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
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
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DOI：
10.1186/1472-6963-8-10
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发表时间：
2008-01-14
影响因子：
2.8
通讯作者：
Grimshaw, Jeremy
中科院分区：
文献类型：
--
作者：
Hrisos, Susan;Eccles, Martin;Grimshaw, Jeremy
背景：行为的心理学理论可以提供一个框架来指导干预措施的设计，以改变职业行为。行为改变干预措施，设计使用心理学理论和针对重要的动机信念，进行了实验评估的影响的行为意图和模拟行为的GP在管理简单的上呼吸道感染（URTI）。方法：该设计是一个2 × 2析因随机对照试验。根据人类行为的三种理论：计划行为理论、社会认知理论和操作学习理论，开发了一份邮寄问卷。在基线和干预后，测量了全科医生对不使用抗生素治疗上呼吸道感染的信念和态度，以及8例患者的处方率。两个理论为基础的干预措施，一个“分级任务”与“行动计划”和“有说服力的沟通”，被纳入干预后的问卷。试验组进行了比较，使用协变量analysis.Results：干预后问卷调查返回340/397（86%）GP谁回答了基线调查。每种干预措施对其目标行为信念有显著影响：与未接受干预措施的人相比，完成干预措施1的全科医生报告了更强的自我效能评分（Beta = 1.41，95% CI：0.64至2.25），完成干预措施2的全科医生有更积极的预期后果评分（Beta = 0.98，95% CI = 0.46至1.98）。干预2对意向有显著影响（Beta = 0.90，95% CI = 0.41 - 1.38）和模拟行为（Beta = 0.47，95% CI = 0.19至0.74）。全科医生对不使用抗生素治疗上呼吸道感染的能力的信心以及他们预期的结果显著影响了他们对上呼吸道感染的预期治疗。这样做.两种有针对性的行为改变干预措施对这些信念的影响不同。一项干预措施还显著增强了全科医生不为URTI开具抗生素的意图，并导致与对照组相比，患者场景下的处方率较低。所使用的理论框架为理解干预措施如何以及为什么会产生这些影响提供了科学依据，提高了这些发现的重现性和普遍性，并为“真实的世界”试验中的干预措施提供了坚实的基础。
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.