56 F . Forster et al .: Radioprotection 2024 , 59 ( 1 ), 55 – 64
were also observed in Austria and Switzerland ( Schreier et al ., 2006 , Schröttner and Leitgeb , 2008 ). Additionally , there is a noteworthy number of individuals reporting electromagnetic hypersensitivity syndrome ( EHS ), which is defined by the attribution of a wide range of non-specific symptoms to EMF exposure ( Röösli , 2008 , Dieudonné , 2020 ).
General practitioners ( GPs ) and — in the case of children and adolescents — paediatricians , as the central pillars of primary care , are the first point of contact in the healthcare system for most parts of the population , including individuals concerned about EMF and patients with EHS . Hence , GPs play a crucial role in imparting medical knowledge and explaining scientific evidence to the public . This role applies particularly to the communication and explanation of results from complex studies on the possible health effects from EMF exposure ( Huss und Röösli , 2006 ), especially as questions around EMF are not only an area of controversial discussions but also a topic that is often connected to non-science-based theories and conspiracy beliefs ( Meese et al ., 2020 , Elzanaty et al ., 2021 ).
Consequently , to communicate and transfer scientific knowledge and risk assessment regarding the potential health effects of EMF to the general population and to ensure that patients are counselled on the basis of scientific evidence , it is vital to understand the state of knowledge , risk perception and information needs of GPs as well as the relevance of this topic in their everyday practice . For instance , these aspects were examined by a survey among Dutch physicians who reported to being consulted frequently with respect to EMF while at the same time feeling not very well informed about the current state of evidence ( Slottje et al ., 2017 ).
To the best of our knowledge , the scope and extent of the literature covering these aspects have not been determined yet . Nonetheless , it would be helpful to summarise the existing scientific evidence concerning GPs attitudes and level of information concerning the potential health risks related to EMF exposure as a basis for health-policy makers to potentially derive needs for educational efforts among GPs . On top of this , such as scoping exercise may also be useful to identify research gaps and core questions that have not been answered yet .
Consequently , our primary aim was to summarise the current state of evidence regarding the state of knowledge , risk perception and information needs of GPS as well as the relevance of questions around EMF in their occupational practice via a scoping review . Our secondary aim was to identify research gaps and derive practical implications and recommendations for future research .
2 Methods
This work was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews ( Tricco et al ., 2018 ). We searched for relevant articles in PubMed and additional scientific / medical sources , screened the identified manuscripts based on a priori defined inclusion criteria and extracted relevant data and information from the eligible articles .
2.1 Search strategy
For the search in PubMed , we developed a search string based on the PICO framework ( Schardt et al ., 2007 ), considering GPs and paediatricians as participants ( P ), EMF and sources of EMF like mobile phones or power lines as exposure ( I / E ) and items like the attitudes , risk perception , knowledge and information needs of participants as outcome ( O ). The C ( comparator ) from the PICO framework was regarded as not applicable . The full search string is provided in Appendix A .
Applying this string , we searched for original articles published in English or German until October 11 , 2022 with no further restrictions regarding other aspects , like article type or study design . In addition , we examined the reference lists of the included manuscripts and the respective list of similar articles provided by PubMed for potentially eligible publications . We also screened the websites of relevant organisations such as the World Health Organization , the International Commission on Non-Ionizing Radiation Protection ( ICNIRP ), the World Medical Association or the Federal Office for Radiation Protection for any relevant reports .
2.2 . Selection process
All identified publications were screened for eligibility based on the PICO criteria described above . As the first step , titles and abstracts of the retrieved articles were evaluated by two researchers . Any disagreement has been reconciled by consultation of a third referee and subsequent discussion until consensus was reached . Next , the full texts of the remaining publications were again judged for eligibility by two researchers and a third referee if necessary .
2.3 . Data extraction
While reviewing the included articles , all data were charted independently in separate tables by two researchers and compared afterwards . Again , any discrepancies were reconciled by consensus .
2.4 . Data items
Five items were relevant outcomes for our review . One of them was the GPs ’ level of information concerning EMF , for example , the knowledge about the legal exposure limits within the general population . Another item was GPs ’ risk perception such as the subjective perception on how hazardous EMF exposure is to health . The item ‘ relevance in practice and EMF-related consultations ’ dealt with the frequency of counselling related to EMF , while ‘ information needs ’ asked for the participation of GPs in training courses on EMF and the type of sources they use when seeking information on EMF . The last relevant data items were potential determinants of the attitudes and beliefs of GPs towards possible health effects of EMF .