Category: Attitude

There will always be so many things running through your mind, but your gut feeling is always something you should listen to. Just by having that one gut feeling it can change your attitude on the output and even change your decision. Most of the time it’s for the better and really how your true self is feeling in that moment.

When it comes to your feelings, it helps make decisions easier, and with what they find in that decision by themselves are usually what is in the best interest for them. But sometimes your feelings can undermine your choices which can be the wrong choice in the moment and won’t be helpful with your decisions. Emotions have been playing a crucial role in the process of making any decisions. You can have overall negative and positive feelings with your decisions. People often rely on their feelings when asked about a topic. They consult not by what they thought or what they knew about the topic, but how they felt about the information they knew about the topic. Although a lot of people are told to ‘go with your gut feeling’ and sometimes it sounds silly, but it actually has a lot of upstream outcomes with it. I personally can say that going with my gut feeling has got me out of situations I didn’t want to be in to begin with, but I’ve also been in positions where I didn’t listen to my gut feeling and everything went wrong for me. Till this day, I will always go with my gut feeling because it’s always been a positive outcome for me and for many other people that I know. Between mental states and actions, it will help find that individual mental state of others as more representative of true selves and how others represent their action tendencies. When you understand the mental state more and people’s tendencies, it reveals their true self.

The true self is so deeply on how your actual self might outwardly, thinking or even act depending on the different situations. Even though your true self to another person might be seen as a residing in feelings. True selves of others see how individuals see their own choices as reflective of their true selves. Sometimes it’s hard being your true self because you don’t want to be judged or be uncomfortable in situations. Although you might have those feelings of being your true self is something you should always want to be. You will connect to your true self and feel stronger felt when able to be yourself. Being yourself enables better and more satisfying decisions. Having that self-love and believing in yourself will always allow yourself to be your true self and making life more meaningful. People utilize their affective reactions for cognitive feedback regarding those thoughts and actions. This will help with positive affects patterns and negative effects, sounding the signals to change course. Being yourself in decision-making lead people to be more certain when it comes to their attitudes regarding people’s options.

People’s attitudes should feel more certain about it because it reflects their true selves. One person’s attitude can seek how you view them each time. The attitude will change the individual opinion on that topic for the better, but sometimes even for the worse. With that attitude it can be betrayed as a strength and how a person views themselves. People should feel more certain about their attitudes regarding options that reflect their true selves. Having that strong attitude will come with respect and to choose your own outcome. You shouldn’t feel like you have to hide your attitude when you believe in something so strongly. That is being true to yourself and not letting anyone make you feel bad for being yourself. A lot of people thing having a bad attitude is always for the worst, but you don’t necessarily have to have a bad attitude when sticking with your gut and not allowing anyone change how you are feeling. I believe that having gut feelings and staying true to yourself plays a huge role in having an attitude because those things reflect on your attitude.

Looking back on what I have learned, I believe that gut choices, being yourself, and attitude play huge a huge role in your life. They shape you into the person you are today and how you view everything in life, it keeps you from holding back and letting people know how your truly feel. Whether it’s for the good or bad, you are never holding things in, letting people effect your decision and staying true to yourself. Knowing that these three topics are important in your life I feel like it will keep you from getting hurt, getting let down, or even not believing in yourself. Once you figure out that is true in you will becomes into a person you love.

Through the close exploration of both john donnes holy sonnets and Margaret Edson’s post-modernist text wit, we are able to collect that context plays a vital role in the construction and understanding of a text. Both texts portray the flaws and faults of humanity and the necessity of individual redemption. Edson has managed to take the strong religious ideas of Donne’s poetry and even his metaphysical conceits and translate them into the secular world. Professor Vivian bearing, a ‘scholar of seventeenth century metaphysical poetry ‘, allows for a connection between Donne’s deeply spiritual and intimate writing, and the secular and emotionless world of the modern hospital ward.

Donne’s increasing religious references are highly reliant on him being a clergyman but also due to his holy sonnet’s being written during the Jacobean era where there was a rise in protestant Christianity. He continues to engage with the big ideas of life, such as the increasing confidence of humanity, depicted in its attitude towards death. Donne expresses the arrogant attitudes of humanity towards death in his sonnet “Death Be not Proud”, whereby he states, “Death be not proud, though some have called thee mighty and dreadful, but thou are not soe”. In the line he personifies the concept of death which greatly disempowers it. Donne portrays his Christian ideals on salvation and represents the strong optimism and confidence of humanity, by eliminating the perception of death being fearful. Comparably Edson’s text wit, also explores this central idea, however, it is reshaped in the context of a post-modernistic society. The portrayal of societies lack fear from impending death is shown through the protagonist Vivian bearing and her approach towards being diagnosed with cancer. In her stream of consciousness during her appointment she states” insidious. Mm curious word, cancer, cancer”. Edson’s utilisation of repetition and the analytical process reveals the preference of intellect to enhance their confidence towards death and its parallel cancer. Similar to how Donne conveys his intellect through the use of strong rhetoric in “From rest and sleepe, which by thy pictures be, much more than from thee, much more must flow”. The alliteration allows for a peaceful representation of death, eliminating the association of fear and further showcases Donne’s Christian beliefs. Conversely, in the sonnet” Hymne to god, my god, in my sickness”. Donne portrays their superiority and confidence in humanity, rather than emotional comfort in “physicians. …Lone grown cosmographers and I their Mapp”. During the renaissance period cosmography was a serious study and is cleverly used as a conceit to reveal the strong intellect. As such this idea has been reshaped in Edson’s text, through the scientist’s research and approach towards Vivian’s cancer. In particular when Jason Posner labels cancer as” immortality in culture”. Revealing the medical worlds preference on research rather than the emotional wellbeing of patients. Thus, both Donne and Edson expose the flaws of humanity and criticise their faults.

Another crucial fault of mankind is explored in the increasing power of intellect and the failure of humanity to understand the necessity of having emotional comfort. Donne reveals this in his poem “if poisonous minerals”, the title of the poem refers to sin and also the intellectual doubts which mentally challenge Donne, but he further exposes the downfall of humanity in “if lecherous goats and serpents envious cannot be damn’d, alas why should I be?”. The use of rhetorical question and tone reveals his frustration and intellectual contemplation as to why the pure man should be punished when the animals symbolic of “deadly sins” escape and are unscathed from god’s wrath. The key idea of poisoning the values and ideals of humanity is also creatively mirrored within Wit, revealed when Vivian says, “My treatment imperils my health”. The paradox depicts Vivian’s inability to grasp the “simple human truth”. This truth Donne also illustrates within his poem “death be not proud”, shown in “Nothing but a breath-a comma-separates life from life everlasting. “The positioning of the word”comma”portrays the importance of it metaphorically embodying the shortness of death.However Vivian fails to see this and thinks of it as a mere predantic case of punctuation.Her annoyance is revealed in “

Abstract

Many important factors are taken into consideration while trying to understand an individual’s choices and attitudes. This is a study conducted to understand how attitude affects the decision-making styles of an individual and if there are any differences among first born and middle born students. The study has 2 main objectives: 1) to understand the role played by the attitudes one has towards himself in his decision-making process 2) to analyse if being a first born or middle born impacts the attitudes or decision-making style of an individual. The results of the paper showed that there is a correlation between Decision-Making Styles and Attitude Towards Self (.186) and Age and Decision-Making Styles (.208)

Keywords: Attitude Towards Self, Decision Making Styles, Birth Order, First Born, Middle Born

Decision Making Styles and Attitude towards Self in First and Middle Born

Decision Making

Decision making is the process of analysing two or more given options and choosing the one best suited for one. Decision-making is defined as determining one or more options among the possible options in accordance with the target and objectives. Making correct and timely decisions brings about many advantages for people (Eroglu and Lorcu 2007). This process requires critical thinking, reasoning, abstract thinking and rational thought. An individual’s decisions are influenced by his values, beliefs, experiences, biases and culture. Values and beliefs shape an individual’s thinking and negative or positive outcomes in the past shape his future decision making. If a previous decision has led to a very unfavourable outcome, the individual avoids taking that course of action again. Seeking counsel is also a very important part of decision making. Many times, high school students go for career counselling and undertake many aptitude tests to help them determine the best career options. Another important factor that influences decisions is biases or personal preferences.

Throughout their life, people come across many instances where they need to choose between two or more alternatives. Uncertainty of outcome is an unavoidable part of most decisions because of decision making can be frightening. Some people tend to gather information and seek advice from professionals to make well informed decisions. Another logical step is weighing down the good and the bad and selecting the best alternative. It is a very lengthy process and each person adopts different patterns of thinking while evaluating their options.

All in all, decision making is a very integral and unavoidable part of life. From the time we’re old enough to think to the time we die, we are bound to make decisions which vary in importance. Children are faced with the challenge of selecting a toy, whereas adults need to make major decisions regarding their career, family and various other things.

Decision making styles are strategies adopted for reaching the right decision. According to Scott and Bruce (1995) there are five primary decision-making styles which dictate how an individual chooses between different alternatives when the need calls for it. Rational style is governed by a thorough search and logical evaluations. Some people tend to avoid and postponing taking decisions to the eleventh hour. This style is termed as the avoidant style. Thirdly, people may take quick decisions as they want to finish their decision making as fast as possible. These people adopt a spontaneous style. People adopting a dependent style may seek counsel from others instead of acting on their own. The intuitive style is characterized by attention to detail and a tendency to rely on feeling. (Bavolar & Orosova, 2015)

Commonly, people adopt the style best suited to their personality rather than the situation. Sometimes people don’t stick to one single strategy and adopt different ones based on various factors. Whether it’s a minor decision or a complex one, decision making can be a stressful process and each person’s approach is different. Decision-making is a complex process which is also determined by one’s attitude towards the situation and himself.

Attitude

Attitude refers to an evaluation of any event, object, person or place which can either be negative or positive in nature. Human beings have the tendency to form opinions about everything around them which may be favourable or unfavourable. (Baron and Branscombe, 2016)

Gordon Allport (1928) defined attitude as a mental and neural state of readiness, organized through experience, exerting a directive or dynamic influence upon the individual’s response to all objects and situations with which it is related.

Multiple factors contribute to the formation of attitudes. People may draw conclusions about an event, or a person based on previous exposure and past experiences. If they had a good experience, then they are more likely to develop a positive attitude towards the thing in question. On the other hand, negative attitudes are a result of bad experiences, unpleasant events and unfavourable outcomes (Baron and Branscombe, 2016). For example, if a person visits a restaurant and the waiters are receptive, serve food on time, cater to their needs and have a hygienic and pleasant environment then they will form a positive attitude towards the restaurant. However, if they go to a new restaurant which is disorganized, the waiters are rude and unhelpful, take lots of time to deliver food, has poor hygiene and serve bland food then they’re going to develop a negative attitude towards them. They are more likely to go to the first restaurant again than the second one. A person is also more likely to advice others against the second restaurant, henceforth influencing their attitude towards it without having experienced it first-hand.

In the teenage years, peers exercise considerable influence on the formation of attitudes. In this stage of life, children are struggling to identify with themselves and have a want to fit in their respective peer groups. Hence, they are more likely to think like their peers who serve as their reference groups than their family members. (Baron and Branscombe, 2016)

Media also has a considerable impact on attitudes. Various forms of media, especially television, can sway people’s minds in the desirable direction. They may paint positive or negative images of various objects, events and people which influence the masses. Sometimes, the media is the only source of some information people need so they tend to believe it and form attitudes based on what they hear. (Baron and Branscombe, 2016)

Culture also affects attitudes as different cultures value different things. In western culture there’s a more positive attitude towards individuality, diversity and freedom than in other cultures which value traditions and sameness over the former. Many studies say that many factors influence attitude and one such factor is birth order.

