Date of Award

May 2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Urban Education

First Advisor

Barbara J Daley

Committee Members

Anne Dressel, Simone C O Conceicao, Rajeswari Swaminathan

Keywords

Clinical Knowledge Translation, Continuing Medical Education, Ghana, Hypertension, Primary Care Physicians, Sub-Sahara Africa

Abstract

ABSTRACT

AN INVESTIGATION INTO GHANAIAN PRIMARY CARE PHYSICIANS’ BELIEFS AND THEIR INFLUENCE ON CLINICAL KNOWLEDGE TRANSLATION

by

Linda D. Caples

The University of Wisconsin-Milwaukee, 2019

Under the Supervision of Professor Barbara Daley, PhD

There is a disconnect between the use of evidence-based clinical practice guidelines and the medical practice of Ghanaian primary care physicians in the care of hypertensive patients. This study sought to answer the question of how the formal and informal beliefs of Ghanaian primary care physicians influence clinical knowledge translation in the management of hypertension in adults. The process of clinical knowledge translation helps physicians construct knowledge along with interactions with other healthcare professionals, their patients, and the communities they serve. These interactions help inform a physician’s salient beliefs. Thus, the use of the Theory of Planned Behavior (TPB) facilitated research into how background factors influenced behavioral, normative, and control beliefs and in turn, how those beliefs influenced intentions and ultimately, physician behavior. Findings in the form of six themes illustrate the importance of culture and context in shaping the beliefs of how primary care physicians saw their patients and how they translated clinical knowledge into medical practice.

The background factors such as a physician’s gender, medical school training, clinical setting, health sector, specialty, and years in practice had some influence on beliefs. However, the patient population significantly influenced their beliefs particularly their interactions with patients within the culture and context of Ghana. Additionally, clinical knowledge translation is supported using continuing medication education (CME) as a primary channel of knowledge translation and as a means to educate physicians and other health care professionals about clinical practice guidelines. Incorporating culture and context into the development of CME content is important for effective clinical knowledge translation and improved patient care. This is particularly important in medically pluralistic societies such as Ghana, where primary care physicians are few and traditional medical practitioners are prevalent. Implications of this research may shape policy, future CME content development, and CME research.

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