIDS patients (3% and 85.7%); “Risk of HIV contagion is high, hence special precautions have to be followed to treat HIV/AIDS patients” (16% and 98.2%); “I will deliver emergency care to HIV/AIDS patients if need arises” (1% and 92.8%) also had similar responses [Table 1] and [Table 2].
The overall positive knowledge score reported was 58.67 ± 2.64. It was noticed that the clinical sections (72.99 ± 2.13) with better positive knowledge compared to the preclinical (44.35 ± 2.46) section (P < 0.01) [Table 3]. The overall favorable attitude score was 22.22 ± 1.75, with significantly higher score in clinical section (28.35 ± 1.77) compared to the preclinical group (16.1 ± 1.65) (P < 0.01) [Table 3]. Comparison of knowledge scores between the years of study showed the highest score among the second–year students (78.57 ± 1.44), and a significant difference was observed between all the years of study in post hoc analysis (P < 0.01) [Table 4]. The favorable attitude was reported to be the highest among the final years (40.5 ± 1.64) which was significantly different from the other years of study (P < 0.01), but the difference was not observed between the remaining years of dental curriculum (1st, 2nd, and 3rd years) (P > 0.01) [Table 5].
|Table 3: Comparison of knowledge and attitude between preclinical and clinical students|
Click here to view
| Discussion|| |
The present study assessed knowledge/attitude regarding HIV/AIDS patients among dental students. The study showed that the knowledge level of clinical students is better than that of preclinical group. For the ease of comparison, we used the percentage of students with positive knowledge/favorable attitude than the mean score in each group as there is difference in student population strength in each group. Student population with positive knowledge constituted 55.87%. The knowledge score was significantly different between the years of study (P < 0.001%), which is similar to the studies by Sheikh et al. and Patil et al. This may be attributed to the improved knowledge acquired as one progresses through the curriculum and also the difference in study topics in the curriculum. A different finding was reported by Shan et al., Ryalat et al., Seacat et al., and Sheikh et al. The present study reported that the number of students having favorable attitude was very low, that is, a mere 22.22% responded strongly agree/agree to the attitude/willingness questions. A marked difference in positive attitude score was observed between the final-year (72.59%) and the remaining batches of students, and only less than 20% of the 1st-, 2nd-, and 3rd-year students expressed favorable attitude. Similar result was reported by Shan et al., Ryalat et al., and Seacat et al. Previous researchers have also reported high negative attitude of students rating the risk of HIV contagion from HIV/AIDS patients during treatment.,, The topics related to infection control and other aseptic procedures including various infectious diseases are mainly being covered from the third-year curriculum onward. Hence, the level of knowledge/attitude is invariably expected to be low in the preclinical student groups irrespective of the year of study. Salivary and aerosols' contamination in dental practice was considered as the means of HIV transmission by the majority of students. Hence, researchers highlighted that the present education system is at the victim end. The methods of training should go beyond a one-way communication of knowledge and should emphasize on problem-based techniques that include experimental methods or affective component to improve self-esteem and also to include social activities in the curriculum to improve their empathic profile of character. One cannot expect a dentist/doctor to welcome a known HIV/AIDS patient without having adequate stimulation from his/her social perspective. Furthermore, incorporating psychological aspects of treating HIV/AIDS patients in the curriculum has been proven as an effective method of improving the attitude of students toward PLWHA and sensitizing them to be sympathetic.,
Limitations and recommendations
The generalizability of the present study may be interpreted considering the limited sample size and single-centered study nature and also the possibility of social desirability bias. A well-organized multicentric trial could light a better explanation into the determinants of lack of favorable attitude.
| Conclusions|| |
The study showed that dental students possess better knowledge and negative attitude toward HIV/AIDS patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Swaminathan S, Nagendran G. HIV and tuberculosis in India. J Biosci 2008;33:527-37.
Wig N, Lekshmi R, Pal H, Ahuja V, Mittal CM, Agarwal SK, et al.
The impact of HIV/AIDS on the quality of life: A cross sectional study in North India. Indian J Med Sci 2006;60:3-12.
] [Full text]
Seacat JD, Litt MD, Daniels AS. Dental students treating patients living with HIV/AIDS: The influence of attitudes and HIV knowledge. J Dent Educ 2009;73:437-44.
Börsum KM, Gjermo PE. Relationship between knowledge and attitudes regarding HIV/AIDS among dental school employees and students. Eur J Dent Educ 2004;8:105-10.
Robert LM, Bell DM. HIV transmission in the health-care setting. Risks to health-care workers and patients. Infect Dis Clin North Am 1994;8:319-29.
Nasir EF, Astrøm AN, David J, Ali RW. HIV and AIDS related knowledge, sources of information, and reported need for further education among dental students in Sudan – A cross sectional study. BMC Public Health 2008;8:286.
Lohrmann C, Välimäki M, Suominen T, Muinonen U, Dassen T, Peate I, et al.
German nursing students' knowledge of and attitudes to HIV and AIDS: Two decades after the first AIDS cases. J Adv Nurs 2000;31:696-703.
Astrom AN, Nasir EF. Predicting intention to treat HIV-infected patients among Tanzanian and Sudanese medical and dental students using the theory of planned behavior – A cross sectional study. BMC Health Serv Res 2009;9:213.
Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ 2005;83:700-6.
Sadeghi M, Hakimi H. Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. J Dent Educ 2009;73:740-5.
Sheikh H, Shankar S, Vinay S. Knowledge and attitudes of undergraduate dental students in the Oxford Dental College Hospital and Research Centre, Bangalore toward patients with HIV/AIDS. J Acquir Immune Defic Syndr 2011;2:1-5.
Patil PB, Sreenivasan V, Goel A. Knowledge of HIV/AIDS and attitude of dental students towards HIV/AIDS patients: A cross-sectional survey. J Educ Ethics Dent 2011;1;2:59-63.
Shan V, Shethwala ND, Bala DV. Knowledge, attitude and health behavior of dental students towards HIV patients. Health Line 2011;2:58-60.
Ryalat ST, Sawair FA, Shayyab MH, Amin WM. The knowledge and attitude about HIV/AIDS among Jordanian dental students: (Clinical versus preclinical students) at the University of Jordan. BMC Res Notes 2011;4:191.
Azodo C, Umoh A, Ezeja E, Ukpebor M. A survey of HIV related knowledge and attitude among dental nursing students in South Western Nigeria. Benin J Postgrad Med 2007;9:1-12.
Kopacz DR, Grossman LS, Klamen DL. Medical students and AIDS: Knowledge, attitudes and implications for education. Health Educ Res 1999;14:1-6.
Azodo CC, Ehigiator O, Oboro HO, Ehizele AO, Umoh A, Ezeja EB, et al.
Nigerian dental students' willingness to treat HIV-positive patients. J Dent Educ 2010;74:446-52.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]