Applying psychological theories to evidence-based clinical practice

identifying factors predictive of placing preventive fissure sealants

Debbie Bonetti, Marie Johnston, Jan E. Clarkson, Jeremy Grimshaw, Nigel B. Pitts, Martin Eccles, Nick Steen, Ruth Thomas, Graeme Maclennan, Elizabeth Glidewell, Anne Elizabeth Walker

Research output: Contribution to journalArticle

40 Citations (Scopus)
5 Downloads (Pure)

Abstract

Background: Psychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour --the placing of fissure sealants.

Methods: Measures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs) in Scotland. Outcomes were behavioural simulation (scenario decision-making), and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model, and knowledge (a non-theoretical construct). Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive value

Results: Behavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT), timeline acute (CS-SRM), and outcome expectancy (SCT) entered the equation, together explaining 38% of the variance. Behavioural intention theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT) and attitude (TPB) entered the equation, together explaining 68% of the variance in intention.

Summary: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that may predict clinical behaviour and so provide possible targets for knowledge translation interventions. Results suggest that more evidence-based behaviour may be achieved by influencing beliefs about the positive outcomes of placing fissure sealants and building a habit of placing them as part of patient management. However a number of conceptual and methodological challenges remain.

Original languageEnglish
Pages (from-to)25
Number of pages14
JournalImplementation Science
Volume5
DOIs
Publication statusPublished - 8 Apr 2010

Keywords

  • health-care profesionals
  • planned behavior
  • implementation
  • interventions
  • intentions
  • children

Cite this

Applying psychological theories to evidence-based clinical practice : identifying factors predictive of placing preventive fissure sealants. / Bonetti, Debbie; Johnston, Marie; Clarkson, Jan E.; Grimshaw, Jeremy; Pitts, Nigel B.; Eccles, Martin; Steen, Nick; Thomas, Ruth; Maclennan, Graeme; Glidewell, Elizabeth; Walker, Anne Elizabeth.

In: Implementation Science, Vol. 5, 08.04.2010, p. 25.

Research output: Contribution to journalArticle

Bonetti, Debbie ; Johnston, Marie ; Clarkson, Jan E. ; Grimshaw, Jeremy ; Pitts, Nigel B. ; Eccles, Martin ; Steen, Nick ; Thomas, Ruth ; Maclennan, Graeme ; Glidewell, Elizabeth ; Walker, Anne Elizabeth. / Applying psychological theories to evidence-based clinical practice : identifying factors predictive of placing preventive fissure sealants. In: Implementation Science. 2010 ; Vol. 5. pp. 25.
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AU - Bonetti, Debbie

AU - Johnston, Marie

AU - Clarkson, Jan E.

AU - Grimshaw, Jeremy

AU - Pitts, Nigel B.

AU - Eccles, Martin

AU - Steen, Nick

AU - Thomas, Ruth

AU - Maclennan, Graeme

AU - Glidewell, Elizabeth

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AB - Background: Psychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour --the placing of fissure sealants.Methods: Measures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs) in Scotland. Outcomes were behavioural simulation (scenario decision-making), and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model, and knowledge (a non-theoretical construct). Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive valueResults: Behavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT), timeline acute (CS-SRM), and outcome expectancy (SCT) entered the equation, together explaining 38% of the variance. Behavioural intention theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT) and attitude (TPB) entered the equation, together explaining 68% of the variance in intention.Summary: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that may predict clinical behaviour and so provide possible targets for knowledge translation interventions. Results suggest that more evidence-based behaviour may be achieved by influencing beliefs about the positive outcomes of placing fissure sealants and building a habit of placing them as part of patient management. However a number of conceptual and methodological challenges remain.

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KW - interventions

KW - intentions

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