Birth Order

Birth Order psychology finds its roots in Alfred Adler’s theory of personality. Birth order refers to the chronological position of a sibling’s birth in their family. According to many studies, birth order influences the behaviour and nature of a person. Family dynamics shape the personality of children. The first-born child is typically considered to be more responsible and independent whereas the youngest to be more social and outgoing. Not much research has been done on middle-born young adults who are neither at the beginning or the end of the spectrum, but rather fall in the middle. (Adler, 1928)

Birth order psychology has recently gained popularity again, although some people think the role of this factor is being overestimated. However, several research studies have validated the role of birth order in personality. First-borns tend to be responsible, competitive and conventional, whereas later born children have to ‘distinguish’ themselves and create a specific niche by being playful, cooperative, and especially, rebellious,’ (Saroglou and Fiasse, 2003).

There has been extensive research into birth-order theory. Many studies look at how specific traits, such as intelligence or creativity, relate to birth order. Many of these studies have confirmed Adler’s theory regarding specific traits. When it comes to gender differences, birth order and number of siblings are found to matter more often among females than among males with respect to real-life decisions. (Lampi and Nordblom, 2011). Firstborns and last-born experience a higher degree of parental preference while middle born children are significantly less likely to be chosen as a parental favourite and also receive less parental investment (Salmon, 2003).

Parents play a huge role in how children see themselves and this could lead to a difference in high standards, self-criticism and generalization from a single failure in children. Little research has been done on attitude towards self and decision-making styles, however it’s possible that the attitude towards self as affected by birth order will lead to a relationship between birth order and decision-making styles (Shah, 2015)

There are numerous studies to understand decision making styles and attitudes among young adults. Some of them are discussed below:

A study was conducted by Bayram and Aydemir (2017) to examine the relationship between decision-making styles and personality traits among a group of Turkish university students. They used the Decision-Making Style Scale (DMS) developed by Scott and Bruce and The Big Five Inventory (BIF) developed by John, Donahue, and Kentle. Their main aims were to identify the relationship between decision making styles and personality traits taking gender into consideration. The findings indicated that females showed more intuitive decision-making capability than males and extraversion personality had a positive relation with rational and intuitive decision-making style. Men had significantly lower scores on agreeableness and neuroticism personality traits as compared to women. Neurotic personality had a positive effect on intuitive, dependent and spontaneous decision-making style. The relationship between extraversion and spontaneous decision-making style was positive. Openness to experience had a positive effect on rational decision-making style. Hence, personality played an important role in decision-making style.

Another study conducted in University of Arizona aimed to find out if there was any relationship between confidence in judgments/decisions made and birth order. Shah & Shruti Mukesh (2015) believed that being reminded of their birth position would affect the later born child’s judgement in a negative way and the first born in a positive way. However, the findings suggested no such relationship between the two. A significant relationship was observed between intuitive decision-making style and birth order; however, it was regardless of assigned condition. Another interesting thing to note was that the lastborn females had the lowest expressed confidence in their answers. Firstborn females on the other hand had the highest expressed confidence in their answers, but also exhibited heavy variability.

A study investigated the effects birth order has on personality, self-esteem, satisfaction with life and age. According to Sharon Johnson (2014), there would be significant differences between birth order categories and personality & self-esteem. She also wanted to study satisfaction in life in terms of self-esteem and personality. The results showed no statistically significant differences between birth order categories and extraversion, agreeableness, conscientiousness and neuroticism. There was however a statistically significant difference between birth order categories and openness to experience. Another thing to note was that last-born children were found to have higher levels of openness to experiences than middle born children.

A study was done by Nicole L Wood (2012) on Individual differences in decision making as predictors of good decision making& examined the relations between decision-making styles. It also evaluated the usefulness of decision-making styles for predicting decision-making quality over and above the Big Five traits. The results suggest that decision-making styles explain decision-making quality, even when the Big Five traits have already been considered. Self-reported rational decision-making style predicted peer rated reason-based, values-based, and general decision making. The Spontaneous style was negatively related to peer-rated reason-based and general decision making and self-reported avoidant style was negatively related to the former only. Because relations between dependent and intuitive decision-making styles, and values based and creative decision-making, failed to be significant, the findings suggested mixed results. However, overall habitual patterns and tendencies in the way a person approaches decisions and problems can impact decision outcomes.

Another study was done to verify the psychometric characteristics of the General Decision-Making on a sample of Slovak high-school and university students. The study was conducted by Bavol’ár & Orosová (2015) on 427 university and school students. It examined the relationship between decision making styles and competencies and its connection to mental health. The findings suggested that two decision-making styles served as significant predictors of the general decision-making competency (avoidant and spontaneous) and the other two helped in determining mental health. The intuitive decision-making style was a protective factor and the avoidant style was a risk factor. The GDMS internal consistency was verified and its original factor structure was confirmed.

In a study by Vaneaa& Ghizdareanu(2012), they sought to identify the differences between university student’s tendencies to adopt high standards and self-criticism taking gender, age and learning context into consideration. The sample size was 250 students. The findings suggested that the interaction between students’ gender and type of faculty they attend and age, year of study and study domain had an impact on both students’ tendencies to set high standards and to respond self-critically to the deviations from such standards. It was also noted that Psychology students set higher standards than people from technical faculties. The higher the standards were, the greater was self-criticism. Females also displayed lower tendency to meet high standards but higher scores in the self-criticism area.

A study done by Arslan and Yilmaz (2015) examined decision making styles and self-esteem at decision making of university students regarding shyness, self-esteem. The total sample size was 636 students. There was significant positive relationship between self-esteem and self-esteem in decision making. It was concluded that there is negative relation between shyness and self-esteem in decision-making and vigilance decision making. According to the findings, self-esteem at decision making and hyper vigilance decision-making were directly related. To conclude, self-esteem and shyness are effective in self-esteem in decision making and decision-making styles, whereas overlap with the theoretical information and findings of the previous research.

A study was done by Baganab& Negovana (2011) to examine the relationship between self-esteem and vulnerability to depression among high school and freshmen university. Data was collected from 200 students ranging from 17-21 years. High school students were reported to have higher standards as compared to university students. Among them, high school female students reported a higher level of self-criticism, overgeneralization of failure and of vulnerability to depression than the male, whereas the female university students reported a higher level of overgeneralization compared to their male peers. Significant differences were found between students’ self-esteem as a function of personal factors and as a function of contextual and situational factors.

Baganaa et al (2010) examined the gender, age and learning context differences on proactive coping and vulnerabilities to depression such as high standards, generalization from a single failure and self-criticism in a university environment. The findings proved that females are more able to proactively cope with the environmental demands than males. However, they showed higher scores for the three vulnerabilities than their male counterparts who scored low in that area.

The present study focuses on the relationship between Decision-Making and Attitudes Towards Self with respect to Gender, Age, Parent Support, Birth Order and other such independent variables. This study focuses on the need to analyse the correlation between Decision Making Styles and Attitudes Towards Self. The researcher has decided to focus on this topic due to lack of information regarding this topic online. There is also an extensive need to focus on variables such as Decision Making and Attitudes that may affect the self-image as well as the future of a young adult. The researcher also wanted to focus on family dynamics and their role in any individual’s decision-making process and attitudes. Another important reason for choosing this topic was to understand various aspects such as Age and Gender and the influence they have on an individual.

Research Questions

• Is there a relationship between decision making styles and attitude towards self?
• Do factors like age, gender and birth order affect attitudes and decision making?

Objectives

• To study the profile of the respondents.
• To study the levels of attitude and decision-making styles.
• To study the levels of the rational, intuitive, dependent, avoidant and spontaneous styles.
• To study the levels of attitude towards self.
• To know the relationship between decision making and attitude towards self
• To understand if there is an impact of age and gender on decision making and attitude towards self.
• To know if there is any difference in the attitude and decision-making style based on birth order

Hypotheses

• There is a relationship between attitude and decision-making style.
• There exists difference in the attitude and decision-making style based on birth order
• There is a correlation between age and decision making.
• There is a correlation between decision-making styles and attitudes towards self.
• There is a correlation between first born/middle born with decision making and attitudes

Method

Research Design

Research design is the logical and systematic planning in directing the research. The present study is performed using a quantitative methodology with a non-experimental comparative design and propose to analyse my data using measures of central tendency, dispersion, correlation and t-test. Non-experimental comparative design is also known as correlational research design. Within correlational research, researchers are primarily interested in determining non-causal relationships amongst variables. More specifically, the correlational research design is a type of non-experimental study in which relationships are assessed without manipulating independent variables or randomly assigning participants to different conditions.

Sample

The present study aims at 120 young adults who fall in the age group of 16-21. Data was collected from 61 males and 59 females. The researcher focused on first born and middle born young adults. To get the sample, the researcher used purposive sampling method. The sample size has been determined by the institution as the research is conducted in an Under Graduate level.

Procedure

The researcher used questionnaire method to collect data. The researcher approached different participants in the college setting. Respondents were informed that participation was voluntary and that the information provided by them in the questionnaire will be confidential. The participants were requested to answer the questions with complete honesty and were supposed to be as reliable as possible. They were also informed that there was no definite time limit to finish the questionnaires.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Participants who fall in the age group of 16-21
• Participants who were the first born and middle born child

Exclusion Criteria

• Participants with more than four siblings were avoided.
• Participants other than Hyderabad.

Research Instrument

General Decision-Making Style (GDMS)

The General Decision-Making Styles Questionnaire (GDMS) was developed by Scott and Bruce in 1995. GDMS is a very easy to administer, self-report questionnaire consisting of 25 items. It is comprised of five subscales: rational, intuitive, dependent, avoidant, and spontaneous decision-making styles. A higher score on any of the five scales indicates a higher presence of that particular decision-making style. The GDMS has good validity and reliability ratings. Scott and Bruce (1995) have validated each of the five scales on the GDMS. Content and face validity range from .68 to .95, internal reliability ranges from .67 to .87, and test-retest reliability ranges from .58 to .67 (Spicer & Sadler-Smith, 2005). Internal reliability for the rational scale is reported to be between .77 and .85, the intuitive scale, .78-.84, the avoidant scale, .93-.94, the dependent scale, .68- .86, and the spontaneous scale, .87.

Attitude Towards Self (ATS)

The Attitudes Towards Self (ATS) Scale was developed by Charles Carver in 1983. This instrument measures three constructs: holding of overly high standards; the tendency to be self-critical at any failure to perform well; and the tendency to generalize from a single failure to the broader sense of self-worth. The instrument consists of 10 questions scored on a 5-point rating scale. Scoring Instructions were clearly given him. All items except question five were to be reverse scored. The three scales of the ATS are factorially distinct, and several samples have demonstrated this. Alpha reliabilities in these samples were on average .76 for the High Standards Scale, .78 for the Self Criticism Scale, and .78 for the Generalisation Scale. In this sample, women reported a stronger tendency towards Generalisation. Internal consistency of the three subscales and of the entire scale was very good (α – Cronbach coefficients of 0.71 to .90).

Data Analysis

Percentages have been calculated to analyse the profile of the respondents that include Age, Gender, Family Size, Religion, Family Type, Personality, Parent support, Home Environment, Number of siblings and Relationship with siblings. The measures of central tendency and standard deviation of the variables, decision making, and attitudes was calculated separately. Correlations and t- test was also applied wherever it is required.

Results

Table 1 shows the t-test ration between birth order and decision-making styles and attitudes.

First Born

Middle Born

t-ratio

Sig.

(n=61)

(n=59)

M

SD

M

SD

Rational

20.1639

3.76023

19.9831

4.00212

.255

.799

Intuitive

20.2951

3.39286

19.3390

3.35081

1.553

.123

Dependent

Avoidant

Spontaneous

High Standards

Self-Criticism

Generalization

17.9016

14.3607

15.5902

12.3443

11.3443

12.8197

3.68196

4.90929

4.22838

2.77420

2.98265

3.96866

18.0847

15.5763

16.4915

12.1864

12.1186

13.4746

5.40845

5.27585

4.34056

2.39593

2.98897

4.17858

-.217

-1.307

-1.152

.333

-1.420

-.881

.828

.194

.252

.740

.158

.380

In Table 4, an independent sample t-test was conducted to compare birth order to the two scales that is decision making styles and attitude towards self. There was no significant difference found between first born and middle born respondents in the subscales of Decision-Making Styles and Attitude Towards Self. Difference based on Self-Criticism was observed.

Table 2 shows the correlation between Age, decision making and attitude towards self.

