Factors Affecting Fertility Intention Among People Living with HIV in Kunming, China.

Background: Survival and quality of life of people living with HIV (PLWH) have been improving. Understanding fertility intention among PLWH is critical in helping them accomplish their pregnancy goals while significantly lowering the risk of HIV transmission. The purpose of this study was to identify factors based on the theory of planned behavior (TPB) that may explain fertility intention among PLWH. Methods: A survey was conducted in face-to-face interviews based on TPB, and the latent variables were devised and tested for their potential influences on fertility intentions in 487 reproductive-aged PLWH at antiretroviral treatment clinics in Kunming, China. Analysis was mainly based on the structural equation model. Results: About 38.4% of the respondents answered that they were likely to have a/another child in the next three years. Our hypothesized factors could explain 53.7% of the total variance of fertility intention. The 20- to 35-year-old group had a higher fertility intention. Perceived partner expectations toward fertility were the strongest predictors of fertility intention followed by beliefs in the support of the two-child policy. In contrast, the three components of attitudes, subjective norm, and perceived behavioral control did not influence fertility intention. Conclusion: In this HIV endemic area of China, fertility intended by PLWH is a matter of the couple that is also influenced by the national population fertility policy.

Family support-based intervention using a mobile application provided by pharmacists for older adults with diabetes to improve glycaemic control: a randomised controlled trial.

Background Family support is crucial in the care of older patients with diabetes. However, more information is needed to evaluate the potential benefits of family-based intervention through a mobile application by pharmacists in the older diabetes patients. Aim To evaluate the effectiveness of family support-based intervention via a mobile application by pharmacists on clinical outcomes, family behaviour, diabetes knowledge, self-management practices and medication adherence in older adults with type 2 diabetes. Method A randomised controlled trial was conducted in a hospital in the south of Thailand with 9 months of follow-up. Family members in the intervention group (n = 78) received diabetes educational courses and encouragement via a mobile application from pharmacists to help their older relatives with diabetes in self-management tasks. The control group received usual care (n = 79). Results As compared to baseline, significant improvements were observed in the intervention patients for glycosylated haemoglobin (HbA1c), blood pressure, family behaviour in diabetes care, diabetes knowledge, self-management practices and medication adherence (P < 0.001). The intervention group showed greater decline in HbA1c levels relative to the control group (- 0.97% vs. - 0.12%; P = 0.001). Significant differences between groups for changes in blood pressure levels including scores of family behaviour, diabetes knowledge, self-management and medication adherence were found (P ≤ 0.001), with the intervention group showing greater improvement. Conclusion Family support intervention via a mobile application by pharmacists is beneficial to diabetes care for older adults.Trial registration number: TCTR20200615001 (date 13 June 2020, retrospectively registered).

Efficacy and Safety of Enteral Erythromycin Estolate in Combination With Intravenous Metoclopramide vs Intravenous Metoclopramide Monotherapy in Mechanically Ventilated Patients With Enteral Feeding Intolerance: A Randomized, Double-Blind, Controlled Pilot Study.

BACKGROUND: In this pilot study, we aimed to determine the efficacy and safety of enteral erythromycin estolate in combination with intravenous metoclopramide compared to intravenous metoclopramide monotherapy in mechanically ventilated patients with enteral feeding intolerance. METHODS: This randomized, double-blind, controlled pilot study included 35 mechanically ventilated patients with feeding intolerance who were randomly assigned to receive 10-mg metoclopramide intravenously every 6-8 hours in combination with 250-mg enteral erythromycin estolate (study group) or placebo every 6 hours for 7 days. The primary outcome was an administered-to-target energy ratio of ≥80% at 48 hours, indicating a successful feeding. Secondary, prespecified outcomes were daily average gastric residual volume (GRV), total energy intake, administered-to-target energy ratio, hospital length of stay, in-hospital mortality, and 28-day mortality. RESULTS: The rate of successful feeding was not significantly different between the study and placebo groups (47.1% and 61.1%, respectively; P = .51). The average daily GRV was significantly lower in the study group than in the placebo group (ß = 91.58 [95% Wald CI, -164.35 to -18.8]), determined by generalized estimating equation. Other secondary outcomes were comparable, and the incidence of adverse events was not significantly different between the 2 groups. One common complication was cardiac arrhythmia, which was mostly self-terminated. CONCLUSION: Although the combination therapy of enteral erythromycin estolate and intravenous metoclopramide reduced GRV, the successful feeding rate and other patient-specific outcomes did not improve in mechanically ventilated patients with feeding intolerance.

