Knowledge, Attitude and Practice Regarding Diagnosis and Management of Gout Among Clinicians in Nepal

Objective To understand the knowledge, attitude and treatment practices of gout among doctors who regularly interacted with gout patients.

Methodology Study population: Physicians (including practicing medical graduates, post-graduates in internal medicine, family medicine) and orthopedic surgeons were selected randomly from the list of data from the Nepal Medical Council registry. All internists with valid email ID on the registry of the "society of internal medicine of Nepal" (SIMON) were included. Also, a list of MBBS graduates, family medicine and orthopedic practitioners working in the peripheral set-up of Nepal was obtained and a random selection with computer-generated random number table based on council registration number was made for enrollment into the survey. Estimating a response rate of 30%, a total of 1200 clinicians were selected based on their council registration number for the invitation to participate in the survey.

Survey instrument: A standardized questionnaire was designed by a 3-member committee of NRA focusing on the areas of knowledge, attitude and practice of gout with 9 questions pertaining to demographic parameters, 8 to knowledge about the disease, 11 to attitude and 10 to practice behaviors [tables 1-4]. The questions were designed as multiple-choice questions (MCQ) to be marked by the respondent. Few questions had the provision of selecting more than 1 options. Open- ended questions were avoided to save the time of the respondents and thus reduce the attrition rates[10].

Procedure: An email containing a letter of invitation for participation was sent to each of the selected participant. It mentioned why they were receiving the email, the objectives of the survey, the assurance of anonymity and confidentiality and a total answering time of less than 5 minutes for encouraging participation. A link to the Google-form was attached in the mail itself and a mention was made on the implied consent for participation in clicking the link. A reminder email was sent after 1 week to all irrespective of whether they had responded earlier.

Platform: A web-based platform was chosen with the use of Google-forms which was compatible and user friendly to both browser and mobile users and to both iOS and Android users. Multiple entries from the same email link were blocked. Web-based platform was chosen over email survey because it provides the ability to transfer survey responses directly into a database, eliminating transcription errors and preventing survey alteration by the survey respondent and most importantly maintaining confidentiality and anonymity of respondents[11]. The answers were collected anonymously in an excel sheet at the main server for analysis.

Statistical analysis: Simple descriptive statistics were used to describe the frequency or correct responses. Chi-square test was performed to assess the difference in knowledge, attitude, and practices between clinicians with different medical qualifications. Analysis was done using SPSS version 21 (SPSS, Inc., Chicago, IL, USA).