Attitudes Towards High Standards Self Criticism Generalization Age

Self

Decision .186* .185* -.208*

Making

Rational 0.203*

Intuitive .281**

Dependent .255* – .212*

Avoidant 0.218* .281** .241** -.266**

Spontaneous

Note:

** Correlation is significant at 0.01 level (2-tailed)

* Correlation is significant at 0.05 level (2-tailed)

ABSTRACT

• Background: The World Health Organization (WHO), states categorically that Hepatitis B infection is the world’s most prevalent liver infection. Nearly forty five percent of the global population lives endemic regions. [1]
• Objective: To analyze the information , attitude, and practices of dental pupils regarding the Hepatitis B Virus infection at Taif university dental college institution of the Kingdom of Saudi Arabia
• Materials and Methods: A cross-sectional survey was conducted using, a validated, pretested, structured questionnaire containing 14 questions on awareness, transmission, prevention, diagnosis, treatment, vaccination status, and post-exposure prophylaxis of HBV infection. Descriptive statistics were carried out along with the chi-square test and contingency coefficient.
• Result: The response rate was ranging from 92% to 100% (n = 100) A total of (100%) pupils have heard of hepatitis B disease. Only 83,3% of pupils were immunized against HBV. A total of (94.4%)of pupils knew that hepatitis B is transmitted through contaminated or infected blood transfusions. Only 63.9% of pupils knew about the precise protocols about management of the post HBV problems.
• Conclusion: The overall awareness regarding HBV disease was found to be acceptable among dental pupils and Hepatitis B awareness education improved their adherence to infection control protocols.

Introduction

The World Health Organization (WHO), states categorically that Hepatitis B infection is the world’s most prevalent liver infection. Nearly forty five percent of the global population lives endemic regions. [1] This blood borne infection places a significant occupational risk amongst the health care workers. [2]

In dental setup, the possible forms by which HBV infection can be transmitted are from contact with blood or saliva of infected patients during dental procedures, while drawing blood, giving injections, or suturing, and needle stick injuries sustained while performing procedures.[3,4).

Dentists are also at an increased risk of cross-infection while treating patients{5,6}. The risk of cross-infection increases more because many infected patients are unaware of their status not willing to disclose their disease status. {5}

Dentist compliance with these recommendations and infection control programs has been recently studied in different parts of the world.[6} These studies indicate that there are gaps in dentist’s information regarding modes of transmission, infection from needle stick injuries, and awareness about general measures which protect against HBV transmission{6}

The incidence of HBV can be reduced by proper education of its transmission and immunizations to the public, and all healthcare workers, and pupils {7}. There is no adequate data on the information of hepatitis B among dentistry pupils in the Taif, Kingdom of Saudi Arabia. Hence this forms the base of the present study which aimed to analyze the awareness of hepatitis B infection among the clinical pupils in Taif University(dental faculty)

Material and Method

This is an institutional-based study to determine the awareness, attitudes, practice, regarding hepatitis B infection among dental pupils in Taif , Kingdom of Saudi Arabia University. A cross-sectional observational study was conducted among the pupils. The study population comprised graduate dental pupils from all the years( second year, third year, fourth year, fifth year, sixth year and interns), except (first year) total sample size was 100. The study protocol was reviewed by the institutional ethical board. The study was conducted in a duration of 3 months from January to March 2019, The necessary permission to carry out the study was obtained from the respective authorities of the dental colleges. Informed consent was obtained from all the pupils. Before the commencement of the main study, a pilot study was conducted among 15 pupils to assess the feasibility and validity of the questioner. A pretested, structured and validated questionnaire was polled to the pupils to collect relevant data about the HBV infections.

(Questions 1–8), attitude (Questions 8–11), and practices (Questions 12–14) of dental pupils regarding HBV infection. The data entry and statistical analysis were done using statistical package for social sciences (SPSS) version 14 for Windows. Descriptive statistical analysis has been carried out in this study

Results

A total of 100 dental pupils participated in the study. Of these 15 were -2nd year-student, 20, 3rd-year student,15,4th year student 20,5th year student.18,6th year student and, interns. The response was 100% among 3rd and 5th-year dental pupils,95% among 2nd and 4th-year dental pupils,98% among 6th-year dental pupils,92% among interns.

A total of 14 questions were asked separated into three main parts,[KAP] Information , attitude, practice. The details of the questioner are given in (Tap1)

In information part A, a total of (100%) pupils have heard of hepatitis B disease. Only a total of (33.3%) of the pupils knew the incubation period of HBV while (56,6%) of pupils did not know. A total of (94.4%)of pupils knew that hepatitis B is transmitted through contaminated or infected blood transfusions. A total of (25%) of pupils knew about the correct immunization intervals. A total of (52,8%) of pupils, they were aware of the risk of exposure to hepatitis before entering dental college, while(47,2%) of pupils weren’t aware. A total of (91,7%) of pupils were aware of the risk of transmission of hepatitis B in their profession. A total of (63,9%) of pupils they aware of the first aid treatment in case of accidental exposure to hepatitis. A total of (22.2%) of pupils knew that hepatitis manifests as jaundice.

A total of (83,3%) of pupils reported that they were vaccinated against hepatitis B.A total of (80,6%) of pupils thy believe that the Dentist has a professional and moral duty to treat hepatitis B infected patient.A total of (58,3%) of pupils answered that Hepatitis patients should be treated separately in a clinic, while (38,9%) of student in the negative . A total of (2,8%) of polled that they did not know. The last part is practice and the total number of questions is 3, A total of (99,9%) of pupils they use gloves In daily clinical practice, A total(99,9%) they change gloves between patients. A total of(99,9%) of pupils In daily clinical practice always use facemasks as it is a standardized protocol.

Discussion

Hepatitis B infection is a serious blood-borne disease, caused by the hepatitis B virus (HBV) which attacks the liver and although in acute cases rarely results in liver failure and death. The main public health problem is that this can lead to lifelong chronic HBV infection, which may be followed by cirrhosis and/or liver cancer. Chronically infected carriers can transmit HBV through contact with their body fluids, which includes occupational exposure to their blood and secretions, sexual intercourse. People at risk include Health service professions in contact with blood and human secretions, hemodialysis staff, oncology, and chemotherapy nurses, all personnel at risk of needlestick/sharps injuries, which includes those working in operating rooms and clinical laboratories, respiratory therapists, surgeons, doctors, dentists, medical, dental and nursing pupils [8] . This study has shown that , A total of (94.4%)of pupils knew that hepatitis B is transmitted through contaminated or infected blood transfusions And that a total of (83,3%) of pupils they were vaccinated against hepatitis B [8].

Another study conducted among first-year dental pupils among three dental colleges in Haryana, India, showed that 84.9% of the pupils were aware of the spread of HBV infection and only 23.7% of the pupils had complete vaccination against hepatitis B[9]. A similar study done in Taiwan reported that 75.0% of the dental pupils had information of hepatitis B infection, but had little, information about vaccine dosage, transmission, prevention, and precautions of HBV infection.[10] Another study done on dental pupils in Maharashtra, India indicated that they had good information about HBV infection.[11], A study done among

Iranian dental pupils showed that they had a relatively good level of information about HBV infection and its control practices.[12] Another study done at the University of Dundee on medical and dental pupils showed that 99.2% of pupils were aware of HBV immunization.[13] In this scientific poll the overall level of information about HBV infection among dental pupils of various levels in graduation was fairly satisfactory in less aspects and below satisfactory levels in most aspects. The possible reason for lower level of information among first-year and second-year pupils could be owing to the lack of school-based health education for pupils in our Saudi education system, because the study has shown only(52,8%) of the student, they were aware of the risk of exposure to hepatitis B Before entering the dental college, Based on the results from this study, we infer that there is a need to improve information about HBV infection among dental student at Taif university, but the study has shown fairly satisfactory result in attitude part of questioner, and very satisfactory among practice part , the reasons for this is due to intensive education about infection control guideline during clinical practice .

CONCLUSION

The results of this study show that the education about Hepatitis B infection, its transmission, prevention along with update infection control practices for health care providers is paramount in improving the quality of health care delivery. The need for mandatory education of this aspect has been confirmed by the study of Bailoor Durgesh N et al in their study at Gandhinagar, Gujarat in India. As the information in this domain was acquired by pupils it was observed that they followed infection control guidelines even more assiduously.

References

1. World Health Organization. Hepatitis B, 2012. Available at: http:// www.who.int/mediacentre/factsheets/fs204/en/index.html
2. T. J. Liang, ‘Hepatitis B: the virus and2
3. Gillen M, McNary J, Lewis J, Davis M, Boyd A, Schuller M, et al. Sharps-related injuries in California healthcare facilities: pilot study results from the Sharps Injury Surveillance Registry. Infect Control Hosp Epidemiol. 2003;24(2):113–21.
4. Cotran RS, Kumar V, Robbins SL. Robbins pathologic basis of disease, the liver and biliary tract. 5th ed. Philadelphia 5. (PA): WB Saunders Company; 1994. p. 945
5. Tirounilacandin P, Krishnaraj S, Chakravarthy K. Hepatitis infection: Awareness among medical, dental interns in India’. Ann Trop Med Public health. 2009:(2):33-36
6. S Naidoo. Dental practitioner risk, information and practice concerning the hepatitis B vaccination in South Africa. Oral Diseases 1997:3(3):172-175.
7. P. A. Leggat, U. Kedjarune, and D. R. Smith, ‘Occupational health problems in modern dentistry: a review,’ Industrial Health, vol. 45, no. 5, pp. 611–621, 2007. View at Publisher · View at Google Scholar · View at Scopus
8. Smelzer SC, Bare B. Brunner and Suddarth’s Textbook of medical surgical nursing, 10th edition. Lippincott Williams and Wiking. Philadelphia. 2003
9. Bansal M, Vashisth S, Gupta N. Information and awareness of Hepatitis B among first-year undergraduate pupils of three dental colleges in Haryana. Dent J Adv Stud. 2013;1(1):15–7.
10. H u SW, Lai HR, Liao PH. Comparing dental pupils’ information of and attitudes toward hepatitis B virus-, hepatitis C virus-, and HIV-infected patients in Taiwan. AIDS Patient Care STDS. 2004;18(10):587–93.
11. Saini R, Saini S, Sugandha RS. Information and awareness of Hepatitis B infection amongst the pupils of Rural Dental College, Maharashtra, India. Ann Niger Med. 2010;4(1):18–20.
12. Alavian SM, Mahboobi N, Mahboobi N, Savadrudbari MM, Azar PS, Daneshvar S. Iranian dental pupils’ information of hepatitis B virus infection and its control practices. J Dent Educ. 2011;75(12):1627–34. 13-Sivarajasingam V, Laszlo J, Ogden GR. The extent of hepatitis B immunization among medical and dental pupils. BMJ. 1995; 311(6999):231.
13. Bailoor DN, Rana T, Patel BJ. Information , awareness and level of vaccination of hepatitis B, amongst the pupils of Rural Dental College, Uvarsad, Gandhinagar, Gujarat, India. J Educ Ethics Dent 2012;2:69-73

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Introductions

Epilepsy is considered one of the most important chronic neurological disorder (1,2), characterized by synchronous recurrent unprovoked seizures due to uncontrolled electrical discharges from the brain neurons (2, 3). Infections either parasitic, viral or bacterial and birth trauma are suggested to be some factors contributing to the disease (2, 4, 5).

The disease has high prevalence estimated that about 50 millions people affected worldwide (6, 7, 8). The global burden of the disease is about 1% in both industrialized and developing countries being more in the developing one such as Sudan (80-85% of the cases) (1,2,4) with high incidence 100-190 per 100,000 people per year in developing countries (4,5).

Epilepsy affect lifestyle of primary school epileptic pupils (9,10,11) both academically because of social barriers (9) and psychologically including anxiety, depression and social stigma (12,13,6,14,15,16). Also make people with epilepsy are low self-esteemed (14) and with low achievement educationally (17,18,19,20).The poorly negative attitude of non-epileptic children and primary school teachers toward those with epilepsy makes the life so difficult to them (1,9,21,22).