Family-based intervention by pharmacists for type 2 diabetes: A randomised controlled trial.

OBJECTIVES: To investigate the effectiveness of family intervention for type 2 diabetes and to examine predictors of glycaemic control. METHODS: This was a prospective randomised controlled trial. Participants with type 2 diabetes were randomly assigned to an intervention group (n = 98) or a control group (n = 98). A pharmacist delivered the educational sessions and encouraged family members to take an active role in self-management practices for the intervention patients. The control patients received usual care. RESULTS: At the end of the study (9-month follow-up), greater reduction in glycosylated haemoglobin (HbA1c) occurred in the intervention group than in the control group (-1.37% and -0.21%, respectively; P < 0.001). Between-group differences in the improvements of low-density lipoprotein cholesterol (LDL-C) and blood pressure were found (P < 0.05). Higher scores in diabetes knowledge of patients, family support, medication adherence, self-management and self-efficacy were seen in the intervention group than in the control group (P < 0.05). Multivariable analysis showed family members who were spouses or women were strong predictors of improved glycaemic control. CONCLUSION: Family-involvement intervention is helpful in diabetes management, especially having spouses or women as caregivers. PRACTICE IMPLICATIONS: Family involvement should be encouraged in diabetes care.

Validity and reliability of the Tibetan version of s-EMBU for measuring parenting styles.

Parenting style experienced during childhood has profound effects on children's futures. Scales developed in other countries have never been validated in the Tibetan context. The present study aimed to examine the construct validity and reliability of a Tibetan translation of the 23-item short form of the Egna Minnen Beträffande Uppfostran [One's Memories of Upbringing] (s-EMBU) and to test the correlation between the parenting styles of fathers and mothers. A cross-sectional study was conducted in a sample of 847 students aged 12-21 years from Lhasa, Tibet, during September and October 2015 with a participation rate of 97.7%. The Tibetan translation of self-completed s-EMBU was administered. Confirmatory factor analysis was employed to test the scale's validity on the first half of the sample and was then cross-validated with the second half of the sample. The final model consisted of six factors: three (rejection, emotional warmth, and overprotection) for each parent, equality constrained on factor loadings, factor correlations, and error variance between father and mother. Father-mother correlation coefficients ranged from 0.81 to 0.86, and the level of consistency ranged from 0.62 to 0.82. Thus, the slightly modified s-EMBU is suitable for use in the Tibetan culture where both the father and the mother have consistent parenting styles.

Appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria.

Background Inappropriate use of antibiotic treatment for pharyngitis by community pharmacists is prevalent in developing countries. Little is known about how the pharmacists identify patients with bacterial pharyngitis. Objective To ascertain the appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria and to identify factors related to antibiotic dispensing. Setting 1040 Thai community pharmacists. Method A cross-sectional survey of community pharmacists was conducted in November 2012 to March 2013. The self-administered questionnaires were mailed to 57 % of community pharmacists in the south of Thailand (n = 1040). The survey included questions on diagnosis of streptococcal pharyngitis, knowledge on pharyngitis, and attitudes and control beliefs regarding antibiotic dispensing. Main outcome measure The appropriateness of diagnosis of streptococcal pharyngitis according to the original and modified Centor criteria and determinants of antibiotic dispensing including demographic characteristics of pharmacists, knowledge on pharyngitis, and attitudes and control beliefs on antibiotic dispensing. Results Approximately 68 % completed the questionnaires (n = 703). Compared to the pharmacists who reported not dispensing antibiotics in the hypothetical case with common cold, those reported dispensing antibiotics were more likely to consider the following conditions-presence of cough, mild sore throat and patients with age >60 years as cues for diagnosis of streptococcal pharyngitis (p < 0.05). The use of fewer scores of the clinical prediction rules for diagnosis was observed in antibiotic dispensers, compared to who did not do so (p < 0.005). Antibiotic dispensing was positively associated with period of dispensing experience (>5 years) [odds ratio (OR) 1.52; 95 % confidence interval (CI) 1.03-2.23], belief that antibiotics could shorten duration of pharyngitis (OR 1.48; 95 % CI 1.11-1.99), belief that antibiotics could prevent the complications (OR 1.44; 95 % CI 1.09-1.91) and belief that dispensing antibiotics could satisfy the patients (OR 1.31; 95 % CI 1.01-1.71). Nonetheless, antibiotic dispensing was negatively associated with knowledge about pharyngitis (OR 0.83; 95 % CI 0.75-0.93). Conclusion Pharmacists who are knowledgeable on the Centor criteria are more likely to appropriately diagnose streptococcal pharyngitis and less likely to dispense antibiotics in such case.

