Parental Attitude And Beliefs Towards Child Vaccination: Identifying .

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1918ISSN 1839-0188June 2018 - Volume 16, Issue 6Parental Attitude and beliefs towards child vaccination: Identifying VaccineHesitant groups in a family health center, Erbil city Iraq . page 17M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

E D I TO R I A LFrom the EditorChief Editor:A. AbyadMD, MPH, AGSF, AFCHSEEmail: [email protected] Editor and PublisherLesley Pocockmedi WORLD .com.au.In this issue a number of papersfrom the region addressed variousissues.Helvaci,M.R et al tried tounderstand whether or not there is achronic inflammatory background ofautoimmune thyroiditis (AT) on vascularendothelium in sickle cell diseases (SCDs).All patients with the SCDs and age andsex-matched controls were studied. Thestudy included 428 patients with theSCDs (220 males) and 414 controls (213males). Mean ages of the SCDs patientswere similar in males and females (30.6versus 30.1 years, respectively, p 0.05).Both smoking (24.0% versus 6.2%)and alcohol (5.0% versus 0.4%) weresignificantly higher in males with theSCDs (p 0.001 for both).Although AT wasdiagnosed in 7.2% of the control cases(26 females and 4 males), this ratio wasonly 0.7% (just in 3 males) in the SCDspatients (p 0.001). On the other hand,transfused red blood cell units in theirlives (47.6 versus 28.4, p 0.000), chronicobstructive pulmonary disease (25.4%versus 7.2%, p 0.001), ileus (7.2% versus1.4%, p 0.001), cirrhosis (7.2% versus1.9%, p 0.001), leg ulcers (20.0% versus7.2%, p 0.001), digital clubbing (14.0%versus 6.2%, p 0.001), coronary arterydisease (18.1% versus 12.9%, p 0.05),chronic renal disease (10.4% versus 6.2%,p 0.05), and stroke (12.2% versus 7.6%,p 0.05) were all higher in males withthe SCDs. The authors concluded thatSCDs are severe inflammatory processeson vascular endothelium at the capillarylevel, terminating with an acceleratedatherosclerosis induced end-organfailures and a shortened survival in bothgenders. Beside that, SCDs may causemoderate to severe immunosuppressionby several mechanisms that may be thecause of significantly reduced prevalenceof AT in SCDs. Raof A.M conducted a descriptive studyto determine parental hesitancy towardvaccination inside Erbil city; Iraq, and tofind associations between the parents’position towards vaccination and theoutcome of immunization. The data werecollected through a self-administeredquestionnaire. It included two sections:The first section related to the demographic characteristics of clients. The Parent Attitudes Childhood Vaccines (PACV)questionnaire, used as a second part todetect parents those who have concernsabout vaccination. Parental position inrespect to immunization of their childrevealed that 65.3% were unquestioningacceptor, 20.6% were cautious acceptor,9.9% were hesitant, 3.5% were late or selective vaccinator and only 0.7% was refusal. Immunization behaviors of parentsamong different groups showed that,20.9% postponed their child vaccinationfor causes other than sickness or sensitivity, while 73% provided immunization intime. More than two third (65.9%) werecompletely sure that, it’s a good idea tofollow the schedule of immunizationfor their child and only 26.6% were notsure. The current study showed parentshad some positive aspects related tovaccination and defect in some domainswere recognized. Identifying these parents is important in order to implementthe necessary measures to maintain andimprove the vaccines intake.Desouky ES et al, carried a cross-sectional study to know the magnitude ofknowledge and attitude of Saudi medical and non-medical students towardsFM specialty. Medical students showeda significant higher percent of studentswho saw that FM specialty has an essential social function, has a pleasant working environment, has a high social status,is an attractive option for a medical students, is an interesting specialty from aresearch perspective, and is an importantspecialty in: disease prevention/Healthpromotion, family-focused health care,bio-psychosocial focus of health care,collaboration with other sectors, teamwork, bioethics, and urgent care. Only6% of medical students chose FM as afuture career, and the most common factor influencing the specialty preferenceswas the good working condition and thequality of life. Female students and oldergrades showed a significant higher percent of choosing FM as a future career.For all participants, the study reflectsthe bad reputation about FM specialtyregarding its status within the medicalprofession, scientific prestige and salary. The authors concluded that Medicalstudents had better knowledge and perception of family medicine compared tonon-medical students, but they had lowinterest in choosing it as a future career.Naseer