Social stigma of epilepsy differ from area to another one being very difficult to overcome causing many of patients avoid seeking medical advice and increasing the ‘treatment gap’ which exaggerates the condition more than the convulsions and the disease itself (23). Disappointingly the stigmatization and social discrimination applied by the community will increase the burden of this disease regarding management and also other aspects of disease (6,14).

Some epileptic pupils were banned because of their recurrent attacks of seizures and some teachers feel uncomfortable of their presence in the classroom representing the severity of disease’s stigma and resulting in social rejection (7,24,25).

Community especially primary school teachers must have to play a great role in eradication of this social disacceptance because they are regarded one of the educated sectors in the community (17,26,27,28) and also by their fundamental participation in the education of the epileptic pupils (20) . We need to minimize epilepsy-associated social stigma (17) by good lightening of the main problem which is teacher’s awareness about epilepsy causes, management and attitude (17,26). Clarification to the teachers and rest of the community that pupils with epilepsy have the same intelligence of their colleges and can participate in the same activities with special limitations (1).

Understanding the misconceptions and false beliefs of teachers about epilepsy putting in mind that there is no formal instructions about epilepsy during their training (1,29), so there is need to design a program to antagonize these misunderstands.

There are several studies show that despite of improvement in perception (30,31) and community attitude, there is still misconceptions (12,32). Up to date, there is still a little researches had been conducted in this part of the disease especially in Middle East (6,33,34) and Sudan (1).

This study aimed to investigate and examine the knowledge, attitude and practice of primary school teachers toward epilepsy regarding causes, clinical presentations and management of convulsing epileptic pupils.

Materials and methods

Study design and population

A descriptive cross-sectional study was conducted. All teachers at pensionable age employed in or training at registered public schools in Alshohda and Soba unit and present at the time of the study were eligible to participate in the study. We exclude those with previous or current seizures, mentally ill and those who did not give verbal consent.

Study area

Alshohda and Soba unit is a big area locating in the center of Khartoum locality, consist of 8 districts with 58 public schools, 82 private schools and 2 universities.

Sampling (size and technique)

The actual sample size calculated with prevalence of 0.09 , margin of error 0.0025 and calculated to be 114 then was shrunken to 132 using modified formula due to limited resources and time .

Questionnaires were given to the directors of schools to distribute them to all eligible teachers to complete them and then returned back to research assistant. Instructions on how to complete questionnaires with few explanations were given avoiding leads.

Study carried out in 8 schools as clusters which were selected randomly, then a total coverage to the selected schools were done. Each school involve about 20 teachers and total sample of 132 was taken. This study was reviewed and approved by university of Khartoum faculty of medicine department of community medicine.

Data collection

The data was collected using semi- structured closed ended self-administered questionnaire and the questions were designed to cover KAP with respect to epilepsy.

In order to maintain the standard of the survey material other similar studies were identified and relevant questions were selected and modified to make them appropriate to the local culture. The selected questions were first forward translated into Arabic the official language of the country, and then back translated into the English using the standard translation procedure. The translated questionnaire was then pretested randomly on selected school teachers which had helped to further redirect and rephrase some of the questions. Participants were asked to complete a self- administered questionnaire, comprising of 21 questions. Consisting of 4 parts, sociodemographic data, knowledge questions, attitude and practice.

Each questionnaire was checked for completion, assigned a code, kept in secured file and entered into electronic database for analysis.

Data analysis

Data was analyzed using SPSS software v21.0.

Results

This research was done to assess the degree of knowledge, attitude and practice of primary school teachers toward epileptic pupils to design a program for raising their awareness about this disease because no formal instructions were given to them during their training. So the study was conducted in (132) primary school teachers with response rate of 100%. The main age of them was found to be (47) years old with interval of (20-70) years with female being the predominant sex ( male : female ratio was 1:2.9). Most of them were married (69.5%) and reported that they were university graduate (60.3%) and. Thirty teachers (22.8%) had teaching experience of (11-20) years (see table 1).

As all the participants heard about epilepsy before, they reported that community (32.1%) and media (29.1%) were the main source of information and few of them (7.2%) gained their information about epilepsy from Health Care Givers. Regarding the causes of epilepsy, most of the participants believed that epilepsy was due to genetic factors (25.4%) and head injuries (18.2%), while seventeen (12.7%) of them thought it was due to evil spirits. About (51.9%) of the participants thought that the most useful treatment was medical treatment in form of tabs and injections and minority of them; nine (6.9%) thought of traditional treatment and eight (6.1%) believed of electrical shock to be the best one (see table 2).

Ninety eight (74.6%) of the participants they believed that epilepsy was a contagious disease. Majority of the participants thought that convulsions should had to occur during episode of epilepsy (65.2%) and about thirty one teachers (23.5%) thought that it wasn’t necessarily to occur. Sixty three (47.2%) of them believed that epileptic pupils can contribute in ALL sport activities as healthy one can do while forty four (33.6%) thought that they can’t (see table 3).

Concerning attitude of the participants, most of them (77.1%) allow epileptic patients to learn with other healthy one. Those whom don’t allow, more than (51.5%) of them they thought that epileptic patients can harm others, (12.1%) had difficulties to learn, (12.1%) not qualified to work later on and (21.2%) they thought that others can harm them. Most of them they thought that epileptic patients were not socially separated by their colleges (71.8%) . Almost all of the participant they show empathy to a convulsing pupil and a very minor group feel afraid of him. Ninety- two (73%) of teachers revised for an epileptic pupil who missed a class because of his illness (see table 4).

Forty two (31.5%) of the teachers taught an epileptic pupil before. About (18.2%) of the teachers did first aid management to an epileptic patient and from this percent (18.2%); (34.5%) remove the sharp object, (13.8%) secure the patient, calculate the duration of convulsion, (22.4%) put the patient in his lateral side, (29.3%) ensure airway patency. (26.1%) do all the management steps. Regarding those who didn’t carry out first aid before have knowledge of following: (29.6%) removing the sharp objects and secure the patient, (20%) putting a piece of clothes or spoon in his mouth (see table 5). In our study, we noticed that some of the questions were answered in a manner to be a politically correct and this might not reflect their own opinions (35,36). Also we noticed that most of primary school teachers were female in a ratio of (1:2.9). this tendency may be because in our society, females are more kind and more polite to children than males that is why they predominate primary schools. The study was conducted in the teachers because they were considered the educators and advisors in any societies especially here in Sudan.

All teachers (100%) participating in this research heard about epilepsy before. Thinking of this to be a very good thing in raising their confidence in dealing with these epileptic pupils and to teach other pupils on how to deal with them. This result was similar to that reported in study done in Assuit, Egypt 2010 (38) and in Sudan in Gezira state (1), slightly higher than value reported in school teachers in Pakistan 99% ( 38), higher than value obtained from teachers in India 97% (37) and in Nigeria 2018 95.5% (20) and much higher than those conducted in Pakistan 90.9% (39), Ethiopia 90%( 40) and Nigeria 84.8% (41).

Majority of teachers in our study got their information about epilepsy from the community 32.1% and media 29.1% highlighting the necessity to encourage health educational public campaign to be community- based and encourage media to disseminate knowledge about the disease. In addition, this was considered to be a good thing, as media became a popular way nowadays and almost all people have an easy access to media. Our result was similar to that obtained from India and Thailand (42,43,44) and in contrast to study done in Ethiopia 2016 in which public media played a minor role (42). Few of our participants gained their information about epilepsy for health care workers 7.2%, this in contrast to that done in Ethiopian teachers (42), in which health care workers represent a common source of information.

Some previous studies reported that teachers had high knowledge about epilepsy (39,45). Despite of that, they had a defected knowledge and some misconceptions about the disease (36,39,46,47). One of this misinformation was the believed that the epilepsy was a contagious disease 74% (20,46,43,48,49, 50,51,52,53) and in contrast to that done in Saudi Arabia (50). This thought play a miserable role in increase the stigma and social barriers and this should be a warning alarm to establish an interventional program to the raise teacher’s awareness. This result was similar to other studies (46,54).

In addition of believing of epilepsy as an infectious disease, some studies reported the thought of teachers in epilepsy to be a risk for increasing insanity of the individual with disease (20,43,55). Teachers believed that children with epilepsy has increased tendency to be insane later on. In this regard, there was observation that developing countries teachers believing that there is a relation between epilepsy and insanity in percent of (23.6%) in Vietnam(56), (16%) in China (57) and (7%) in Taiwan (58). These percentages compared to studies carried out in developed countries such as USA , Denmark and Italy which reported a negative relationship between epilepsy and insanity (59,60,61).

On other hand, a significant percentage (28.2% , 44%) of teachers participating in a previous studies (1,39) reported that they believed that epilepsy affect growth and development of children despite their greater years of experience. This misconception also increases stigmatization and discrimination more and more. The importance of teachers attitude is that it affects other children attitude affecting their own development.

Other aspect defected in their knowledge, evil spirits being one of the causes of epilepsy and this also contribute in increasing social stigma (20). Few of participants 12.7% still believe in evil spirits as a cause of epilepsy compared to 21.1% reported in Sudan 2017 (62), 26% reported in Nigerian teachers (63). 10% of Sudanese doctors believe in evil spirits as a possible cause of epilepsy (64). There was study done in Pakistan reported good knowledge of the teachers about clinical presentations and causes of epilepsy knowing that it isn’t due to evil spirit or even supernatural abilities (39). This is in contrast to study carried out in India reporting that teachers rate of awareness was found to be 97% (65).

Similarly about causes of epilepsy, a part of those didn’t know the cause, most of our participants report genetics 25.4% and head injuries 18.2% as a common causes of epilepsy compared to study done in Sudan 2017 in which 78% of teachers believe epilepsy was due to neurological problems and slightly less than this value reported in Ethiopia (40) and Pakistan (38).

More than half of our teachers thought of medical treatment to be the most useful one. This proportion is lower than that reported in Nigerian which was found to be two third (66). In Ethiopia 98% of participants thought about medical treatment as the most useful one. 6.9% of our participants believed of traditional one as best in contrast to study done in Zambia reported that about 84.5% of teachers thought of traditional healer as the best rather than doctors (67) and also in contrast to another study done in Ethiopia which reported that near half of the teachers were believing of those healers (42). In study done in Sudan, 9.4% believed in traditional treatment as a curative one compared to 51% who didn’t.

More than two third of the teachers reported in our study that they allowed epileptic pupils to learn with their healthy colleges in the same classroom. Despite this high proportion, a significant percent of them (12.2%) didn’t allow comparable to study done in Nigeria (7%), India (20.8%) and in Thailand (15.1%) (20,43,55). Even severely, there was study reported that 4.5% of teachers refused to teach epileptics at all (39) and another one reported 13% refused also (68). Our teachers whom didn’t allow, 51.5% of them believed that epileptics can harm other similar to study done in Egypt 46.6% (37) or might be not able to worker later on 12.1% similar to studies which reported that teachers thought epileptics can’t be a good teacher in the future and can’t succeed in their life (46,69,39). This believed reflect the great gap that teachers think of epilepsy as a disease affecting the cognitive functions of the patient as reported in similar study leading us to think of their inferior misconception about epilepsy(46).

Most of our participants 71.8% think epileptics were not socially separated by their colleges reflecting teachers with some positive attitude. In our study, almost half of the teachers allow epileptics to participate and contribute in activities with healthy one similar to previous studies with high percentage also (39,67). Despite that we need to tell them that there must be some special limitations in those activities like swimming or driving.

Luckily, only 5.6% of teachers in this research felt afraid of epileptics when seeing them convulsing which is much lower than that reported in study done in Saudi Arabia (50) and more than ninety percent of teachers said that they felt sympathic to a fitting child which is higher than that reported in Egypt 76.8%, Nigeria which reported that more than half of them afraid of those students, 32% of teachers afraid of epileptic in study done in India and 9.8% afraid of epileptics in study done in Thailand (20,43,55) reflecting good attitude of our teachers in this regard. The feeling of fear toward epileptics affect them both psychosocially and academically raising the stigmatization and discrimination upon them.

