title: Knowledge, attitude, and practices with respect to disease surveillance among urban private practitioners in Pune, India.
abstract: BACKGROUND
  Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts.
  
  
  METHODS
  A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1.
  
  
  RESULTS
  Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234-7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237-10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998-14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting.
  
  
  CONCLUSIONS
  The high response rate and the practitioners' willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted.
authors.affiliation: Institute of Geography, University of Cologne, Cologne, Germany.|Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, United Kingdom; revati.phalkey@nottingham.ac.uk.
authors.forename: Revati K
authors.initials: RK
authors.lastname: Phalkey
authors.affiliation: Institute of Geography, University of Cologne, Cologne, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Kroll
authors.affiliation: Institute of Environment Education and Research, Bharati Vidyapeeth Deemed University, Pune, India.
authors.forename: Sayani
authors.initials: S
authors.lastname: Dutta
authors.affiliation: Center for Modelling and Simulation, Savitribai Phule University of Pune, Pune, India.
authors.forename: Sharvari
authors.initials: S
authors.lastname: Shukla
authors.affiliation: Institute of Geography, University of Cologne, Cologne, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Butsch
authors.affiliation: Institute of Environment Education and Research, Bharati Vidyapeeth Deemed University, Pune, India.
authors.forename: Erach
authors.initials: E
authors.lastname: Bharucha
authors.affiliation: Institute of Geography, University of Cologne, Cologne, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Kraas
mesh_terms: D002983:Clinical Competence; D000529:Complementary Therapies; D005260:Female; D014943:Global Health; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017149:Private Sector / Q000592:standards*; D062486:Public Health Surveillance / Q000379:methods*; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: barriers and facilitators; disease surveillance; knowledge-attitude-practice; private practitioners