Muhammad, Musarrat Shaheen,Muhammad Khalil Ur Rahman, FaizaRahman, and Fazal Haleem reviewedthe relationship between teachers’behavior and corporal punishment:Lessons, implications, and recommendations in KPK district, Pakistan. Theyfound that male teachers show morepositive behavior than female teacherstowards corporal punishment whichimplies that female teachers should beappointed at the primary school levelin preference to men who engage incorporal punishment, in order to provide a healthy and free from corporalpunishment learning environment forstudents.CopyrightWhile all efforts have been made to ensurethe accuracy of the information in thisjournal, opinions expressed are those of theauthors and do not necessarily reflect theviews of The Publishers, Editor or the Editorial Board. The publishers, Editor and Editorial Board cannot be held responsible forerrors or any consequences arising from theuse of information contained in this journal;or the views and opinions expressed.p-ISSN: 1839-0188; e-ISSN : ymedicine.com.Editorial Boardhttp://www.mejfm.com/editorial board.htmAuthor Information:http://www.mejfm.com/author info.htmPublishersLesley Pocockmedi WORLD .com.au.WORLD FAMILY MEDICINE/MIDDLEEAST JOURNALOF FAMILY MEDICINEVOLUME 16 5ISSUE 6, JUNE 2018OFMFAMILYM I D D LMIDDLEE E A S T EASTJ O U RJOURNALN A L O F FAI LY M EMEDICINED I C I N E VOLUMEV O LU M8EISSUE7, ISSUE 10

TA B L E O F CO N T E N T STable of Contents2EditorialOriginal Contribution / Clinical Investigation4Saudi university students’ awareness and attitude towards family medicine specialtyDalia El-Sayed Desouky, Maryam Hassan Turkistani, Wedad Saeed Althobaiti,Mai Muaiwedh AlgethamiDOI: 10.5742/MEWFM.2018.9339017Parental Attitude and beliefs towards child vaccination: Identifying Vaccine Hesitant groups in a familyhealth center, Erbil city IraqAwring Maroof RaofDOI: 10.5742/MEWFM.2018.9338627What a low prevalence of autoimmune thyroiditis in sickle cell diseasesMehmet Rami Helvaci, Abdulrazak Abyad, Lesley PocockDOI: 10.5742/MEWFM.2018.93388International Health Affairs33On the relationship between teachers’ behavior and corporal punishment: Lessons, implications, andrecommendationsNaseer Muhammad, Musarrat Shaheen, Muhammad Khalil Ur Rahman, Faiza Rahman, Fazal HaleemDOI: 10.5742/MEWFM.2018.93399WORLD FAMILY MEDICINE/MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 16 ISSUE 6, JUNE 2018M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NSaudi university students’ awareness and attitude towardsfamily medicine specialtyDalia El-Sayed Desouky (1,2)Maryam Hassan Turkistani (3)Wedad Saeed Althobaiti (3)Mai Muaiwedh Algethami (3)(1) Department of Family and Community Medicine, College of Medicine, Taif University, Saudi Arabia(2) Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University,Egypt(3) Faculty of Medicine, Taif University, Saudi ArabiaCorresponding authorDr. Dalia El-Sayed DesoukyAssistant Professor of Public Health & Community Medicine, Department of Public Health andCommunity Medicine, Faculty of Medicine, Menoufia University, Egypt.Assistant Professor of Public Health & Community Medicine, Department of Family and CommunityMedicine, College of Medicine and Applied Medical Sciences, Taif University, Saudi ArabiaSaudi Arabia, Taif city, Alsalama streetEmail: [email protected]: April 19, 2018; Accepted: May 10, 2018; Published: June 1, 2018Citation: Dalia El-Sayed Desouky, Maryam Hassan Turkistani, Wedad Saeed Althobaiti, Mai Muaiwedh Algethami. Saudiuniversity students’ awareness and attitude towards family medicine specialty. World Family Medicine. 2018; 16(6): 4-16.DOI: 10.5742/MEWFM.2018.93390AbstractObjectives: The aim of this study was to know themagnitude of knowledge and attitude of Saudimedical and non-medical students towards FMspecialty.students chose FM as a future career, and the mostcommon factor influencing the specialty preferences was the good working condition and the qualityof life. Female students and older grades showeda significant higher percentage of students choosing FM as a future career. For all participants, thestudy reflects the bad reputation about FM specialtyregarding its status within the medical profession,scientific prestige and salary.Methods: A cross-sectional study was done on 708students of Taif University using a self-administeredquestionnaire about socio-demographic factors,knowledge and attitude towards FM specialty.Conclusion: Medical students had better knowledgeand perception of family medicine compared tonon-medical students, but they had low interest inchoosing it as a future career.Results: Medical students showed a significanthigher percentage of students who saw that FMspecialty has an essential social function, has apleasant working environment, has a high socialstatus, is an attractive option for a