We think of necessity to establish an educational program including during teacher’s training course taking about epilepsy understanding and management procedures that at least should be done because our study reported that a considerable percent of teachers ever did first aid or management before similar to study done in Saudi Arabia (50). Those who didn’t carry out first aid before the reason behind this may be not seeing an epileptic pupil convulsing before (1) or might get in panic attack when see this act. One-fourth of the teachers who did first aid before, carried out all the steps of management correctly. Unfortunately, some of them did the procedures in a wrong way as reported in similar studies by pulling the tongue or putting objects like spoon inside the mouth (46,69,20,70,71, 39). Because of that, there must be school health services as the teachers being always in contact with epileptic pupils. Regarding these services, physicians also should contribute by sharing the knowledge and the medications that can help the teachers to deal with such a situation.

Conclusion

This study assess knowledge, attitude and practice among primary school teachers in Khartoum. In conclusion, the knowledge of the teachers vary at time of this research. There was a misunderstandings and misconceptions in some aspects of the disease like causes of epilepsy being evil spirit and being a contagious disease and good knowledge reported in area of treatment. The more educated teachers about epilepsy the less likely for having negative attitude. Teachers of our study were considered to have negative attitude toward epilepsy which badly affect their awareness. Lack of awareness is a warning alarm of establishing educational programs about epilepsy. Bad attitude increases stigma and social barriers. The practice of teachers was considered to be in need of improvement as there is no formal instructions about epilepsy during their training.

Recommendations

We need further researches in context of knowledge of primary school teachers about epilepsy in order to explore areas of deficiencies that teachers suffered from. Also we need these researches aiming to investigate about the practical aspect of epilepsy as teachers form the cornerstones in the educational process of those epileptic pupils. The need for educational health public programs is of the greatest importance recommended to erase all myths and misconceptions about epilepsy which is the main cause of the social stigmatization and discrimination

ABSTRACT

Introduction: The term “drugs” include prescription and non-prescription medicines, including complementary healthcare products. Rational use of drugs, as per directions will result in safer and better outcome for the patients. Rational use of drug requires the patient receive medications appropriate to their clinical needs. The concept of rational use of drug is new to the younger generations. It is important to know the usage of drugs and traditional medicine. The result of the study can be used to understand, highlight and create awareness among the society about the rational use of drugs. Objective: To assess the knowledge, attitude, awareness on rational use of drugs among non – medical students. Materials and Methods: This cross sectional study was done on 342 students in Saveetha Engineering College. The study was started after obtaining the consent from the IRB and informed consent. This study was a questionnaire-based study. It is a semi-structural questionnaire with 35 questions. Data was collected by consecutive sampling technique and analyzed using SPSS V20.0 software. Result: 35% of the participants were female and 65% of them were male participants. The analysis was done by categorizing the questions into sections of knowledge, attitude and awareness. Only about 50% of the people had knowledge about the rational use of drugs. More than 45% have wrong attitude regarding rational use of drugs. More than 65% of people, were aware about drug and its usage. Conclusion: After the analyzing the responses given in the questionnaire, we can conclude that 50% to 60% of the participants had basic knowledge, attitude and awareness regarding rational use of drugs. So we should conduct awareness programmes regarding drugs and its side effects.

INTRODUCTION

The term “drugs” includes prescription and non-prescription medicines, including supplementary healthcare products, Irrational use of drugs is a major problem worldwide WHO estimates that more than half of all drugs are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly.(1) The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards. Examples of irrational use of drugs include: use of too many drugs per patient (“poly-pharmacy”); inappropriate use of antimicrobials, often in inadequate dosage, for non-bacterial infections; (2)over-use of injections when oral formulations would be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medication; inappropriate self-medication, often of prescription-only medicines; non-adherence to dosing regimens.(3)

Medically inappropriate, ineffective, and economically inefficient use of pharmaceuticals is commonly observed in the health care system throughout the world, particularly in the developing countries. Most physicians would vouch for having observed this in their day-to-day practice and there is a plenty of hard evidence to reinforce this impression. Even a cursory survey of the available literature provides a wealth of data which is amazingly uniform across nations. Without any doubt, this is a global problem.(4)

Rational use of drugs or consumption of drugs as per directions will result in safer and better outcome for the patient. A conference of Experts on the Rational Use of Drugs, convened by the World Health Organisation in Nairobi in 1985 defined that: “Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in does that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community”.(5) This is often simplified as the five rights- the right drug at the right dose by the right route at the right time for the right patient.

Some measures are necessary to take against the irrational use of the drugs which include the creation and revision of the rational drug therapy practice. Also, there is need to include people of the health care team to create awareness among patients about the rational use of drugs.

The concept of rational use of drugs is new to the younger generation, it is important to know their usage of drugs including prescription and non-prescription drugs and traditional medicines.(6)The aim of the study is to understand and highlight the need to create awareness among the society about rational usage of drugs.

MATERIALS AND METHODS

This cross –sectional retrospective study was conducted in Saveetha Engineering College, Chennai. A total of 342 students were included, who were only non-medical students. The participants included only UG students of various department of Saveetha engineering college. In this study 500 students were approached out which 342 of them were willing to take part in the study. Whenever they wanted if they felt unsafe or uncomfortable. they were given the liberty to pull off from the study. The study period from 20th February to 12th May 2019. Institutional Review Board (IRB) was applied and obtained before starting.

All the students who took part in the study was briefed on the study was distributed after describing the purpose of the study. The participants were assured that participation was voluntary and confidentiality will be maintained.(7) A semi-structured questionnaire containing 35 questions relating to knowledge, attitude, awareness about rational use of drug. Consent form was obtained from the participants, after which their responses were collected and confidentiality regarding their data was maintained throughout the study. Data was entered in the excel sheet and the data was analysed using spss V20.0 software, frequency and percentage were obtained and percentage with graphs and charts.

Result

As the study was performed with a population of 342 engineering students. As the population consisted of students with age group ranging from 19 to 21. In the total of 342 participants, femaleparticipants were 35% and 65% were male participants. As the study was among engineering students 65% participants were belonging to a Mechanical engineering, 35% participants were pursuing electronics and communication engineering

Out of 342 participants, all participants were from urban areas, among which majority of participants(50%) were from Kadappa, followed by 40% participants from Nellore and 10% participants were from Tamilnadu. Amount the 342 participants majority of the participants that is 92% participants were from state board curriculum based school and remaining 8% participants finished the studied from CBSE curriculum based schools. Out of 342 Engineering students who participated in the study, 50.44% participants felt safe with self medication while 44.87%participants felt unsafe to have self medication.

When questioned about the awareness about over the counter (OTC) medicines, 36.07% participants were aware while remaining 43.11% participants were not aware. When asked about the OTC and its safety with prescription medicines, 41.94% participants agreed and 36% participants disagreed. 50.73% participants were aware about generic medicine and the remaining 34.90% participants were not aware. When asked about a question that the same generic content of medicines is available under different names 51.32% participants 30.79% participants disagreed whileAbout 59.65% participants have the knowledge of taking the precautions which using medicine inpregnant and breastfeeding women while the remaining 23.98% participants are unaware.

The participants were then questioned on their attitude towards drugs as like costlier medicines are better than cheaper ones for which 50.6% students agreed 31.6% students disagreed and the remaining where 17.8% were not aware about the relationship between cost and the quality of drugs. The participants of about 50.7% of total participants had an attitude that medicines manufactured by foreign multinational companies are better whereas remaining 34.9% of the participants were strongly against that attitude. But when asked about the fact that is it important for patient to know about common side effects of medicines, 50.6% of the participants strongly agreed and 34.8% of the participants disagreed. A question assessing the attitude of the participants were asked which stated that whether mass communication a bad medium to educate about medicines for which 50.6%participants agreed and 32.7% participants strongly disagreed.

The participants were asked a question assessing their approach towards drug. Majority of them agreed to the fact that they will take the medicines only after reading the label. Brand name and the expiry date was the main categories of choice. Other categories are listed below in (figure.4)

About 45.32% participants agreed to the fact that medicines can be bought without prescription whereas the around 38.30% participants strongly disagreed. 50.58% participants had an attitude that medicines can be stopped if the symptoms disappear and the remaining 36.55% participants were against this attitude.

Around 46.20% participants purchase medicines online, while 39.77% prefer retail outlets. Around 41.81% participants agreed that they will purchase all medicines written in the prescription and 39.18% participants don’t. 47.21% agree and stick to doctor’s advice and instructions where as 36.07% participants were not following doctor’s advice & instructions.

Discussion

This study assess the knowledge, attitude, and awareness of rational use of drugs among Engineering students. This study would take into consideration minimal exposure to knowledge and attitude, of the engineering students about various issues concerned about rational usage of drugs. Hence assessing their knowledge about the rational use of drugs would be helpful in promoting the rational use of drugs and improving the awareness. It is well known that safe and effective drug therapy is possible when patients are well informed about medications and about their use and side effects if taken without prescription . In this study majority of the participants had the knowledge and were aware about most of the issues concern about the rational usage of drugs as addressed in the questionnaire which seems to be a promising finding but in a long run all of them need to have a correct knowledge about all the issues addressed(8). Surprisingly only 36.07% of the participants were aware about over the counter (OTC) medicine.(figure:1)Ironically only 41.81% of the participants responded the OTC can be safely taken with the prescription medicines. Another study reports that many patients reported that they were not aware about the name, composition and side effects of the drugs prescribed for them.(9) As is clear from this study, majority of the participants had the attitude of reading the label on the medicines before using it but 76% of them look for its brand name and a whooping 100%of the participants look for its expiry date. (Figure:4)But, here 57% of them look for the generic name of the drug. About 47.21% participants stick to the doctor’s advice and instruction regarding the prescribed drugs. And About 46.20% participants agree that they mix medicines obtained from various doctors for the same problem. While 43.40% of the participants strongly disagree with the concept of mixing allopathic treatment with alternative medicine method like Ayurvedic traditional home remedy homeopathy. While a majority of participants(10), 50.58% stop their medications without consulting a doctor.(figure:3)This study brings out clearly the fact that majority of students possess moderate attitude and awareness, and their knowledge about rational use of drugs is encouraging and at the same time has to be improved drastically.(11)

CONCLUSION

Majority of students were aware about various issues concerned with Rational use of drugs but the knowledge related to Over the counter Drugs was found to be limited. As students are future pillars of the nation, they need to be aware of all the aspects of Rational use of drugs. Inadequate/improper knowledge in the above areas is a matter of concern and needs to be taken. Awareness programmes regarding rational use of drug and its Adverse drug reactions should be undertaken so that the deficit in knowledge, attitude and practice of rational use of drugs can be identified and appropriate corrective measures taken which will help in improving the quality of health care.

Limitations

• The participants were from the college level, who may have a basic knowledge about commonly used drugs in the market.
• The participants were from the engineering discipline only; other coaching or education streams weren’t included in the study.