Factor Analytical Investigation of Krathom (Mitragyna speciosa Korth.) Withdrawal Syndrome in Thailand.

Krathom (Mitragyna speciosa Korth.) is an addictive and illicit substance used in Thailand and other Southeast Asian countries. It has become the most commonly used substance among villagers. The study aimed to explore the factor structure of the krathom withdrawal syndrome based on the findings of an earlier qualitative study. The current study was divided into two stages. Cross-sectional data collections were employed in both phases. The samples comprised, respectively, 196 and 330 krathom users aged over 25 years. The characteristics of krathom withdrawal symptoms and signs were identified and the factor structure examined using exploratory factor analysis (EFA). Confirmatory Factor Analysis (CFA) was used to examine the construct validity and multivariate linear regression was used to identify factors predicting the intensity of krathom withdrawal symptoms. The final scale comprised 20 items with four factors: craving-fatigue syndrome; musculoskeletal system and insomnia; mood symptoms; and autonomic nervous system/physical sickness. Symptoms and signs of krathom withdrawal similar to those of the withdrawal syndrome of opioid substances appear to be present in regular krathom users. The krathom withdrawal intensity is predicted by duration of krathom use, frequency, and daily amount of krathom use.

Public knowledge and factors associated with inappropriate analgesic use: a survey in Thailand.

OBJECTIVE: This study aims to evaluate knowledge of analgesics and factors associated with inappropriate analgesic use among the public. METHODS: The cross-sectional study was carried out in one large city in the south of Thailand. The survey was conducted using interview of people of age 16 or older. The questionnaire elicited information regarding knowledge, attitudes and behaviours on analgesic use including prevalence of taking paracetamol >4 g/day (overdosage) and not taking non-steroidal anti-inflammatory drugs (NSAIDs) with meals (inappropriate taking). KEY FINDINGS: Of 1982 participants, paracetamol overdose (n = 595) and inappropriate NSAID users (n = 751) were less likely to give correct answers about analgesics compared with appropriate users. The overdose use was inversely associated with knowledge on paracetamol (odds ratio (OR) 0.90; 95% confidence interval (CI), 0.83, 0.98) but directly associated with positive attitudes towards high dose taking (OR 2.15; 95% CI, 1.49, 3.11), and high frequency of analgesic use (OR 1.78; 95% CI, 1.24, 2.54). Inappropriate NSAID ingestion was inversely associated with knowledge on NSAIDs and directly associated with more commonly obtaining analgesics from community pharmacies (OR 0.87; 95% CI, 0.82, 0.92 and OR 1.27; 95% CI, 1.01, 1.61, respectively). CONCLUSIONS: Poor knowledge, positive attitudes towards high dose or high frequency of analgesic consumption and the patterns of using drugs were associated with inappropriate analgesic use especially that of paracetamol.

Validation of Krathom (Mitragyna speciosa Korth.) Dependence Scale (KDS): a dependence screen for internationally emerging psychoactive substance.