medical students, is an interesting specialty from a researchperspective, and is an important specialty in:disease prevention/Health promotion,familyfocused health care, bio-psychosocial focus ofhealth care, collaboration with other sectors, teamwork, bioethics, and urgent care. Only 6% of medicalKey words: students, Saudi, awareness, attitude,family, medicineBackground: Worldwide, there is shortage of familymedicine (FM) specialists and disinterest of medicalstudents in choosing FM as a career. Saudi Arabiais facing the same problem. AbbreviationsFMFPKSASPSSχ2Family medicineFamily PhysicianKingdom of Saudi ArabiaStatistical Package of Social ScienceChi-square testWORLD FAMILY MEDICINE/MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 16 ISSUE 6, JUNE 2018M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NIntroductionFamily medicine (FM) is a cornerstone for developinga community based health care system (1), and familyphysicians (FPs) are the most appropriate physicians tobe located in primary health care (2). They are qualifiedto provide continuing and comprehensive medical care,health maintenance and preventive services to eachmember of the family (3).Worldwide, many people suffer from lack of access toproper preventive and curative health services due toshortage of FM specialists (4,5), or their mal-distribution(6), a matter that has forced many countries to adoptnational strategies to overcome this problem.knowledge about the family medicine specialty and theirattitude towards choosing FM as a career. The studyfound that students knew the importance of FM specialtyonly after the FM course was taken in the college. Thestudy notified the high probability that the general Saudipopulation will have little knowledge and appreciation ofthe importance of the family medicine practice (22).Knowledge and attitudes of Saudi university studentstowards FM is presently not well known as only one knownstudy was done to address this issue. That is why thisstudy was carried out to know the magnitude of knowledgeand attitude of both medical and non-medical students ofTaif University towards FM specialty.Subjects and methodsThere is a decrease in the number of medical studentsinterested in choosing FM as a career (4,7,8,9,10), a matterthat makes the low number of FM specialists a worldwideproblem (2,4, 5, 7,8,9,10).Study Design and time frame: The present study was across-sectional study done on students of Taif University inthe time frame from January to May 2018.Studies have found that medical students know theimportance of FM specialty, but did not consider it attractiveaccording to the scientific and technical interest, workplaceconditions, and research prospective (11,12,13). Theirknowledge about FM specialty was found to increase bystudying it as a mandatory course in medical collages,but that doesn’t increase their interest in choosing it as aprofession (6, ogy was carried out, and the university communityof Taif University was the sampling frame. The universityincludes two (female and male) sections. The medicalcollege was chosen by its male and female sections andsimple random sampling methodology was carried outto choose the non- medical college, where its male andfemale sections were included.A systematic review of ten studies done on medical studentsin western countries found that over the last decade,medical students showed a decreased interest in FM as acareer choice. This result was revealed although studentsfound FM an interesting specialty, but they considered it acareer of low prestige (4, 5, 8, 15).The total number of students from the medical and nonmedical colleges (male and female sections) registeredin the academic year 2017-2018 was obtained from theoffice of the student’s affairs. After exclusion of the nonrespondents, the total number of participants was 753students, with a response rate of 69.46%. Incompletequestionnaires (45) were excluded leaving 708questionnaires for final analysis.According to studies done in Arab countries, a nationwideweb-based survey carried out on 600 students of sevenEgyptian medical colleges showed that, although 90.7%of them believed in the importance of FM in the Egyptianhealthcare system, only 4.7% showed an interest in itschoice as a future career (16).In the Kingdom of Saudi Arabia (KSA), FM practice becamea recognized specialty because of increasing cases ofmorbidity and mortality due to preventable diseases (17).That is why there is an urgent need to train as many familymedicine practitioners as possible to deal with these cases(17). Studies from KSA have shown that more attention isrequired at all levels of FM in order to produce an adequatenumber of family physicians to improve the academicaspects and the services provided by FM in the country(18,19,20).According to a study titled “ Family medicine practice inSaudi Arabia: the current situation and proposed strategicdirections plan 2020”, there is a shortage of qualified familyphysicians in all Saudi health care sectors (21). Despite thescarcity of Saudi FM practitioners and the governmentalneed for this specialty, only one study was done on medicalstudents of King Saud University to assess students’Inclusion/exclusion criteria: All students who agreed toshare in the study from the two colleges were included.Non-Saudi students and those who refused sharing wereexcluded.Ethical Considerations: The study was reviewed andapproved by the Research Ethics Committee of TaifUniversity, and from the deanships of the colleges includedin the study. Verbal consent was obtained from studentsbefore participating in the study.Study instrument: A self-report format of a pre-designedquestionnaire where the first few question were to collectdata about age, sex, marital status, and educational grade,was used. A filter question about previous knowledgeabout FM specialty was added, where students whoreplied “yes” (502 students) were qualified to reply to thesubsequent questions on knowledge and attitude towardsFM specialty. For each item a 5-point Likert scale fromstrongly disagree to strongly agree was used and scoredfrom 1- 5 respectively, where a score greater than 3 wasconsidered a positive response /MIDDLEEASTEASTJOURNALJOURNALOF FAMILYOF FAMILYMEDICINEMEDICINEVOLUMEVOLUME15 ISSUE16 ISSUE10, DECEMBER6, JUNE 20182017M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NFor medical students, an additional section was added toaddress their specialty preference, factors influencing theirpreferences, and reason for not choosing FM specialtyfor students who replied they were not choosing FM as afuture career. The items of the questionnaire were takenfrom questionnaires used in previous research (9, 16,23, 24). Afterwards, pilot testing of the questionnaire wascarried out on 40 university students to check the clarity,comprehension and the interpretation of each item.Statistical analysis: Data was coded, tabulated andanalyzed using (SPSS) version 20 (Armonk, NY: IBMCorp.). Qualitative data was expressed as numbers andpercentages, and Chi- squared test (χ2) was applied to testthe relationship between variables, and quantitative datawas expressed as mean and standard deviation (Mean SD). A p-value of 0.05 was considered as statisticallysignificant.ResultsIn the present study, among the 708 participants, 53.4% were females, 61% were from the medical college, and their meanage was (20.48 1.75) years. The percentage of the participants from each grade ordered from the 1st to the 6th is as follows:15.1%, 18.5%, 19.9%, 19.5%, 13.6% and 13.4% respectively. About 70% of all participants had heard about FM specialtybefore, and only 48% thought that they had a good knowledge about FM specialty. Of the participants, only 7.5% had a FPamong relatives, 64.4% visited a PHC Unit as consumers before, and 79.4% of them were satisfied with the service given(Table 1).Table 1: Comparison between medical and non-medical students according to their response to statements relatedto FM specialtyTable 1 shows that a highly significant difference was found between medical and non-medical students (in the favor ofmedical students) according to previous hearing about FM, and having adequate knowledge about it (p 0.001). LEEASTEASTJOURNALJOURNALOF FAMILYOF FAMILYMEDICINEMEDICINEVOLUMEVOLUME15 ISSUE16 ISSUE10, 6,DECEMBERJUNE 20182017M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NTable 2: Comparison between medical and non-medical students according to their response to statementsabout the FM role in Saudi ArabiaTable 2 shows a highly significant difference between medical and non-medical students (in the favor of medicalstudents) according to their opinion that FM specialty: (1) Has an essential social function, (2) Has a pleasant workingenvironment, (3) Has a high social status, (4) Is an attractive option for a medical students, and (5) Is an interestingspecialty from a research perspective (p 0.001). A non-significant difference was found between medical and nonmedical students according to their opinion that FM specialty: (1) Has a high status within the medical profession, (2)Provides a high salary in comparison with other specialties, and (3) Has a level of scientific prestige equivalent to RNALOF FAMILYMEDICINEVOLUME16 ISSUE6, JUNE 2018WORLDFAMILYMEDICINE/MIDDLEEASTJOURNALOF FAMILYMEDICINEVOLUME15 ISSUE10, DECEMBER2017M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NTable 3: Comparison between medical and non-medical students according to their response to theimportance of FM’s contributions to other areas of preparation LEEASTEASTJOURNALJOURNALOF FAMILYOF FAMILYMEDICINEMEDICINEVOLUMEVOLUME15 