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An intervention modelling experiment to change GPs' intentions to implement evidence-based practice: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #2.

Hrisos S, Eccles M, Johnston M, Francis J, Kaner EF, Steen N, Grimshaw J - BMC Health Serv Res (2008)

Bottom Line: Each intervention had a significant effect on its targeted behavioural belief: compared to those not receiving the intervention GPs completing Intervention 1 reported stronger self-efficacy scores (Beta = 1.41, 95% CI: 0.64 to 2.25) and GPs completing Intervention 2 had more positive anticipated consequences scores (Beta = 0.98, 95% CI = 0.46 to 1.98).Intervention 2 had a significant effect on intention (Beta = 0.90, 95% CI = 0.41 to 1.38) and simulated behaviour (Beta = 0.47, 95% CI = 0.19 to 0.74).One intervention also significantly enhanced GPs' intentions not to prescribe antibiotics for URTI and resulted in lower rates of prescribing on patient scenarios compared to a control group.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health and Society, Newcastle University, UK. susan.hrisos@ncl.ac.uk

ABSTRACT

Background: Psychological theories of behaviour may provide a framework to guide the design of interventions to change professional behaviour. Behaviour change interventions, designed using psychological theory and targeting important motivational beliefs, were experimentally evaluated for effects on the behavioural intention and simulated behaviour of GPs in the management of uncomplicated upper respiratory tract infection (URTI).

Methods: The design was a 2 x 2 factorial randomised controlled trial. A postal questionnaire was developed based on three theories of human behaviour: Theory of Planned Behaviour; Social Cognitive Theory and Operant Learning Theory. The beliefs and attitudes of GPs regarding the management of URTI without antibiotics and rates of prescribing on eight patient scenarios were measured at baseline and post-intervention. Two theory-based interventions, a "graded task" with "action planning" and a "persuasive communication", were incorporated into the post-intervention questionnaire. Trial groups were compared using co-variate analyses.

Results: Post-intervention questionnaires were returned for 340/397 (86%) GPs who responded to the baseline survey. Each intervention had a significant effect on its targeted behavioural belief: compared to those not receiving the intervention GPs completing Intervention 1 reported stronger self-efficacy scores (Beta = 1.41, 95% CI: 0.64 to 2.25) and GPs completing Intervention 2 had more positive anticipated consequences scores (Beta = 0.98, 95% CI = 0.46 to 1.98). Intervention 2 had a significant effect on intention (Beta = 0.90, 95% CI = 0.41 to 1.38) and simulated behaviour (Beta = 0.47, 95% CI = 0.19 to 0.74).

Conclusion: GPs' intended management of URTI was significantly influenced by their confidence in their ability to manage URTI without antibiotics and the consequences they anticipated as a result of doing so. Two targeted behaviour change interventions differentially affected these beliefs. One intervention also significantly enhanced GPs' intentions not to prescribe antibiotics for URTI and resulted in lower rates of prescribing on patient scenarios compared to a control group. The theoretical frameworks utilised provide a scientific rationale for understanding how and why the interventions had these effects, improving the reproducibility and generalisability of these findings and offering a sound basis for an intervention in a "real world" trial.

Trial registration: Clinicaltrials.gov NCT00376142.

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Related in: MedlinePlus

Response rates.
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Figure 1: Response rates.

Mentions: One thousand, two hundred and twenty-five GPs at 289 practices were sent the pre-intervention survey booklet. Six hundred and sixty-eight (60%) GPs were male (excludes 78 GPs where gender was not confirmed), and 245 (96%) practices were multi-practitioner surgeries. Completed questionnaires were returned by 397 (32.4%) GPs from 191(66%) practices (Figure 1). GPs responding to this first mailing had been qualified for a mean (SD) of 19.9 (8.0) years, 21% were GP trainers, 97% were from multi-practitioner surgeries and 56% were male. These 397 respondents were randomised to receive the study interventions and were mailed the post-intervention survey booklet. Three hundred and forty (86%) GPs returned the post-intervention survey booklet, from 178/191 (93%) practices. These 340 GPs had been qualified for a mean (SD) of 19.9 (8.1) years, 22% were GP trainers, 97% were from multi-practitioner surgeries and 56% were male.