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Review Board

REFERENCES

1. 1World Health Organization: Guide to Good Prescribing, Geneva. World Health Organization. 1994;101-3.
2. Holloway K. Promoting rational use of medicines. Contact a publication of world council of churches. 2006;183:2-3.
3. The Selection of Essential Medicines-Perspectives WHO policies. 2002;1-6.
4. National list of essential medicines 2015 (India). Available at: http://cdsco.nic.in/WriteReadData/NLEM-2015/Recommendations.pdf. Last accessed on 20th December 2016 at 9 pm.
5. Manikandan S, Gitanjali B. National list of essential medicines of India: The way forward. J Postgr Med. 2012;58(1):68-72.
6. Patrício KP, Alves NA, Arenales NG, Queluz TT. Teaching the Rational Use of Medicines to medical students: A qualitative research. BMC Med Educ. 2012;12:56.
7. Toklu HZ, Demirdamar R, Gümüşel B, Ersin YE, Dülger G. Rational drug use awareness of the nurses in the Turkish republic of Northern Cyprus near east university hospital. Marmara Pharmaceutical Journal. 2012;16:150-4.
8. Kunda G, Thawani V, Sontakke S, Chaudhari K, Bankar M, Diwe R. Effect of information, education and communication intervention on awareness about rational pharmacy practice in pharmacy students. Indian Journal of Pharmacology. 2011;43(4):381-4.
9. Sankaravadivu T, Kumar SE, Bhavya E. A prospective study on rational drug use and the essential drug concept. International Journal of Research in Pharmaceutical and Biomedical Sciences. 2011;2(2):503-6.
10. Badran IG. Knowledge, attitude and practice the three pillars of excellence and wisdom: A place in the medical profession. Eastern Mediterranean Health Journal. 1995;1:8-16.
11. Mahajan R, Singh NR, Singh J, Dixit A, Jain A, Gupta A. Current scenario of attitude and knowledge of physicians about rational prescription: A novel cross-sectional study. J Pharm Bioalln Sci. 2010;2(2):132-6.
12. Bajait CS, Pimpalkhute SA, Sontakke SD, Dakhale GN, Jaiswal KM, Urade CS. Evaluation of knowledge, attitude and practice of rational use of medicines among clinicians in a tertiary care teaching hospital. Int J Nutr Pharmacol Neurol Dis. 2014;4:153-7.
13. Dakhale G, Pimpalkhute S, Bajait C, Raghute L. Evaluation of Knowledge, Attitude and Practice of Rational use of Medicine Among Interns and Resident Doctors in a Tertiary Care Teaching Hospital. J Young Pharm. 2016;8(2):114-7.
14. Hogerzeil HV. The concept of essential medicines: Lessons for rich countries. BMJ. 2004;329:1169‑72.
15. Rathod R, Rathod A, Gupta VK, Ahmed T, Jha RK, Gaikwad N. Audit in Dermatology for Rational Prescribing. RJPBCS. 2012;3(3):518-24.

Sexually transmitted diseases (STDs) are a group of diseases that can be transferred from person to person or between sexual partners through sexual intercourse. These diseases travel via semen, sperm, blood or vaginal fluids from one person to the next through sexual contact, and from mother to child. These includes diseases such as gonorrhoea, chlamydia, syphilis, HIV and genital herpes (Satterwhite, 2017). STDs have proven themselves to be more common in university students and this can be attributed in part to the lack of knowledge about these diseases and also to ignorance attributed to either personal irresponsibility or lack of pre-exposure to reproduction and sexual health education, either formerly at an institution by a trained professional or informally at home.

Risk behaviours associated with either the acquisition or transmission of STDs from one person to the next. Risk behaviours are a set of individual conducts that increases an individual’s risk profile for a particular fate, in this case acquiring STDs. The most common risk behaviours known among young adults and students are a promiscuous life style, use of recreational substances partying, and cheating. More often than not the use of recreational substances leads to unprotected sex which gets one at the risk of being infected with STDs (Sieving, 2017). A promiscuous life seems to be fashionable among young adults and students, multiple sex partners make one reservoir of transmitting STDs more especially in girls because in most cases they do not show signs and symptoms.

Signs and symptoms are not always present more especially in women and girls. Some STDs do not show any visible signs and symptoms the individual is referred to as being asymptomatic. Signs and symptoms are referred to as mental or physical features that serve as an indication to a condition of a particular disease. Signs and symptoms associated with STDs are usually open sores, bumps, blisters and itching of the external sex organs and change in vaginal discharge in women and girls. Every individual sexually transmitted disease has a range or a set of signs and symptoms that serve as diagnostic features, so in effect experiencing the generalized signs and symptoms does not necessarily mean that one is affected with an STD they may as well serve as indicators for other diseases.

Failure to treat beyond the level of the body’s potential to tolerate the discomfort can lead to infertility and death. If the signs and symptoms are discovered early enough, measures can be put forward to either stop the occurrence of an STD or at least decrease its rate of development in case it has already occurred. Just as every disease has its own signs and symptoms so is the case with the treatment measures for every STD. individuals are firmly advised to see a medical doctor when they start to experience any signs and symptoms associated with any of the STDs because the diseases cannot be treated properly without the prescriptions offered by a medical professional (Jones, 2016). Antibiotics prescribed must be used until they finish even though symptoms disappear.

Sexually transmitted diseases can be prevented to a certain extent, as measures available for one to prevent getting the diseases under normal circumstances. The most reliable of the preventions is abstinence from sexual contact, oral, anal or vaginal. Other preventive measures include vaccination, reduction of sexual partners, mutual monogamy practise and the constant condom use (Diclemente, 2017). The sexual behaviours of university students are dependent on the information and approach towards sexually transmitted diseases, through a set of questions we hope to prove this.

Materials and Methods

Sample

The study was conducted at Zone Alpha in the Nobody district based on logistic purposes. Since the study involved future healthcare providers, two higher-learning institutions, which represent both public and private universities, were selected from this zone.

Study Design

The study employed a cross-sectional study design.

Study Population

Simple random sampling was used for the selection of students. The list of students was obtained from the registration units. Then, a computer random number generator was used to select the students recruited for the study. This simple random technique was employed to avoid any potential biases.

The purpose of the study was explained to the selected students [females = 205 and males n =158] before their class sessions, and they were encouraged to participate. Selected students who were present at the time of the survey were approached by the investigators. Those who agreed to participate were asked to give their consent and complete a set of questions. The questionnaires were designed in English.

Instrument

The study instrument was a self-administered questionnaire. The content validity of the study instrument was done by cross-checking and authentication from experts in the field of study. Afterwards, modifications were made according to the recommendations and counsel. The validated questionnaire was made up of four parts: socio-demographic characteristics (gender, age, ethnicity, and educational level). The students’ knowledge on STDs was assessed by using – a diagnostic item questionnaire. Participants were instructed to give a “yes”, “no” or “do not know” answer.

Data Analysis

Data were analysed using Stata statistical software. Descriptive statistics were used to determine the frequency of the students’ responses.

Results and Discussion

The aims and objective for this research was to describe the knowledge and attitudes regarding sexual transmitted diseases amongst university students and to relate the findings to sexual behaviour. A questionnaire based on sexually transmitted diseases was conducted amongst students in a tertiary institution. A total of 205 young females took part in the survey while only 158 males took part. This indicates that woman are more likely to go head to head with the reality of sexually transmitted diseases (STDs). From the study conducted and shown in table above, it is evident from the first question (which is the most important basic question asking about the knowledge of STDs) that women are more aware of what STDs are than men. It is said that awareness plays a significant role in the acquisition of STDs, giving women a slight advantage when it comes to that. Even though females showed to have more knowledge about the ins and outs of STDs, another important question asked was if any of them have ever had an STD and there were 76% of the females that said yes while only 71% males answered yes. This corresponds to past statistics and clinical surveys made about women being more susceptible to acquiring STDs, including HIV/AIDS, than males. There are many possible explanations behind that. One of them the anatomy of the female genitalia. Unlike the penis, the vagina is on the inside, this means that the male’s seminal fluids get trapped inside there and if they have infections, those will easily cause infections in the woman’s uterus or fallopian tubes. Also women are more prone to sexual violence, cultural practices and being more submissive to men. All these may result in vaginal tearing and thus a greater STD predisposition (Forhan et al., 2017). From the results, 13% of the males don’t know if they’ve had STDs while all the females know whether or not they’ve had STDs. That further indicates the ignorance of males regarding awareness of their health status. This questionnaire further revealed that the male population is rather selfish or shy when it comes to speaking out about their STD status as 95% of them feel entitled to knowing their partners’ status but only 76% of them feel that their partner is not entitled to know if they have any STDs themselves. That percentage remained on the same level for females, meaning they felt both partners are entitled to knowing each other’s statuses, which is morally correct as that would prevent any unwanted STDs. When it came to condoms and their use, it was seen that males are more informed about how to use them and their effectiveness as compared to females. This is true because male condoms are much more popular than female condoms. Buying condoms is also seen as a “men thing” when it comes to protection.

There have been many other studies that have been conducted in order to assess the knowledge of sexually transmitted diseases amongst the different sexes. Our finding indicates that females are much more aware and knowledgeable about the sexually transmitted diseases than males. This differs with the study titled ‘Knowledge, attitudes and behaviour towards sexually transmitted diseases in Turkish Cypriot adolescents’ (Kaptanoğlu, 2016). Their study revealed that girls are not as knowledgeable as boys. This difference can perhaps differ because of the age groups that the survey was focused on. Their study was based on high school students’ sources of information and knowledge of the STDs issue. It can therefore be concluded that age plays a huge role in the knowledge of sexually transmitted diseases. It is evident that the older females (varsity students) are more sexually promiscuous and more knowledgeable and exposed to STDs. Different countries might also differ in exposure and knowledge as the other study was conducted in Turkey. On the other hand our study coincides with the study conducted (Pereira and Carmo, 2016). This was where females showed a higher prevalence in contracting sexually transmitted diseases, they had a 4% difference. Their study was conducted based on university students. It can be said that the general overview is mostly similar among the same age groups and the genders.

The results indicates who is more educated and knowledgeable about sexually transmitted diseases between men and women and they also provide light on who needs attention between this two genders. The women have a higher percentage of being knowledgeable and educated about STDs, in that they might have been more exposed to STDs and have acquired the knowledge from their health care facilities. Provided that young adults are the ones responsible for the increase in STDs transmission, we can find out why and address these issues. The results also indicates that there are still men who need to be educated about the STDs, how to use a condoms and the importance of telling their partners when they get any STD and to advice their partners to also get tested. Real life application of the data collected can be used by the government in association with health workers and non-government organizations (NGOs) as insight of means to better improve campaigns and structures to inform tertiary students about sexually transmitted diseases and use the different data to produce local standard cut off points that can be compared nationally and internationally with other tertiary institutions. This information can be used to keep progress of the campaigns and structure placed to determine whether the sexual health of the individuals in tertiary institutions is improving or decreasing.

Conclusion

From the results obtained we can confirm that females in tertiary institution have a positive approach towards not only understanding but also applying their knowledge towards sexually transmitted diseases unlike males who tend to deviate from the reality which is that of sexually transmitted diseases. To alleviate the effect of sexually transmitted diseases, it has to be a combined effort not only by women but also by men. Initiatives and campaigns to encourage the interest of man as well as more women can be applied in tertiary institutions to increase healthier sexual behaviors and reduce sexually transmitted diseases.

References

1. DiClemente, R.J., Salazar, L.F. and Crosby, R.A. 2017. A review of STD/HIV preventive interventions for adolescents: Sustaining effects using an ecological approach. J Pediatr Psychol, 32:888–906.
2. Forhan, S.E., Gottlieb, S.L. and Sternberg, M.R. 2017. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States: Pediatrics, 124:1505–1512.
3. Jones,R.E and Lopez, H.K. 2016. Human Reproductive Biology, 4th edition: Sexually Transmitted Diseases Academic Press.Carlifornia.323.347
4. Kaptanoğlu, A.F.,Süer, K., Diktaş,H. and Hınçal, E. 2016. Cent Eur J Public Health, knowledge, attitudes and behaviour towards sexually transmitted diseases in Turkish Cypriot adolescents, 25: 54–58.
5. Pereira, H. and Carmo, A. 2016. International STD Research& Reviews, sexually transmitted diseases: Knowledge and perceived prevalence of symptoms in university students.
6. Satterwhite, C.L., Torrone, E. and Meites, E. 2017. Sexually transmitted infections among US women and men: Prevalence and incidence estimates sexual transmitted disease, 40:187–193.
7. Sieving, R.E., Bernat, D.H. and Resnick, M.D. 2017. A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: Prime time pilot study. Health Promot Pract, 13:462–471.

Sexually transmitted diseases (STDs) are a group of diseases that can be transferred from person to person or between sexual partners through sexual intercourse. These diseases travel via semen, sperm, blood or vaginal fluids from one person to the next through sexual contact, and from mother to child. These includes diseases such as gonorrhoea, chlamydia, syphilis, HIV and genital herpes (Satterwhite, 2017). STDs have proven themselves to be more common in university students and this can be attributed in part to the lack of knowledge about these diseases and also to ignorance attributed to either personal irresponsibility or lack of pre-exposure to reproduction and sexual health education, either formerly at an institution by a trained professional or informally at home.