ISSUE16 ISSUE10, DECEMBER6, JUNE 20182017M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NIn Table 3 a significant difference was found between medical and non-medical students (in the favor of medical students)according to their response to the importance of FM in:(1) Disease prevention/Health promotion,(2) Family-focused health care,(3) Bio-psychosocial focus of health care,(4) Collaboration with other sectors (education, social services or other),(5) Team work(6) Bioethics, and (7) Urgent care (p 0.005). A non-significant difference was found between medical and non-medical students accordingto their response to the importance of FM in:(1) Research,(2) Clinical epidemiology,(3) Community-focused health care,(4) Health care across the lifespan,(5) Clinical attention for the most common problems, and(6) Communication/Doctor-patient relationship (p 0.005).Figure 1 (next page) shows that according to the students’ specialty preferences, FM ranked the tenth among elevenspecialty options given to students (only 6% of students chose it a future career). The most common factor that influencedthe specialty preferences of medical students was the good working condition and the quality of life, and the least factorwas the popularity of the specialty (Figure 1).The reasons for not choosing FM as a future career for medical students was the student’s disinterest in the specialtyfor (44.2%) of students, lack of information about FM for (29.5%) of them, being a difficult field (15.5%), and (10.5%) ofstudents had multiple reasons of the above.Table 4 (page 27) shows that a significant gender difference was found according to choosing FM as a future career, as8% of female students chose it compared to 3% of male students (p 0.034). A significant difference was found betweenstudents’ grades as regards choosing FM as a future career, where the 6th grade students had the highest percentageof students who chose FM, followed by the 5th grade, the 4th , the 3rd and the 2nd grade students (11.6%, 8.3%, 7.4%,2.7%, and 1.7% respectively) (p 0.022). None of the students in the 1st grade chose FM as a future career.A significant difference was found between students according to their choice of FM as a future career and having a FPamong relatives, where 18.5% of those who have a FP among relatives chose FM, compared to 5.2% of those whodon’t have a FP relative and chose FM (p 0.005). A non-significant difference was found between students who choseand who didn’t choose FM according to: having a good knowledge about FM specialty, previous visit of a PHC Unit ortheir satisfaction as consumers with the service given (p 0.005).WORLDFAMILYMEDICINE/MIDDLEEASTJOURNALOF FAMILYMEDICINEVOLUME16 ISSUEDECEMBER6, JUNE 2018WORLDFAMILYMEDICINE/MIDDLEEASTJOURNALOF FAMILYMEDICINEVOLUME15 ISSUE10,2017M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NFigure 1: Medical students’ specialty preferences and factors influencing their INE/MIDDLEEASTEASTJOURNALJOURNALOF FAMILYOF FAMILYMEDICINEMEDICINEVOLUMEVOLUME15 ISSUE10,16 ISSUEDECEMBER6, JUNE 20182017M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 0

O R I G I N A L CO N T R I B U T I O NTable 4: Association between some studied variables and the choice of FM as a future career by medicalstudentsDiscussionDetermining the public knowledge and attitudes towardsFM specialty and identifying deficiencies in knowledgecan help those responsible for health education to raiseawareness of the community about the importance of FMand correct any related misconceptions (25).In the present study medical college had a significanthigher percentage of students who had heard previouslyabout FM or had adequate knowledge about it whencompared to non-medical students (Table 1). This resultgoes along with that revealed from another Saudi studywhich stated that the general Saudi population does notknow the importance of FM specialty to the country (22).The study reported that this lack of information was presenteven among medical students, where their knowledgeand attitude towards FM did not improve until they hadcompleted the FM training course in the college.Compared to the non-medical college, medical collegealso had a significant higher percentage of students whohad a positive response towards FM as having an essentialsocial function, a pleasant working environment, a highsocial status, and their response that FM is an attractiveoption for medical students, and is an interesting specialtyfrom a research perspective (Table 2). This result wasobserved in previous studies done with medical studentswhere the vast majority of students surveyed reported theessential social function of FM (11,12,15).The same positive response regarding the workenvironment was displayed also in previous studies wherestudents saw the work environment of the family practice isfriendly due to lack of competition compared to a hospitalwork environment (26), and the ability of working in amultidisciplinary team (27).This work shows that, despite 84.1% of medical studentswho thought that FM has an essential social function, only37.8% thought that it is an attractive option for a medicalWORLDFAMILYMEDICINE/MIDDLEEASTJOURNALOF FAMILYMEDICINEVOLUME16 ISSUE6, JUNE 2018WORLDFAMILYMEDICINE/MIDDLEEASTJOURNALOF FAMILYMEDICINEVOLUME15 ISSUE10, DECEMBER2017M I D D L E E A S T J O U R N A L O F FA M I LY M E D I C I N E V O LU M E 7 , I S S U E 1 011

