Assessment of clinician’s knowledge and attitude toward health extension program in Ethiopia: An exploratory factor analysis

Health extension workers (HEWs) are the primary implementers of the health extension program (HEP) – a government-led community-based health-care program, but clinicians are anticipated to play a critical part in providing extensive support, thus, this study aimed to assess clinicians’ knowledge and perceptions of HEP, a cross-sectional study was conducted with 1239 clinicians. A set of 54-item questions was created based on HEP guidelines and relevant literature. Exploratory factor analysis (EFA) identified latent variables with Eigenvalues matrix >1. Cluster variables were derived through orthogonal varimax factor rotation, and internal reliability was evaluated using Cronbach’s alpha coefficient. A composite score was generated for each constructed factor, and the associations between variables were determined using a one-way analysis of variance. Multiple linear regression analysis was conducted to eliminate confounders, with statistical significance set at P < 0.05. EFA provides three factors explaining 91% of the total variance and labeled as “clinician-perceived attitude towards the skill of HEWs” (F1), “clinician knowledge on HEP activities” (F2), and “clinician-perceived attitude towards the impact of HEP” (F3). Internal reliability for the 54 items was 0.96, and it was 0.93, 0.90, and 0.89 for F1, F2, and F3, respectively. 75.5% and 76.2% of clinicians had favorable attitudes toward F1 and F3, respectively, and 70.2% had good knowledge of F2. F1 was positively correlated with participation in HEP review meetings, home visits, HEP outreach, and willingness to work in HEP but negatively correlated with degree holders. F2 was positively correlated with participation in HEP review meetings, home visits, being married, and non-medical doctors but negatively correlated with willingness to work in HEP, older age, female, and degree holder clinicians. Three factors, focusing on knowledge, skill, and the impact of HEP, were found and fall under the second-generation HEP framework. Therefore, strengthening HEP guidelines is essential to ensuring the delivery of sustainable and pro-poor HEP.