BACKGROUND: Krathom (Mitragyna speciosa Korth.) is the most commonly used illicit substance in Thailand, and its use has become widespread internationally. Studies on krathom dependence and its health impact are scarce, as there has been no instrument to measure its dependence syndrome and classify krathom users. This study aimed to develop and explore the factor structure, reliability, and validity of a Krathom Dependence Scale (KDS). METHODS: This study comprised 2 phases. First, cross-sectional surveys were conducted with 523 (Phase I) and 595 (Phase II) male villagers aged >25 years who were regular, occasional, ex-, or nonusers of krathom. Scale construction was based on the qualitative results from users and previous literature. Exploratory factor analysis (EFA) using maximum likelihood extraction with oblimin rotation was conducted in Phase I and confirmatory factor analysis (CFA) in Phase II to confirm the construct of the scale. Internal consistency of the KDS was assessed using Cronbach's alpha coefficient. Discriminative validity was examined by checking its ability to differentiate between regular and occasional users and patterns of krathom use and its concurrent validity by comparing its levels of score with the Fagerstrom Test for Nicotine Dependence (FTND). The KDS contains 16 items on a 0-3 (never-always) rating scale, making a total score of 0-48. RESULTS: Phase I EFA revealed a single-factor solution for the scale, which was confirmed by the CFA in Phase II, with an alpha coefficient of .98. The KDS discriminates regular from occasional users reasonably well and is highly correlated with the FTND score. Two cutoffs were suggested: 34/35 for distinguishing moderate from high dependence and 13/14 for low from moderate. CONCLUSIONS: The KDS appears to capture key theoretical constructs and correlates with indices of drug dependence by standard criteria. It should be useful in early intervention for those with krathom use disorders in community and primary care settings.

Identifying the Zheng in psoriatic patients based on latent class analysis of traditional Chinese medicine symptoms and signs.

BACKGROUND: There are approximately five Zhengs reported in psoriatic patients. Systematic data collection and proper analysis for the classification of psoriasis have been lacking. This study aims to cluster the Zhengs in psoriatic patients based on the application of a checklist of traditional Chinese medicine (TCM) symptoms and signs followed by latent class analysis (LCA). METHODS: A cross-sectional study of 507 psoriatic patients aged above 10 years was performed in Yunnan Provincial Hospital of TCM and the First Affiliated Hospital of Kunming Medicine University from October 2010 to September 2011 using a TCM symptoms and signs checklist obtained from 16 TCM experts by the Delphi technique. LCA was applied to obtain the best fitted model for clustering of symptoms and signs that can be interpreted as underlying Zhengs of psoriasis. RESULTS: The LCA identified three Zhengs: dampness-heat Zheng (35.1%); blood heat Zheng (34.7%); and yin deficiency and blood dryness Zheng (30.2%). The first Zheng was associated with winter, the second with male sex, old age, smoking, and drinking alcohol, and the third with outpatient status, which reflected a mild disease course. CONCLUSIONS: In this study, 507 psoriasis patients were clustered into three Zhengs, which had different associated factors.

Migraine management in community pharmacies: practice patterns and knowledge of pharmacy personnel in Thailand.

OBJECTIVES: To describe practice behavior and understanding among pharmacy personnel, both pharmacists and non-pharmacist staff, in the management of mild and moderate migraines. BACKGROUND: Migraine is recognized as a prevalent and chronic neurological disorder. In developing countries, such as Thailand, community pharmacies are a widely used source of health care for various illnesses including migraine. However, the quality of migraine management and knowledge among pharmacy personnel is unclear. METHODS: Cross-sectional study. The sample comprised 142 randomly selected community pharmacies in a city in the south of Thailand. Simulated clients visited the pharmacies twice, at least 1 month apart, to ask for the treatment of mild and moderate migraines. After the encounters, question asking, drug dispensing, and advice giving by pharmacy staff were recorded. Subsequently, the providers in 135 pharmacies participated in the interview to evaluate their knowledge in migraine management. RESULTS: The majority of pharmacy personnel were less likely to ask questions in cases of mild migraine when compared with moderate attack (mean score [full score = 12] 1.8 ± 1.6 vs 2.6 ± 1.5, respectively, P < 0.001). Mean difference of question asking between mild and moderate migraines was -0.8 (95% confidence interval -1.1 to -0.5, P < 0.001). Approximately 33% and 54% of the providers appropriately dispensed non-steroidal anti-inflammatory drugs for mild attack and ergotamine for moderate migraine, respectively, P < 0.001. Prophylactic medications (eg, atenolol, propranolol, flunarizine) were inappropriately recommended, particularly in moderate attack (28.2% vs 17.6% in mild migraine, P = 0.018). Less than 30% of providers advised the patients on the maximum limit of dose or discontinuity of medications when recovered. Compared with non-pharmacists, pharmacists tended to ask more questions, give more advice, and dispense less appropriately; however, there were no significant differences. The results from the interview showed that most pharmacy personnel had inadequate knowledge on migraine management. Pharmacists had better knowledge on question asking (mild migraine 5.1 ± 2.1 vs 3.1 ± 1.3, respectively, P < .001; moderate disorder 6.5 ± 3.1 vs 3.9 ± 2.1, respectively, P < .001) and tended to have more knowledge on advice giving but poorer drug dispensing in moderate migraine according to the guidelines, relative to non-pharmacists (20.5% vs 40.3%, P = .014). CONCLUSIONS: A large number of community pharmacists and non-pharmacist staff had inappropriate practice behavior and understanding. Continuing education and interventions are important to improve the practice and knowledge of pharmacy personnel, particularly the pharmacists.

