title: Staff knowledge, attitudes and practices in public sector primary care of diabetes in Cape Town.
abstract: OBJECTIVE
  To audit staff knowledge, attitudes and practices in the interest of improved public sector primary care for diabetics.
  
  
  METHODS
  External audit using face-to-face, private, questionnaire-based interviews.
  
  
  METHODS
  Twelve public sector ambulatory health centres in Cape Town.
  
  
  METHODS
  Non-specialist, principal staff members (N = 35)-12 doctors, 10 primary health care nurses (PHCNs), 7 registered nurses (RNs) and 6 staff nurses (SNs).
  
  
  RESULTS
  Staff members were long-standing employees (mean-doctors 6 years, PHCNs 8 years, RNs 5 years, SNs 12 years). Few had post-basic training (doctors 25%, PHCNs 20%, RNs 26%, SNs 83%). Knowledge of chronic diabetic complications was adequate, e.g. diabetic eye disease was mentioned by 100% of staff. There were gaps in knowledge of pathophysiology and of signs and symptoms of diabetic emergencies, e.g. < 33% knew control of hypertension to be important in the prevention of diabetic nephropathy. Knowledge of appropriate care of patients with hypoglycaemia (94% mentioned glucose administration) was better than that of hyperglycaemia (69% mentioned intravenous fluids). Problems were reported in inter-staff communication within (approximately 50%) and between (approximately 75%) disciplines by doctors, PHCNs and RNs. Staff/patient communication problems were reported by approximately 75% of staff. Solutions suggested by staff included meetings between staff members and with management, in-service training programmes and appointment systems for patients. Despite logistic, organisational and communication-related problems, most staff enjoy and believe in the value of their work.
  
  
  CONCLUSIONS
  This study reveals deficiencies in in-service training with consequent gaps in knowledge and practice. Recommendations that would lead to improved quality of care and increased staff and patient satisfaction have been given.
authors.affiliation: Centre for Epidemiological Research in South Africa, South African Medical Research Council, Parowvallei, W. Cape.
authors.forename: G R
authors.initials: GR
authors.lastname: Goodman
authors.forename: M F
authors.initials: MF
authors.lastname: Zwarenstein
authors.forename: I I
authors.initials: II
authors.lastname: Robinson
authors.forename: N S
authors.initials: NS
authors.lastname: Levitt
mesh_terms: D001291:Attitude of Health Personnel; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009726:Nurses; D010820:Physicians; D011320:Primary Health Care / Q000592:standards*; D017150:Public Sector; D013019:South Africa; D000078329:Workforce