Assessment of Knowledge and Attitude of Health Care Workers Regarding Continuous Professional Development Programs, Alexandria, Egypt

: Continuous Professional Development (CPD) refers to the educational pursuits that professionals make after completing their basic education and continues throughout their professional working lives in order to improve their knowledge, proficiency, and personal skills. CPD programs are crucial for enhancing the abilities of healthcare professionals and allowing them to provide patients with better care. However, few studies have discussed on this issue in Egypt. We conducted the current study to assess the knowledge and attitude of health care workers regarding CPD programs in a tertiary care hospital. A descriptive cross-sectional study was conducted in Sporting Tertiary Care Hospital, Alexandria after the acceptance from Ethical Committee. The data were collected by interviewing questionnaire from a purposive sample of thirty-two healthcare workers who are representative of stakeholder groups to assess the knowledge and attitude regarding continuous professional programs. The questionnaire consists of three divisions, the first one is concerned with personal data, second one covers the knowledge assessment, and the last one embraces the attitude evaluation section. The study lasted 3 months. Data were analyzed by using a suitable statistical software. We found that majority of the participants had good knowledge level (96.9%) and strongly positive attitude (75%) regarding CPD programs. In conclusion, the study findings demonstrated a significant level of knowledge and attitude of the participants regarding continuous professional programs which opens the way for further research that assess the implementation


Introduction
Continuing Professional Development (CPD) refers to a period of education and training for health care workers (HCW) that begins after they complete their basic medical education and continues throughout their professional working lives (World Federation for Medical Education [WFME], 2003).CPD activities are classified into conference, symposium, training course, specialized workshop, scientific publication and review, general workshop, seminar, internal activity, and distance learning (Center for Continuing Education and Professional Development [CEPD], 2021).The main objective of CPD programs is to improve the efficiency and quality of HCWs to provide better service to patients (Center for Continuing Education and Professional Development [CEPD], 2021).
Several studies have been conducted to assess the effectiveness of CPD programs on HCW.For instance, a survey of geriatric physicians' satisfaction and availability for CPD was conducted in Australia; the findings showed that while on-campus training courses are beneficial to them, they require more flexible training courses to increase physician participation and meet their needs and expectations (Etherton-Beer et al., 2016).Wagner, a pre-and post-test was conducted to assess the impact of family medicine courses in KSA showed a positive impact on knowledge and skills of the participants (Al-Baghli et al., 2015) In addition, a cross sectional study was done at public hospitals, Douala, Cameron reported that 98.0% of the nurses had ever heard of CPD, but only 59.9% could identify it (Ndang, E. A., 2022).One more study conducted on Scottish pharmacists' views and attitudes regarding CPD revealed four associated factors: "having positive support in the workplace, having access to resources and meeting learning needs, having confidence in the CPD process and motivation to participate in the CPD process" (Power et al., 2011).
Furthermore, another study was conducted in Lebanon to identify the views and assess motivation and attitudes of pharmacists towards mandatory CPD has found that 55.4% felt confident that CPD meets their needs.(Saade et al., 2018).Because academic research on CPD in Egypt is sparse, we performed our study to assess Health Care Workers' Knowledge and Attitudes toward Continuous Professional Development Programs.

Methodology Study Setting
The study was conducted at Sporting Tertiary Care Hospital, HIO, Alexandria.

Target Population
Health care workers who are representative of all departments of a selected hospital were included in the study till we reached to sample size.

Type of Sample
Non-random and purposive sample.The purposive sampling could be used when the researcher wants to discover, understand, and gain insight into a phenomenon (Merriam, 1998).

Sample Size and Method
The targets are representative of stakeholder groups, which affect and are affected by CPD.This includes, for example, department directors, specialists, consultants, GP, fellowship trainers, Residents, Nurses, and Frontline officers.Thirty-two health care workers were included in the study.

Statistical Analysis
Statistical analysis was done using IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA).Numerical data were expressed as mean and standard deviation or median and range as appropriate.Qualitative data were expressed as frequency and percentage.Pearson's Chi-square test or Fisher's exact test was used to examine the relation between qualitative variables.For Knowledge and attitude score, comparison between two groups was done using Mann-Whitney test (non-parametric t-test).Correlation between scores was tested using Spearman-rho correlation.All tests were two-tailed.A p-value < 0.05 was considered significant.