Knowledge, attitudes, and behaviors regarding antibiotic use for upper respiratory tract infections: a survey of Thai students.

The objectives of this study were to determine knowledge, attitudes, and behaviors of antibiotic use in upper respiratory tract infections (URI) among students at different educational levels (Grade 12 students and high vocational students) and to examine factors influencing antibiotic use for URI. A cross sectional questionnaire survey was used with students in one large and one small city in Thailand. Of 712 respondents, more than 75% of all groups had misconceptions on the benefits of antibiotics. Grade 12 students, especially those in the big city, had the highest knowledge scores about antibiotic use in URI, while high vocational students had the lowest. Incomplete taking of a course of antibiotic treatment recommended by health providers was found in more than 45% of respondents in each group. In addition, approximately half of them had taken antibiotics for less than 5 days. Knowledge about antibiotic use in URI, attitudes towards antibiotic use, attitudes towards antibiotic prescribing for treating colds by physicians and by drugstores, belief in the common use of antibiotics for colds, and expectations of receiving antibiotics from physicians significantly influenced intentions and behaviors about antibiotic use. Students had misconceptions on antibiotic use for URI. The Ministry of Education should incorporate information on proper antibiotic use in the formal health education. Reliable sources of information on the correct use of antibiotics should also be more widely available to improve the use of antibiotics.

Factor analysis on symptoms and signs of chronic low-back pain based on Traditional Chinese Medicine theory.

OBJECTIVES: The objective of this study was to use factor analysis to explore patterns of symptoms and signs from patients with chronic low-back pain (CLBP) based on the Traditional Chinese Medicine (TCM) theory. DESIGN, SETTINGS, AND SUBJECTS: A cross-sectional study was carried out among 513 patients with CLBP in four hospitals affiliated with Yunnan University of Traditional Chinese Medicine, China. OUTCOME MEASURES: Outcome measures comprised 31 symptoms and signs on a six-level self-report questionnaire. RESULTS: Four (4) factors were extracted. They were eventually interpreted as (1) "Qi and/or Blood Stagnation," which includes eight items such as piercing pain; activity limited by feeling of local heaviness, lumbar and flank stiffness with bending limitation and purple tongue, etc.; (2) "Cold/Damp," which has seven items (for example, Cold/Damp pain, pallid face and greasy coating, etc.); (3) a part of "Kidney Deficiency," which includes two items: "dull pain and recurrent vague pain"; (4) "Warmth/Heat," which is related to three items (namely, purple tongue, yellow tongue coating, and burning pain). The four factors accounted for 12.7%, 8.2%, 8.2%, and 7.8% of the total variance, respectively. There are seven items with uniqueness over 0.8. CONCLUSIONS: Four (4) TCM major groups of pathophysiology could explain 37% of variance of 31 symptoms and signs of the CLBP patients. Thirteen (13) items are not groupable.

Practice and attitudes regarding the management of childhood diarrhoea among pharmacies in Thailand.

