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
Open accessAbstract
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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The interventions reported across the review varied widely and included a few targeting behavioural change at the individual patient level, such as weight reduction and smoking cessation programs, or at the level of healthcare professionals, such as interventions targeting general practitioners to reduce inappropriate prescribing behaviours.
“The interventions reported across the review varied widely and included a few targeting behavioural change at the individual patient level, such as weight reduction [27] and smoking cessation programs [10, 44, 49], or at the level of healthcare professionals, such as interventions targeting general practitioners to reduce inappropriate prescribing behaviours [26, 45, 46, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [46]
Two included studies followed the intervention modelling process.
“In addition, two studies followed the intervention modelling process [45, 46]”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [46]
Seven included studies were a preliminary investigation of the effect of the intervention or a combination of its components on proxy or final outcomes and intervention long-term impact.
“Seven studies were a preliminary investigation of the effect of the intervention or a combination of its components on proxy or final outcomes and intervention long-term impact [10, 24, 44–46, 49, 50].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [46]
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Self-citation
- Authors
- Hrisos, S., Eccles, M., Johnston, M., Francis, J., Kaner, E. F., Steen, N., & Grimshaw, J.
- Affiliations
- Newcastle University (GB)
- University of Aberdeen (GB)
- University of Ottawa (CA)
- Corresponding author
- Hrisos, Susan
- Venue
- BMC Health Services Research
- Published
- 2008-01-14
- Volume
- 8
- Issue
- 1
- Pages
- 10-10
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC2262061
- OpenAlex
- W2092548209
- Cited by
- 63
- References
- 31
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 1 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 2 · 2016: 4 · 2015: 5 · 2014: 11 · 2013: 6 · 2012: 4
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- European Commission
- Economic and Social Research Council (ES/G007470/1)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- general practitioners, upper respiratory tract infection, antibiotic prescribing, evidence-based practice, behaviour change interventions, theory of planned behavior, social cognitive theory, self-efficacy, action planning, persuasive communication, prescribing intentions, simulated clinical scenarios, primary care quality improvement, theory-based intervention design
- MeSH terms
- Adult, Anti-Bacterial Agents, Attitude of Health Personnel, Behavior, Cognition, Decision Making, Family Practice, Female, United Kingdom, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Physicians, Family, Psychological Theory, Surveys and Questionnaires, Respiratory Tract Infections, Health Care Surveys, Self Efficacy, Intention
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