A–Z OF PUBLIC HEALTH

SEE ALSO behaviour change; health promotion; lifestyle; peer education; youth

Knowledge, attitude and practice (KAP) is an approach that can be used to promote and evaluate an increase in the knowledge, attitude and practices or behaviours of targeted individuals and groups (Corcoran, 2013).

The process of knowledge, attitude and practice has been identified as having three key steps centred first on the provision of knowledge, the acceptance and the development of a positive attitude towards the new knowledge and an intention to take action to change a behaviour or practice (Corcoran, 2013). Education is considered to be the first step in changing attitudes towards further action by providing the relevant technical information, motivating people to change unhealthy behaviours and giving them the necessary confidence to make those changes. Persuasion is also a key aspect of changing a person’s (or a group’s) attitude, belief or behaviour towards an event or idea by using methods of communication to convey information, feelings or reasoning (Seiter and Gass, 2010).

KAP surveys are an approach in public health to provide a representative study of a specific population by collecting information on what is known, believed and done in relation to a particular health topic such as breastfeeding or hand-washing. In KAP surveys, data are collected using a structured, standardized questionnaire or qualitatively collected data using focus group discussions and individual interviews. The data analysis can then provide programme managers with the evidence that they need to select appropriate and effective interventions (WHO, 2008).

The KAP survey has six steps. Step 1: Defines the survey objectives and contains information about how to access existing information, determine the purpose of the survey and main areas of enquiry, identify the survey population and sampling plan. Step 2: Develops the survey protocol, outlines elements to include in the survey and the key research questions, a work plan and a budget. Step 3: Designs the survey questionnaire and proposes important steps for developing, pre-testing and finalizing the questionnaire and for making a data analysis plan. Step 4: Implements the KAP survey, recruits and trains survey supervisors and interviewers. Step 5: Analyses the data. Step 6: Uses the data to translate the survey findings into action, produces the study report and disseminates the survey findings (WHO, 2008c).

Another increasingly important role for KAP surveys is to provide essential data for demonstrating the impact of programme activities. This is achieved by measuring the knowledge, attitude and practices of the beneficiaries of the programme before and after the targeted interventions to demonstrate positive outcomes. A before and after study has no control or comparison group and the attributing causality is ascertained by asking people why they had changed, using, for example, a self-reporting questionnaire (Jirojwong and Liamputtong, 2009).

Communication strategies to promote a change in knowledge, attitude and practice have mainly relied upon one-directional methods, such as the mass media, and this may have resulted in a difference between knowledge levels and observed or reported practice. For example, the knowledge of school pupils about the proper use of latrines (98%), safe water supplies (98%) and the prevention of worm infection (95%) was found to be very high in one study covering four provinces in Vietnam (Trinh et al., 1999). However, a study of intestinal worm infection in adults and children (felt to be a reliable indicator of hygiene practice and sanitary conditions) found rates for round-worm, thread-worm and hook-worm to be 83%, 94% and 59% respectively (Needham et al., 1998).

A number of causes have been identified for the gap between knowledge and practice in KAP communication interventions (UNICEF, 2001) including:

•The reliance on a top-down apparatus using didactic styles of communication;

•Communication interventions have lacked adequate research;

•There has been poor coordination of communication activities between agencies and sectors;

•Proper audience segmentation has not always been included in programme design resulting in inappropriate message content and social exclusion of specific groups;

•The demand generated by communication messages has not always been matched by supply;

•Materials development and distribution have not been given sufficient attention.

The assumption that by changing knowledge, an intervention can also lead to a change in a person’s attitude and practice is overly simplistic and places too much emphasis on individual responsibility. It is a top-down perspective that is incorrect because it assumes that people are free to choose healthier options when in fact other factors that determine their attitude and practices may be out of their control, for example, being unemployed or living in stressful conditions (Holland, 2007).

KEY TEXTS

•Corcoran, N. (ed.) (2013) Communicating Health: Strategies for Health Promotion. 2nd edn (London: Sage)

•UNDP (2002) Communication Behaviour Change Tools. Entertainment-Education. 1: 1–6 (New York: UNDP)

•World Health Organization (2008c) ‘Advocacy, Communication and Social Mobilization for TB Control’. A Guide to Develop a Knowledge, Attitude and Practice Survey (Geneva: World Health Organization)