Accounting for attitude in a KAP Study: A comment on knowledge, attitude and practice of stroke in India versus other developed and developing countries

Sir,

Went through an article entitled “Knowledge, attitude, and practice of stroke in India versus other developed and developing countries" published in Ann Indian Acad Neurol (2013; 16:488-93).[1] The authors need to be congratulated for their effort in touching an important aspect neuroepidemiology related to stroke in India. As we all aware awareness about a medical condition is the cornerstone for planning prevention. By referring to the study as a review, the authors have been honest in their interpretation of the methodology used to choose studies included in this study. However, given the vast body of evidence referred to in this article, one would have been happy to see a systematic review as a methodology for conducting this study. Systematic reviews and meta-analyses are a key element of evidence-based healthcare. This would have answered our concerns as to why did the authors select certain studies and not others? What did they do to pool results? This would also have reflected on the inadequate number of studies reflecting on all components of KAP (Knowledge, Attitude and Practice) on stroke across populations.

A review becomes systematic if it is based on a clearly formulated question, identifies relevant studies, appraises their quality and summarizes the evidence by use of explicit methodology.

The authors rightly talk of attitude toward stroke being an almost unexplored area of research. Most of the KAP studies lack in measuring attitude properly (the second part of a standard KAP survey questionnaire.[2] And if studies make an effort to understand attitude, the efforts are inadequate. This study highlights this fact again. Attitude essentially includes three components:

1. A cognitive or knowledge element,

2. An affective or feeling element, and

3. A tendency to action.[3]

The authors tend to do well with the feeling element of the attitude, but have handle “tendency to action” inadequately. This is also reflected in the statement used by the authors; Indian participants were observed to hold an attitude that stroke could occur without any risk factors, simply being an event associated with senility and hence consultation with health personnel was reportedly low. Further it goes on to add that about more than half of the study participants reported that they did not know the appropriate treatment for stroke. Both these statements actually are an extension of awareness or knowledge component only.