Risk behaviours associated with either the acquisition or transmission of STDs from one person to the next. Risk behaviours are a set of individual conducts that increases an individual’s risk profile for a particular fate, in this case acquiring STDs. The most common risk behaviours known among young adults and students are a promiscuous life style, use of recreational substances partying, and cheating. More often than not the use of recreational substances leads to unprotected sex which gets one at the risk of being infected with STDs (Sieving, 2017). A promiscuous life seems to be fashionable among young adults and students, multiple sex partners make one reservoir of transmitting STDs more especially in girls because in most cases they do not show signs and symptoms.

Signs and symptoms are not always present more especially in women and girls. Some STDs do not show any visible signs and symptoms the individual is referred to as being asymptomatic. Signs and symptoms are referred to as mental or physical features that serve as an indication to a condition of a particular disease. Signs and symptoms associated with STDs are usually open sores, bumps, blisters and itching of the external sex organs and change in vaginal discharge in women and girls. Every individual sexually transmitted disease has a range or a set of signs and symptoms that serve as diagnostic features, so in effect experiencing the generalized signs and symptoms does not necessarily mean that one is affected with an STD they may as well serve as indicators for other diseases.

Failure to treat beyond the level of the body’s potential to tolerate the discomfort can lead to infertility and death. If the signs and symptoms are discovered early enough, measures can be put forward to either stop the occurrence of an STD or at least decrease its rate of development in case it has already occurred. Just as every disease has its own signs and symptoms so is the case with the treatment measures for every STD. individuals are firmly advised to see a medical doctor when they start to experience any signs and symptoms associated with any of the STDs because the diseases cannot be treated properly without the prescriptions offered by a medical professional (Jones, 2016). Antibiotics prescribed must be used until they finish even though symptoms disappear.

Sexually transmitted diseases can be prevented to a certain extent, as measures available for one to prevent getting the diseases under normal circumstances. The most reliable of the preventions is abstinence from sexual contact, oral, anal or vaginal. Other preventive measures include vaccination, reduction of sexual partners, mutual monogamy practise and the constant condom use (Diclemente, 2017). The sexual behaviours of university students are dependent on the information and approach towards sexually transmitted diseases, through a set of questions we hope to prove this.

Materials and Methods

Sample

The study was conducted at Zone Alpha in the Nobody district based on logistic purposes. Since the study involved future healthcare providers, two higher-learning institutions, which represent both public and private universities, were selected from this zone.

Study Design

The study employed a cross-sectional study design.

Study Population

Simple random sampling was used for the selection of students. The list of students was obtained from the registration units. Then, a computer random number generator was used to select the students recruited for the study. This simple random technique was employed to avoid any potential biases.

The purpose of the study was explained to the selected students [females = 205 and males n =158] before their class sessions, and they were encouraged to participate. Selected students who were present at the time of the survey were approached by the investigators. Those who agreed to participate were asked to give their consent and complete a set of questions. The questionnaires were designed in English.

Instrument

The study instrument was a self-administered questionnaire. The content validity of the study instrument was done by cross-checking and authentication from experts in the field of study. Afterwards, modifications were made according to the recommendations and counsel. The validated questionnaire was made up of four parts: socio-demographic characteristics (gender, age, ethnicity, and educational level). The students’ knowledge on STDs was assessed by using – a diagnostic item questionnaire. Participants were instructed to give a “yes”, “no” or “do not know” answer.

Data Analysis

Data were analysed using Stata statistical software. Descriptive statistics were used to determine the frequency of the students’ responses.

Results and Discussion

The aims and objective for this research was to describe the knowledge and attitudes regarding sexual transmitted diseases amongst university students and to relate the findings to sexual behaviour. A questionnaire based on sexually transmitted diseases was conducted amongst students in a tertiary institution. A total of 205 young females took part in the survey while only 158 males took part. This indicates that woman are more likely to go head to head with the reality of sexually transmitted diseases (STDs). From the study conducted and shown in table above, it is evident from the first question (which is the most important basic question asking about the knowledge of STDs) that women are more aware of what STDs are than men. It is said that awareness plays a significant role in the acquisition of STDs, giving women a slight advantage when it comes to that. Even though females showed to have more knowledge about the ins and outs of STDs, another important question asked was if any of them have ever had an STD and there were 76% of the females that said yes while only 71% males answered yes. This corresponds to past statistics and clinical surveys made about women being more susceptible to acquiring STDs, including HIV/AIDS, than males. There are many possible explanations behind that. One of them the anatomy of the female genitalia. Unlike the penis, the vagina is on the inside, this means that the male’s seminal fluids get trapped inside there and if they have infections, those will easily cause infections in the woman’s uterus or fallopian tubes. Also women are more prone to sexual violence, cultural practices and being more submissive to men. All these may result in vaginal tearing and thus a greater STD predisposition (Forhan et al., 2017). From the results, 13% of the males don’t know if they’ve had STDs while all the females know whether or not they’ve had STDs. That further indicates the ignorance of males regarding awareness of their health status. This questionnaire further revealed that the male population is rather selfish or shy when it comes to speaking out about their STD status as 95% of them feel entitled to knowing their partners’ status but only 76% of them feel that their partner is not entitled to know if they have any STDs themselves. That percentage remained on the same level for females, meaning they felt both partners are entitled to knowing each other’s statuses, which is morally correct as that would prevent any unwanted STDs. When it came to condoms and their use, it was seen that males are more informed about how to use them and their effectiveness as compared to females. This is true because male condoms are much more popular than female condoms. Buying condoms is also seen as a “men thing” when it comes to protection.

There have been many other studies that have been conducted in order to assess the knowledge of sexually transmitted diseases amongst the different sexes. Our finding indicates that females are much more aware and knowledgeable about the sexually transmitted diseases than males. This differs with the study titled ‘Knowledge, attitudes and behaviour towards sexually transmitted diseases in Turkish Cypriot adolescents’ (Kaptanoğlu, 2016). Their study revealed that girls are not as knowledgeable as boys. This difference can perhaps differ because of the age groups that the survey was focused on. Their study was based on high school students’ sources of information and knowledge of the STDs issue. It can therefore be concluded that age plays a huge role in the knowledge of sexually transmitted diseases. It is evident that the older females (varsity students) are more sexually promiscuous and more knowledgeable and exposed to STDs. Different countries might also differ in exposure and knowledge as the other study was conducted in Turkey. On the other hand our study coincides with the study conducted (Pereira and Carmo, 2016). This was where females showed a higher prevalence in contracting sexually transmitted diseases, they had a 4% difference. Their study was conducted based on university students. It can be said that the general overview is mostly similar among the same age groups and the genders.

The results indicates who is more educated and knowledgeable about sexually transmitted diseases between men and women and they also provide light on who needs attention between this two genders. The women have a higher percentage of being knowledgeable and educated about STDs, in that they might have been more exposed to STDs and have acquired the knowledge from their health care facilities. Provided that young adults are the ones responsible for the increase in STDs transmission, we can find out why and address these issues. The results also indicates that there are still men who need to be educated about the STDs, how to use a condoms and the importance of telling their partners when they get any STD and to advice their partners to also get tested. Real life application of the data collected can be used by the government in association with health workers and non-government organizations (NGOs) as insight of means to better improve campaigns and structures to inform tertiary students about sexually transmitted diseases and use the different data to produce local standard cut off points that can be compared nationally and internationally with other tertiary institutions. This information can be used to keep progress of the campaigns and structure placed to determine whether the sexual health of the individuals in tertiary institutions is improving or decreasing.

Conclusion

From the results obtained we can confirm that females in tertiary institution have a positive approach towards not only understanding but also applying their knowledge towards sexually transmitted diseases unlike males who tend to deviate from the reality which is that of sexually transmitted diseases. To alleviate the effect of sexually transmitted diseases, it has to be a combined effort not only by women but also by men. Initiatives and campaigns to encourage the interest of man as well as more women can be applied in tertiary institutions to increase healthier sexual behaviors and reduce sexually transmitted diseases.

References

1. DiClemente, R.J., Salazar, L.F. and Crosby, R.A. 2017. A review of STD/HIV preventive interventions for adolescents: Sustaining effects using an ecological approach. J Pediatr Psychol, 32:888–906.
2. Forhan, S.E., Gottlieb, S.L. and Sternberg, M.R. 2017. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States: Pediatrics, 124:1505–1512.
3. Jones,R.E and Lopez, H.K. 2016. Human Reproductive Biology, 4th edition: Sexually Transmitted Diseases Academic Press.Carlifornia.323.347
4. Kaptanoğlu, A.F.,Süer, K., Diktaş,H. and Hınçal, E. 2016. Cent Eur J Public Health, knowledge, attitudes and behaviour towards sexually transmitted diseases in Turkish Cypriot adolescents, 25: 54–58.
5. Pereira, H. and Carmo, A. 2016. International STD Research& Reviews, sexually transmitted diseases: Knowledge and perceived prevalence of symptoms in university students.
6. Satterwhite, C.L., Torrone, E. and Meites, E. 2017. Sexually transmitted infections among US women and men: Prevalence and incidence estimates sexual transmitted disease, 40:187–193.
7. Sieving, R.E., Bernat, D.H. and Resnick, M.D. 2017. A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: Prime time pilot study. Health Promot Pract, 13:462–471.

Source credibility

Source credibility is traditionally defined as the ability or willingness of a message source to provide reliable and truthful information (Kelman and Hovland 1953). Traditionally, source credibility has been conceived as consisting of two dimensions: source expertise and source trustworthiness (Mills and Jellison 1967; Rhine and Severance 1970). Source expertise refers to the extent of which a source is perceived of being knowledgeable on the message topic whereas source trustworthiness refers to the text of which the source is believed to make unbiased conclusions about a message topic. Thus, although expertise may affect a message source of making valid claims, trustworthiness is likely to influence a message source willingness to communicate valid claims (Hovland et al., 1953; McCracken, 1989). While most research does not manipulate source expertise and trustworthiness, source credibility research continues to underline the general effects of source credibility (O’Keefe 2002). It is likely, however, that assumed source expertise and trustworthiness could have different individual and situational factors (Moore, Hausknecht, and Thamodaran 1986; DeBono and Klein 1993; Pornpitakepan 2004). With regard to expertise, consumers have been found to not believe advertising messages when they do not perceive that they know what they are talking about i.e. that they are experts in the related area of the message that they are passing (Karmarkar and Tormala, 2010). To explain this, in the sales context, an expert salesperson generated far greater sales than the non-expert salesperson did (Woodside & Davenport, 1974). These propositions were confirmed by Speck, Schumann and Thompson [68] whose study found that celebrities with expertise to the endorsed product would develop significantly higher brand recall than a non-celebrity; however, the difference was not statistically important. More precisely, a positive attitude towards the endorsed product may be driven by more reliable information about the product provided by the expertise of the celebrity [69].

Trust has been recognised as an essential part in human relations, communication and marketing (Gambetta 1988; Luhmann 1980). Trust has been the subject of little systematic study in advertising, given the large amount of research in other disciplines. Credibility, a related trust construct, has been studied in advertising for some time, but literature argues that credibility and trust are separate constructs that have distinct conceptual characteristics (Doney and Cannon, 1997; Hovland, Janis, and Kelly, 1953; Ohanian, 1990; Swan et al., 1988). Soh, Reid, and King (2009) defined advertising trust as “confidence that advertising is a reliable source of product/service information and willingness to act on the basis of information conveyed by advertising”. The endorser has been shown to affect buyer purchasing decisions as it offers useful knowledge (Power et al., 2008). In an online environment where products cannot be touched or checked, the endorser communications important information on the product (Degeratu et al., 2000). Similarly, endorser trust beliefs or expectations regarding the actions of the endorser have been shown to affect consumer behaviours such as loyalty (Chaudhuri and Holbrook, 2001; Lau and Lee, 1999) and purchasing intentions (Delgado-Ballester et al . , 2003; Elliott and Yannopoulou, 2007) as they mitigate perceived uncertainties about the product (Power et al., 2008). Delgado-Ballester et al (2003) found that confidence in the credibility of the endorser had an effect on purchasing intentions. Lau and Lee (1999) consider that expectations regarding the trustworthiness and expertise of the endorser have an effect on repurchase intentions. Chaudhuri and Holbrook (2001) consider that the trust in the benevolence of the endorser has an influence on loyalty. Power et al., (2008) suggests that endorser trust has a positive effect on endorser attractiveness, which in effect, influences consumer purchasing intentions. Previous literature therefore provides support for the proposal that trustworthiness has a positive impact on purchase intentions.

