title: Improved knowledge and reported practice regarding sexually transmitted infections among healthcare providers in rural Vietnam: a cluster randomised controlled educational intervention.
abstract: BACKGROUND
  Healthcare providers (HCPs) play a critical role in controlling the spread of sexually transmitted infections (STI) through early and accurate diagnosis, appropriate treatment and prevention counselling. This study aimed to assess the effectiveness of an educational intervention about STI on knowledge and reported practice among HCPs and to explore which determinants may influence the intervention's effects.
  
  
  METHODS
  A cluster randomized controlled educational intervention was carried out in a rural district, Vietnam. 32 communes of the district were randomized into two arms, with 160 HCPs in an STI intervention arm and 144 in a control arm. The STI intervention comprised interactive training with basic STI knowledge, case scenarios, and poster distribution. Questionnaires to evaluate knowledge and reported practice were completed three times: before, during and after the intervention. Correct answer was scored as 1; "do not know", incorrect answer was scored as 0. Univariate and multilevel multivariate analyses were applied.
  
  
  RESULTS
  Of the maximum 56 points, the mean knowledge score increased significantly in the STI intervention arm and in the control arm post-intervention (37.2 to 48.4, and 32.7 to 41.7, respectively). In multivariate regression analysis, knowledge improvement in the intervention arm was significantly higher than that in the control arm (regression coefficient = 2.97, p = 0.008). Other factors which positively influenced the increase in knowledge were being between 35 and 50 years old, having intermediate professional training, being a pharmacist or working at a village level (regression coefficient: 2.81, 4.43, 5.53 and 7.91, respectively). Post-intervention, the mean reported practice score increased significantly in the STI intervention arm (from 17.6 to 21.8) and insignificantly in the control arm (maximum 36 points). Factors which positively influenced the increase in reported practice were being between 35 and 50 years old, having intermediate professional training, or working at a pharmacy/drugstore (regression coefficient: 2.15, 3.33 and 3.22, respectively).
  
  
  CONCLUSIONS
  This study indicates that an educational intervention including interactive training and multi-faceted interventions may be effective in improving STI knowledge and reported practice of HCPs at grassroots level, particularly among pharmacists, HCPs who work in villages or pharmacies/drugstores, and who initially have low STI knowledge.
authors.affiliation: Hanoi Medical University, Hanoi, Vietnam. landhy2003@yahoo.com.|Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. landhy2003@yahoo.com.
authors.forename: Pham Thi
authors.initials: PT
authors.lastname: Lan
authors.affiliation: Institute of Mathematics, VAST, Hanoi, Vietnam. hodang54@yahoo.com.
authors.forename: Ho Dang
authors.initials: HD
authors.lastname: Phuc
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. quynhhoa29@gmail.com.|National Cancer Hospital, Hanoi, Vietnam. quynhhoa29@gmail.com.
authors.forename: Nguyen Quynh
authors.initials: NQ
authors.lastname: Hoa
authors.affiliation: Hanoi Medical University, Hanoi, Vietnam. ntkchuc@yahoo.com.
authors.forename: Nguyen Thi Kim
authors.initials: NT
authors.lastname: Chuc
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. cecilia.stalsby.lundborg@ki.se.
authors.forename: Cecilia Stålsby
authors.initials: CS
authors.lastname: Lundborg
mesh_terms: D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014744:Vietnam; D055815:Young Adult