OBJECTIVES: to compare practice behaviour and attitudes of pharmacy personnel in the management of childhood diarrhoea between type I (requiring a pharmacist to be on duty) and type II (pharmacist not required) pharmacies, between those surveyed in 2008 and in 2001, and between new-generation (graduation ≤ 10 years) and old-generation (graduation >10 years) pharmacists. METHODS: the setting was 115 pharmacies in a city in the south of Thailand. The study was separated into two phases: a simulated client method to evaluate history taking, drug dispensing and advice giving among pharmacy personnel and a questionnaire to measure attitudes and factors affecting diarrhoea treatment. KEY FINDINGS: in the simulated client method study, questions asked and advice given by the providers (the pharmacists or non-pharmacists responding to the simulated clients), especially in type II pharmacies, were insufficient. Only 5.2% of pharmacies correctly dispensed for a child with viral diarrhoea, using oral rehydration salts (ORS) alone. Appropriate ORS dispensing of providers was not affected by shop type, survey time or peer generation. However, 52.2% of providers inappropriately dispensed antibiotics for such illness. In the questionnaire study, 108 completed surveys were obtained (a response rate of 93.9%). The providers working in 2008 more strongly agreed that ORS was effective, safe, used by health professionals and requested by patients, relative to those in 2001 (P < 0.05). No potential factor influencing the actual ORS dispensing was identified. Nevertheless, antibiotic dispensing was affected by beliefs in producing recovery and high profit. CONCLUSIONS: practice and attitudes of pharmacy personnel were inappropriate in the management of childhood diarrhoea. Revision of the pharmacy curriculum did not result in improvement of practice as seen by the similarity of practice patterns among the 2001 and 2008 samples. Improvement of knowledge and practice behaviour among providers in pharmacies is needed.

Development and validation of the patient trust in community pharmacists (TRUST-Ph) scale: results from a study conducted in Thailand.

BACKGROUND: The quality of the pharmacist-patient relationship has been examined in various perspectives, for example patient satisfaction. Trust is another concept within which the quality of the relationship might be examined and is critical in contemporary pharmacy practice. OBJECTIVE: To develop and validate a scale to measure patient trust in community pharmacists. METHODS: A 5-dimension conceptual model of trust, which includes fidelity, competence, honesty, confidentiality, and global trust, was originally used for scale development. Candidate items were generated and revised using expert reviews, focus group discussion, and think aloud method in the first phase. The items and their revisions were tested in 2 successive phases. Data were collected from 2 convenience samples of 400 each in Songkhla and Yala provinces of Thailand. Factor analysis and item analysis were used to determine dimensions and refine items of the trust scale. Internal consistency and construct validity of the scale were determined. RESULTS: At first, exploratory factor analysis showed that the most interpretable solution consisted of 2 factors labeled Benevolence and Technical Competence. The Technical Competence had unsatisfactory internal consistency (Cronbach's alpha < 0.80). An improvement was made in the later phase and another dimension, Communication, was identified. The final 30-item scale, namely TRUST-Ph, with 3 dimensions had good internal consistency (Cronbach's alpha = 0.84-0.91). The scale exhibited a strong positive association with satisfaction with pharmacy services (r = 0.70, P < .001). It also showed positive associations between the level of patient trust and other patient-pharmacist aspects. CONCLUSIONS: The developed scale (TRUST-Ph) to measure patient trust in community pharmacists had relatively high validity and reliability. It had 3 dimensions, which were Benevolence, Technical Competence, and Communication. The TRUST-Ph scale can be potentially used as a measure of patient-reported outcome for community pharmacist services.

Impact of the Konstanz method of dilemma discussion on moral judgment in allied health students: a randomized controlled study.

The objective of the study was to determine the effect of the Konstanz method of moral dilemma discussion (KMDD) on moral judgment in allied health students. The study employed the Moral Judgment Test, translated from English into Thai and validated in 247 students, as an moral judgment instrument. The scale satisfied four validity criteria: preference hierarchy, quasi-simplex structure of stage preference, affective-cognitive parallelism, and positive correlation between education and moral competence score (C-index). Test-retest reliability at a 1-month interval was 0.90. To investigate the impact of the KMDD, 83 pharmacy technician and dental nursing students were asked to participate in the study. The subjects were randomly assigned into control (n = 41) or experimental (n = 42) groups. The experimental group participated in a 90-min KMDD once a week for 6 consecutive weeks. Students in the control group also met once a week for 6 weeks to discuss the topics not related to ethics. All subjects completed the Moral Judgment Test before and after the intervention and again 6 months later. Split-plot ANOVA of the C-indexes at the beginning revealed that the experimental and control groups were not different (20.57 +/- 13.45 and 24.98 +/- 16.12). However, the experimental group scored significantly higher than the control group did after the intervention (35.18 +/- 10.96 and 24.20 +/- 14.70) and 6 months later (33.00 +/- 11.02 and 23.67 +/- 14.35). The KMDD appears to be a practical and effective intervention for developing moral judgment in allied health students. The effect on moral judgment remains at least 6 months after the intervention.