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Patient Attitudes Toward Issues
of Environmental Health (cont'd)

Results

Response Rate

Of the 496 patients approached, 415 patients accepted the questionnaire, and 373 patients returned complete and acceptable questionnaires. A response rate of 75.2% was therefore obtained. The study sample included approximately equal representation from the four family practice clinics involved. Of the complete and suitable questionnaires collected, 92 (24.7%) were from Wingra, 102 (27.4%) from Verona, 93 (24.9%) from Belleville, and 86 (23.1%) from Northeast. Most refusals were based on process (eg, lack of time, significant illness, or the presence of small children) rather than on content issues.

General Demographics of Study Sample

The demographics of the study sample followed those of the clinics' usual patient populations (see Table 1). The mean age of respondents was 41.5 years, although the sample ranged from 18 to 86 years of age. The majority of respondents were female (70.4%), and 79.5% of respondents had children (ie, were parents).

Patient Concerns, Information Source, and Trust

Patients rated their level of interest and concern regarding seven different environmental issues using a 7-point Likert scale
(1 representing “very interested” and 7 representing “not at all interested”). High levels of interest (median; mean) were recorded for all issues: food quality (1; 1.78), water quality (1; 1.84), air quality (2; 2.02), land use (2; 2.26), biodiversity and wildlife (2; 2.29), radiation (2; 2.37), and population growth (3; 2.76). Overall, the mean composite level of interest in environmental issues was 2.18 (median = 2; Figure 1), indicating a general high level of interest and concern. The composite level of interest was related to age (ANOVA: F[3,330] = 5.36; P = .001), but not significantly related to sex, ethnicity, education level, parental status, or clinic affiliation. Respondents between the ages of 45 and 59 expressed the greatest level of interest and concern about environmental issues (mean = 1.93) whereas the youngest group (18–29 years old) had the lowest level of interest (mean = 2.57).

Perception of environmental risk was assessed using two questions. First, respondents were asked to what degree environmental problems affect them or their family. On a 7-point Likert scale with 1 meaning “very much” and 7 meaning “not at all,” the median (mean) response to this question was 2 (2.72). Then patients were asked to what degree environmental problems affect their health or the health of their family. With the same scale as before, the median (mean) response was 2 (2.67). The majority of respondents strongly felt that environmental problems affected them and their health (Figure 2).

Patients were asked to identify from a list their major sources of information on environmental issues (Figure 3). These included television (broadcast media), magazines and newspapers (print media), church or clergy, politicians, doctors, family, friends, and environmental organizations or activists. The greatest percentage of patients utilized print (87.3%) and broadcast (83.3%) media as major sources of information. Approximately one third of respondents used friends (35.6%), family (33.7%), and environmental activists or organizations (27.2%). The least utilized sources included doctors (18.7%), politicians (11.3%), and church or clergy (10.5%).

Significant differences in level of trust were found among the sources of information (ANOVA: F[7,2605] = 83.80; P < .001; Figure 4). Although physicians represented one of the least likely sources of information on environmental issues, the respondents rated doctors the most trustworthy with a median (mean) rating of 2 (2.33) on a 7-point Likert scale (1 representing “high level of trust” and 7 representing “no trust at all”). Sex was the only significant demographic factor in determining level of trust in doctors. Women were more trusting of physicians than men (ANOVA: F[1,317] = 6.04; P = .015). Broadcast and print media received median (mean) ratings of 3 (3.20) and 3 (2.95), respectively. Lower scores (median; mean) were awarded to family (3; 2.69), friends (3; 2.89), church or clergy (3; 3.33), and environmental organizations or activists (3; 3.37). Politicians were rated the least trustworthy with a median (mean) score of 5 (4.85).

Physician Knowledge and Adequacy of Information

Patients were asked how knowledgeable their physician was about environmental issues and their effects on patients' health (Figure 5). On a 7-point Likert scale (1 representing “very well informed” and 7 representing “not informed at all”), the median (mean) level of environmental knowledge given to doctors was 4 (3.41). However, patients responded that their physicians had higher levels of knowledge (median = 2; mean = 2.69) when asked, “How knowledgeable is your doctor about environmental effects on your health?”

A minority of respondents (22.5%) had discussed an environmental issue and its effect on their health with a doctor. This level was in good agreement with the percentage of patients regarding their physician as a major source of environmental information. Of these patients, the average length of time since that discussion was 1.06 years. When asked if they would like more environmental education from their doctor, 54.6% of surveyed patients responded “yes.” Women were more likely to respond “yes” than men (58.5% vs 46.5%: 2 = 4.112; df = 1; P < .05). Significant differences also existed between clinics. Patients from the urban clinics (65.5% and 65.3%) were more likely to answer “yes” than those from the suburban (45.6%) and rural (44.4%) sites (2 = 14.207; df = 3; P < .005).

In general, the majority of the patient population (73.4%) felt that they had received too little information and education from their physician regarding environmental issues (Figure 6). Only 6% of patients felt that they had received too much information. The mean (median) composite level of information received was 2.43 (2) on a 7-point Likert scale (1 representing “too little” and 7 representing “too much”). Specifically, patients felt that they had received too little information concerning land use (median = 2; mean = 2.25), radiation (2; 2.26), biodiversity (2; 2.27), population growth (2; 2.34), air pollution (2; 2.52), water pollution (2; 2.56), and food quality (2; 2.74). Significant differences in the adequacy of environmental information or education received were detected among demographic groups on the basis of parental status and clinic affiliation. Patients without children reported receiving less information and education than those with children (means of 1.94 vs 2.55; ANOVA: F[1,295] = 9.40; P = .002). Subjects from the urban (means of 2.22 and 2.42) and suburban (2.19) clinics reported receiving less information than patients at the rural (2.90) site (ANOVA: F[3,297] = 4.39; P < .005).

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