Celebrity attractiveness

Attractiveness is the extent to which one is physically pleasing and appealing. Studies such as Amos et al. (2008) and Wang and Scheinbaum (2017) have centred the term ‘attractiveness’ around ‘one who is viewed as beautiful, classy or elegant.’ According to McGuire (1969), the attractiveness of the source as perceived by consumers has a direct impact on the effectiveness of the advertising message. Stafford et al . (2002) notes that the likeability and approach of consumers towards advertising has an impact on the promotional results of celebrity endorsement. Praxmarer Decision (2009) observed the congeniality factor in the transfer of a favourable attitude towards the brand and found a direct relationship to purchasing intention. Thus, information sources that are highly likeable increase the effectiveness of the advertising message, as these sources increase the attention and recall of the message (Jain & Posavac, 2001, p. 179). Also, the effectiveness of physically attractive celebrities used to communicate advertising messages was supported concerning attitude change (Debevec and Kernan 1984), consumer behaviour and increasing purchase intentions (Petroshius and Crocker 1989; Petty and Cacioppo 1981; Tingchi Liu et al. 2007). This shows that the attractiveness of the endorser purchase intentions of the endorsed product (Kahle and Homer, 1985; Kamins, 1990). People like to be around attractive people because they are appealing to look at and because looking like them feels rewarding. Moreover, the positive characteristics of attractive people seem to ‘rub off’ those around them as a result of associational learning (Sigall and Landy, 1973) Physically more attractive celebrities are perceived as stronger, mentally healthy, sexually warm, intelligent and socially skilled compared to physically less attractive celebrities (Eagly, Ashmore, Makhijani, and Longo, 1991). Ohanian (1991) found that knowledgeable, honest and physically attractive celebrities are perceived to be trustworthy and thereby promote positive perceptual and behavioural reactions from consumers.

Marketers and academics (Patzer 1985) share the belief that physical attractiveness of endorsers has a significant influence on the effectiveness of advertising and marketing practices (Erdogan, 1999). However, studies have shown, that while attractive endorsers an effect on advertising evaluation (Baker and Churchill 1977), they usually have little or no impact on the purchasing intention (e.g. Baker and Churchill 1977).The unexpected findings from Caballero and Solomon (1984) study in which respondents were more receptive to low attractiveness when buying tissue, led Caballero, Lumpkin and Madden (1989) to use to use the reinforcement theory of attraction of Byrne (1971) which suggests that the effect of an attractive source would depend on the properties of the endorsed product. They observed the willingness of consumers to purchase a videotaped advertised product with three different levels of attractiveness. The authors were unable to establish a relationship between the properties of the product and the attractiveness, i.e. the association between the willingness to purchase and the level of attractiveness. The study considered low involvement and frequent purchases of coffee and cologne. In retrospect, this was considered to be a limitation, as the level of consumer transactions in these types of product categories may have had an impact on the findings. They suggested that the findings may differ in different attractiveness-related product categories such as cosmetics and fashion clothing which enhance physical attractiveness. According to a study by Kamins (1990) there is a correlation between attractiveness on the perceptions of advertising of attractiveness-related products. The study shows that when an attractive celebrity endorsed an attractiveness-related product, e.g. beauty enhancers or camouflage products, they were perceived as more credible compared an unattractive celebrity that endorsed the same product. Thus, physical attractiveness is a strong source of influence on people through their appearance and has a direct effect on their purchase intention.

Match-up Between Product and Endorser

The match-up hypothesis theory shows that the congruence between the characteristics of the celebrity endorser and the attributes of the product is critical in order to allow the correct transfer of meaning and increase the credibility of the source used to endorse the product (Erdogan, 2010). In line with this, celebrity endorsement has a significant effect on consumer attitude towards advertising when there is a congruence that is consistent between the endorser and the product being endorsed. Congruence between celebrity and endorsed product is considered to be a key factor of celebrity endorsement effectiveness (Erdogan, Baker, & Tagg, 2001; Kahle and Driver, 1985; Kamins, 1990; Kamins and Gupta, 1994). Friedman and Friedman (1979) suggested that the influence of celebrities on advertising differs depending on the type of product being endorsed. They concluded that a stronger match-up between celebrity and product fit, as perceived by consumers, leads to a higher degree of brand evaluation and a higher level of endorsement effectiveness. The degree of congruence between the celebrity endorser and the product has an influence on consumer perception towards the brand and celebrity endorser (Till and Busler, 2000). For example, a celebrity athlete was most effective as an endorser for the energy bar that enhanced athletic performance compared to a non-athletic product unrelated to athletic performance. This suggests that the target audience will only react to the advertisement if the image of the celebrity endorser matches strongly with the image of the brand or product. This is because the celebrities selected convey a message that suggests a higher perceived similarity between the elements selected for their self-image and the product. In support of this statement, the research by Choi and Rifon (2007) found that a strong match-up between the endorser and the product appeared to give positive attitudinal and behavioural responses from the target audience.

Kanungo and Pang (1973) conducted a preliminary study to determine the perceived physical attractiveness of a group of male, female and male-female endorsers with different product types. The study found that the male model for the car produced a more favourable attitude towards the product than the female model, while the male model for the sofa produced an unfavourable attitude towards the product than the female model (Kanungo and Pang, 197). The physically attractive celebrity endorsers were liked more and had more positive impact when the product was related to a and attractiveness such as cosmetics (Choi and Rifon, 2012; Kahle and Homer, 1985). This is in contrast to technology-related products which were less likely to have a similar effect due to the insignificance of physical attractiveness to the product type (Choi and Rifon, 2012; Till & Busler, 2000). In addition, to the findings of Kahle and Homer (1985) on product-endorser fit, Kamins (1990) noticed that a physically attractive endorser was less effective at endorsing an unrelated product to their area of expertise even when the product was attractive. In addition to attractiveness, Till and Busler (2000) considered expertise to be another potential match-up element influencing the source-object congruence effect. Two very similar design and method studies were conducted to test the hypotheses. The study looked at the congruence effect of physical attractiveness on advertising effectiveness, while the second study used expertise as a match-up factor. This study did not identify the interaction effect of the physical attractiveness by product type as opposed to previous research (e.g. Kahle and Homer, 1985; Kamins, 1990). In addition, the second study demonstrated the importance of expertise as a match-up factor. The study uncovered that the perceived expertise of the endorser was more relevant than the perceived attractiveness for matching a product to achieve greater endorsement effectiveness.

Match-up Between Endorser and Consumer Self-image

Previous research on the match-up hypothesis has primarily focused on celebrity endorsers and the product being endorsed (Kamins & Gupta, 1994). More recent research, however, has shown that the effect of congruence between celebrity endorsers and consumer self-image is based on consumer personality and self-concept. According to Escalas (2004) consumers are able to create a relationship with the brand and develop a self-brand connection. Self-brand connection suggests that, as a person purchases a brand, they integrate the brand their self-concept, thus incorporating the brand as part of their extended self (Escalas & Bettman, 2005). A strong self-brand connection is more likely to exist where the personal experience of the consumer with the brand is directly linked to the identity of the brand and the brand itself meets their psychological needs (Moore & Homer, 2008). The self-concept of consumers is a key factor in shaping their consumption behaviours. Self-image congruence allows marketers to anticipate various aspects of consumer behaviour (Hosany & Martin, 2012; Quester, Karunaratna, & Kee, 2000). Consumers are more likely to be persuaded to buy the endorsed product if their self-image matches that of the celebrity endorser (Hosany & Martin, 2012). As Choi (2012) points out, a strong match between the celebrity image and either the self-image of the endorsed product or the consumer is more effective than a weak match between them. Consumer self-concept has been conceptualised from a multidimensional perspective (Burns 1979; Rosenberg 1979). Previous research identified four dimensions of self-concept to study and forecast consumer behaviours: (1) real self-concept, how a individual perceives himself or herself, (2) potential self-concept, how an individual would like to view himself or herself, (3) external self-concept, how customers believe others interpret them, and (4) potential external self-concept, how a person would like to be viewed by others.

According to Sirgy (1982), self-concept can be categorised into four (4) dimensions: self-concept (how an individual perceives themselves), ideal self-concept (how an individual would like to perceive themselves), social self-concept (how an individual thinks others perceive them), and ideal social self-concept (how an individual would like to be perceived by others; Noble & Walker, 1997; Schiffman, Bednall, O’Cass, Paladino, & Kanuk, 2005; Sirgy & Su, 2000). In recent research, the two dimensions of self-concept that have received a vast body of empirical support and theoretical consideration are actual self-concept and ideal self-concept (Graeff, 1996). Accordingly, Sirgy (1982; 1985) defined self-image value under two dimensions: (1) actual self-image and (2) ideal self-image. Self-image congruence is the fit between consumers’ self-concept (e.g., actual self, ideal self, social self and ideal social self) and brand personality (Aaker, 1999, Sirgy, 1982). Self-congruence, self-image congruence, image congruence and self-congruity are used much in the same way to explain this congruency effect (Hosany & Martin, 2012; Sirgy, 1985). Self-image congruence is a strong factor influencing consumer behaviour (Kressmann, Sirgy, Herrmann, Huber, & Lee, 2006; Sirgy, Johar, Samli, & Claiborne, 1991; Hosany & Martin, 2012; Sirgy & Samli, 1985, 1991) For example, prior research has shown that self-image congruence influences consumers’ choice (Hosany & Martin, 2012; Quester et al., 2000), perceived quality (Hosany & Martin, 2012; Kwak & Kang, 2009), brand loyalty through functional congruity (Hosany & Martin, 2012; Kressmann et al., 2006), brand preferences (Hosany & Martin, 2012; Jamal & Goode, 2001), attitudes and consumer buying behaviours (Hosany & Martin, 2012; Ibrahim & Najjar, 2008), contributes to more favourable attitudes toward product and brands (Ekinci & Riley, 2003; Hosany & Martin, 2012; Sirgy et al.,1997) and affects advertising effectiveness (Bjerke & Polegato, 2006; Hong & Zinkhan, 1995; Hosany & Martin, 2012).

Langner et al. (2013) suggested that consumers show more positive attitudes and stronger purchase intentions towards brands that they feel are compatible with their self-image and show negative attitudes towards brands that they feel are not incompatible with their self-image. According to Park et al. (2010) a brand is also judged on the grounds of whether it represents itself or how important the brand is to the customer. Graeff (1996) suggested that there are two types of self-brand congruence; self-congruity and ideal congruity. Self-congruity is a match between the image of the brand and the actual self-image of the consumer, while ideal congruity is a match between the image of the brand and the ideal self-image of the consumer (Graeff, 1996). More recently, brands serve not only their primary roles, but also their psychological and social objectives as indicators for consumers to communicate their identity and to facilitate social interaction with others (Aaker, 1996; Belk, 1988; Choi & Rifon, 2012; Sirgy, 1982). Sirgy et al. (1997) suggested that the images consumers hold of various products interact with their self-concept and generate a self-image congruence during the consumer buying process. A celebrity endorser can influence the self-construction of the consumer through this process. In addition, McCracken (1989) suggested that consumers develop their own perceptions of the product when buying a celebrity-sponsored product and use it to form a positive self-concept of themselves. In summary, self-image congruence can influence a number of consumer behaviours, such as brand preferences (Hosany & Martin, 2012; Jamal & Goode, 2001), attitudes and buying behaviours (Hosany & Martin, 2012; Ibrahim & Najjar, 2008). Consumers pursue self-esteem by enhancing their ideal self-image and finding celebrities with inspirational personalities with positive associations to enhance their ideal self (Boon & Lomore, 2001; Choi & Rifon, 2012; Escalas & Bettman, 2003).