O R I G I N A L CO N T R I B U T I O Nstudent, 17.5% thought that FM has a high status withinthe medical profession, 14.3% thought that it has a levelof scientific prestige equivalent to other specialties, andonly 9.5% thought that FM specialty provides a highsalary in comparison with other specialties (Table 2). Thisdisappointing trend was observed in a study done in Spainwhich found that despite 89.8% of medical students whoreported the important social role of FM; only 20% believedthat FM has a high status within the medical profession(9).This result is in agreement with previous studies whichreported that FM is at the ‘bottom of the medical hierarchy’and it is considered as an inferior choice according tomedical students’ point of view (4,11).In the present study, only 37.8% of medical studentsthought that FM is an attractive option for a medicalstudent. This result was seen in other studies whichfound that despite medical students who agreed on theessential social role of FM they did not consider it to bean attractive option for a medical student. The cause oftheir opinion was the lower scientific prestige, lower salaryand less research opportunities of FM compared to otherspecialties (11,12,15).This study showed that, only 9.5% of medical studentsthought that FM specialty provides a high salary incomparison with other specialties, a result that wasrevealed from another study done on medical students inToronto University where about 89% of them saw that FPsare paid too little (28). In another study medical studentssee that the FP is unable to gain additional income fromthe private sector (11).In the present work only 14.3 % of medical studentssurveyed thought that FM has a level of scientific prestigeequivalent to other specialties. This negative opinion wasalso revealed from a systematic review which found thatdespite medical students finding FM appealing, it wasconsidered as a specialty of low interest and prestige(15).The non-significant difference found between medical andnon-medical students according to the previous four items(FM as an attractive option for a medical student, has ahigh status within the medical profession, has a level ofscientific prestige equivalent to other specialties, providesa high salary in comparison with other specialties), reflectsthe ignorance of the general Saudi population of the basicrole of FM and the aspects it presents as an importantmedical specialty for the Saudi society. It also reflects thebad reputation and misconceptions about FM specialtyamong the general population.This study showed that compared to students of the nonmedical college, medical students reported a significanthigher positive response to the importance of FM in diseaseprevention/health promotion, family-focused health care,bio-psychosocial focus of health care, and collaborationwith other sectors, team work, bioethics, and urgent care(Table 3). This result goes along with that revealed from12a study done in Spain where students found that themost important contributions of FM was in doctor-patientrelationship and the clinical attention for the most commonproblems (9), a matter that can solve the Saudi healthsector problem of the shortage of qualified FPs (21).This study showed a non-significant difference betweenmedical and non-medical students according to theirresponse to the importance of FM in clinical attention forthe most common problems, and communication/doctorpatient relationship, where more than 70% of all studentshad a positive response to the importance of FM in thesetwo fields (Table 3). The same result was revealed fromprevious studies where medical students pointed outthe FPs/patients relationship, as they saw the generalphysicians, were more patient centered (29,30).Similarly, less than 40% of all students (without a significantdifference between medical and non-medical students) hada positive resp

had some positive aspects related to vaccination and defect in some domains were recognized. Identifying these par-ents is important in order to implement the necessary measures to maintain and improve the vaccines intake. Desouky ES et al, carried a cross-sec-tional study to know the magnitude of knowledge and attitude of Saudi medi-