Data Collection Tools
The interviewing questionnaire was designed and developed by the researcher to gain information about the knowledge and attitude of HCW regarding the CPD program.

Questionnaire Validation
First, we established face validity.There were two important steps in this process.The first one was evaluating the questionnaire by experts who understand our topic to determine whether the questions effectively captured the topic under investigation.They checked the survey for common errors like double-barreled, confusing, and leading questions.
The second step was to perform a pilot study.A pilot study was done before gross data collection to ascertain the clarity and feasibility of the tool, to estimate the exact time needed for filling it up, and to detect any problems that might face the researcher and interfere with data collection.It entailed pretesting of the questionnaire on 3 participants which was not included in the final analysis.The respondents took an average of 15 minutes to answer the questionnaire, with a range of 12 to 18 minutes.The majority of respondents found the questionnaire easy to understand.A few items were reworded for clarity.Relevant modifications were instituted before the commencement of actual data collection.
We checked the internal consistency of questions loading onto the same factors.It is a measure of reliability in that it checks whether the responses are consistent.A standard test of internal consistency is Cronbach's Alpha (CA).Cronbach Alpha values range from 0 -1.0.In present study, Cronbach Alpha value was 0.68 which is considered acceptable value.

The Questionnaire Included 3 Main Sections
The first part concerned with personal, professional, and qualified characteristics of participants such as name, age, gender, ID, previous experience, qualifications, specialty, position title, job status (permanent or contract), and past medical history.
The second one assessed the knowledge of participants regarding the CPD program through 10 yes/no questions, the correct answer was given a score of 1 and the wrong score was 0.
The third division assessed the attitude of participants toward the CPD program, a total of 10 statements representing positive and negative attitudes were administered to all respondents.For positive attitudes, the score was given 5 for strongly agree, 4 for agree, 3 for uncertain, 2 for disagree, and 1 for strongly disagree response.However, the reverse score was given to negative attitude statements.

Results
The sociodemographic and professional characteristics of the participants are summarized in Table 1, it was found that half of the participants were in the age group of 40 years or older, the majority of respondents were female (75%), about three fourths were married, approximately one third had bachelor degree while, only 9% had diploma certificate, the nurse and pediatric specialty predominated and recorded 43.7%, and about 60% had experience for 15 years or more.Table 2 shows the findings of knowledge assessment regarding CPD programs; ten (yes/no) questions were used to assess the awareness of the participants about CPD.The results demonstrated that the median knowledge score was 9 (8-10) which mirrored a good level.
We found that all the participants realized the right definition and activities of CPD programs and indicated that CPD activities should be documented.In the fourth, fifth, eighth, and tenth questions, it was found that about 97% of the respondents agreed with the concepts of that CPD programs have positive role in enhancing knowledge, professional skills, practices, and reduced adverse events in health care facilities and that they are necessary for HCW promotions respectively.Last, 100% of the participants in sixth and ninth questions acknowledged that CPD programs could improve the educational department and that they should include guidelines to explain the procedure.The total knowledge score was converted into levels, the current results demonstrated that about 96.9 % of the participants had good knowledge level while, only 3.1% had a fair level as shown in figure (1).The attitude of participants was assessed by ten questions as shown in table (3).It was found that the median attitude score was 4.6 (3.8-5) which reflected strongly positive attitude.Regarding the first question, it was found that about half of the participants (46.9%) did not accept that CPD programs as a bureaucratic process.The second question demonstrated that 90.6% of the participants agreed and strongly agreed that CPD is an enjoyable process.On the third and fourth questions, the results showed that more than three fourths of respondents (81.35%) strongly agreed on the concept that CPD programs are necessary for professional life and patient safety.Approximately two thirds (68.8%) strongly agreed with a belief that CPD programs are mandatory for career progression.Three fourths of participants believed that CPD programs are rewarding while, only 3.1% strongly accorded with that CPD is threatening and unnecessary.Lastly, we found that more than 90% of the participants agreed and strongly agreed with the faith that indicated that CPD programs enhance patient outcome and practical skills of health care workers.The present results demonstrated that 75% of the HCWs had strongly positive attitude as shown in figure (2).We tested the relationship between the median knowledge and attitude scores, and socio demographic and professional characteristics, we found that there was not statistically significant association between knowledge or attitude and any of the sociodemographic and professional factors of the participants as shown in tables ( 4) and ( 5).