An intervention modelling experiment to change GPs' intentions to implement evidence-based practice: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #2.

Hrisos S, Eccles M, Johnston M, Francis J, Kaner EF, Steen N, Grimshaw J - BMC Health Serv Res (2008)

Response rates.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2262061&req=5

Figure 1: Response rates.
Mentions: One thousand, two hundred and twenty-five GPs at 289 practices were sent the pre-intervention survey booklet. Six hundred and sixty-eight (60%) GPs were male (excludes 78 GPs where gender was not confirmed), and 245 (96%) practices were multi-practitioner surgeries. Completed questionnaires were returned by 397 (32.4%) GPs from 191(66%) practices (Figure 1). GPs responding to this first mailing had been qualified for a mean (SD) of 19.9 (8.0) years, 21% were GP trainers, 97% were from multi-practitioner surgeries and 56% were male. These 397 respondents were randomised to receive the study interventions and were mailed the post-intervention survey booklet. Three hundred and forty (86%) GPs returned the post-intervention survey booklet, from 178/191 (93%) practices. These 340 GPs had been qualified for a mean (SD) of 19.9 (8.1) years, 22% were GP trainers, 97% were from multi-practitioner surgeries and 56% were male.

Bottom Line: Each intervention had a significant effect on its targeted behavioural belief: compared to those not receiving the intervention GPs completing Intervention 1 reported stronger self-efficacy scores (Beta = 1.41, 95% CI: 0.64 to 2.25) and GPs completing Intervention 2 had more positive anticipated consequences scores (Beta = 0.98, 95% CI = 0.46 to 1.98).Intervention 2 had a significant effect on intention (Beta = 0.90, 95% CI = 0.41 to 1.38) and simulated behaviour (Beta = 0.47, 95% CI = 0.19 to 0.74).One intervention also significantly enhanced GPs' intentions not to prescribe antibiotics for URTI and resulted in lower rates of prescribing on patient scenarios compared to a control group.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health and Society, Newcastle University, UK. susan.hrisos@ncl.ac.uk

ABSTRACT

Background: Psychological theories of behaviour may provide a framework to guide the design of interventions to change professional behaviour. Behaviour change interventions, designed using psychological theory and targeting important motivational beliefs, were experimentally evaluated for effects on the behavioural intention and simulated behaviour of GPs in the management of uncomplicated upper respiratory tract infection (URTI).

Methods: The design was a 2 x 2 factorial randomised controlled trial. A postal questionnaire was developed based on three theories of human behaviour: Theory of Planned Behaviour; Social Cognitive Theory and Operant Learning Theory. The beliefs and attitudes of GPs regarding the management of URTI without antibiotics and rates of prescribing on eight patient scenarios were measured at baseline and post-intervention. Two theory-based interventions, a "graded task" with "action planning" and a "persuasive communication", were incorporated into the post-intervention questionnaire. Trial groups were compared using co-variate analyses.

Results: Post-intervention questionnaires were returned for 340/397 (86%) GPs who responded to the baseline survey. Each intervention had a significant effect on its targeted behavioural belief: compared to those not receiving the intervention GPs completing Intervention 1 reported stronger self-efficacy scores (Beta = 1.41, 95% CI: 0.64 to 2.25) and GPs completing Intervention 2 had more positive anticipated consequences scores (Beta = 0.98, 95% CI = 0.46 to 1.98). Intervention 2 had a significant effect on intention (Beta = 0.90, 95% CI = 0.41 to 1.38) and simulated behaviour (Beta = 0.47, 95% CI = 0.19 to 0.74).

Conclusion: GPs' intended management of URTI was significantly influenced by their confidence in their ability to manage URTI without antibiotics and the consequences they anticipated as a result of doing so. Two targeted behaviour change interventions differentially affected these beliefs. One intervention also significantly enhanced GPs' intentions not to prescribe antibiotics for URTI and resulted in lower rates of prescribing on patient scenarios compared to a control group. The theoretical frameworks utilised provide a scientific rationale for understanding how and why the interventions had these effects, improving the reproducibility and generalisability of these findings and offering a sound basis for an intervention in a "real world" trial.

Trial registration: Clinicaltrials.gov NCT00376142.

Show MeSH
Related in: MedlinePlus