Drivers of Physicians’ Engagement in Addressing Eco-health Problems
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Physicians are in a unique position to be first-hand observers of the effects of environmental factors on population health. As a source of information which is highly trusted, they are also well-suited to raise awareness about the linkages between ecosystem and population health. Yet, current clinical practice in many parts of the world rarely includes environmental health assessments and patient education. The empirical evidence on the reasons for this lack of engagement is limited by the small number of studies published, its narrow geographical scope and the dearth of multivariate statistical analysis. This study used a mixed-methods approach to investigate the determinants of whether physicians at selected hospitals in Thailand assess the environmental history of their patients and provide environmental health advice. Using an ordered logistic regression model, it was found that physicians’ engagement was associated with their knowledge, personal motivation, perception of being supported by senior staff and ability to discuss with colleagues. According to key informants, possible remedies for the observed lack of physicians’ engagement include revisions of the medical school curriculum, clear strategies for addressing eco-health linkages in the clinical context at the national and hospital level, and better cooperation between relevant government institutions in Thailand.
KeywordsMedical doctors Environmental health Population health Environmental history taking Patient education Multivariate analysis
This research has been funded by Mahidol University (TM 126/2559). The authors would like to acknowledge Churnrurtai Kanchanachitra, Theerathorn Yoongthong, Donlachai Hawangchu and Reena Tadee on their invaluable assistance with this study. Our thanks go to all the key informants cited that gave their times for discussions. Comments by two anonymous reviewers are gratefully acknowledged.
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