Which factors explain variation in intention to disclose a diagnosis of dementia? A theory-based survey of mental health professionals

Robbie Foy, Claire Bamford, Jillian Francis, Marie Johnston, Jan Lecouturier, Martin Eccles, Nick Steen, Jeremy Grimshaw

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background
For people with dementia, patient-centred care should involve timely explanation of the diagnosis and its implications. However, this is not routine. Theoretical models of behaviour change offer a generalisable framework for understanding professional practice and identifying modifiable factors to target with an intervention. Theoretical models and empirical work indicate that behavioural intention represents a modifiable predictor of actual professional behaviour. We identified factors that predict the intentions of members of older people's mental health teams (MHTs) to perform key behaviours involved in the disclosure of dementia.

Design
Postal questionnaire survey.

Participants
Professionals from MHTs in the English National Health Service.

Methods
We selected three behaviours: Determining what patients already know or suspect about their diagnosis; using explicit terminology when talking to patients; and exploring what the diagnosis means to patients. The questionnaire was based upon the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), and exploratory team variables.

Main outcomes
Behavioural intentions.

Results
Out of 1,269 professionals working in 85 MHTs, 399 (31.4%) returned completed questionnaires. Overall, the TPB best explained behavioural intention. For determining what patients already know, the TPB variables of subjective norm, perceived behavioural control and attitude explained 29.4% of the variance in intention. For the use of explicit terminology, the same variables explained 53.7% of intention. For exploring what the diagnosis means to patients, subjective norm and perceived behavioural control explained 48.6% of intention.

Conclusion
These psychological models can explain up to half of the variation in intention to perform key disclosure behaviours. This provides an empirically-supported, theoretical basis for the design of interventions to improve disclosure practice by targeting relevant predictive factors.

Trial Registration
ISRCTN15871014.
Original languageEnglish
Article number31
JournalImplementation Science
Volume2
DOIs
Publication statusPublished - Sep 2007

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Dementia
Mental Health
Disclosure
Terminology
Theoretical Models
Psychological Models
Patient-Centered Care
Professional Practice
Surveys and Questionnaires
National Health Programs

Cite this

Which factors explain variation in intention to disclose a diagnosis of dementia? A theory-based survey of mental health professionals. / Foy, Robbie; Bamford, Claire; Francis, Jillian; Johnston, Marie; Lecouturier, Jan; Eccles, Martin; Steen, Nick; Grimshaw, Jeremy.

In: Implementation Science, Vol. 2, 31, 09.2007.

Research output: Contribution to journalArticle

Foy, Robbie ; Bamford, Claire ; Francis, Jillian ; Johnston, Marie ; Lecouturier, Jan ; Eccles, Martin ; Steen, Nick ; Grimshaw, Jeremy. / Which factors explain variation in intention to disclose a diagnosis of dementia? A theory-based survey of mental health professionals. In: Implementation Science. 2007 ; Vol. 2.
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abstract = "Background For people with dementia, patient-centred care should involve timely explanation of the diagnosis and its implications. However, this is not routine. Theoretical models of behaviour change offer a generalisable framework for understanding professional practice and identifying modifiable factors to target with an intervention. Theoretical models and empirical work indicate that behavioural intention represents a modifiable predictor of actual professional behaviour. We identified factors that predict the intentions of members of older people's mental health teams (MHTs) to perform key behaviours involved in the disclosure of dementia. Design Postal questionnaire survey. Participants Professionals from MHTs in the English National Health Service. Methods We selected three behaviours: Determining what patients already know or suspect about their diagnosis; using explicit terminology when talking to patients; and exploring what the diagnosis means to patients. The questionnaire was based upon the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), and exploratory team variables. Main outcomes Behavioural intentions. Results Out of 1,269 professionals working in 85 MHTs, 399 (31.4{\%}) returned completed questionnaires. Overall, the TPB best explained behavioural intention. For determining what patients already know, the TPB variables of subjective norm, perceived behavioural control and attitude explained 29.4{\%} of the variance in intention. For the use of explicit terminology, the same variables explained 53.7{\%} of intention. For exploring what the diagnosis means to patients, subjective norm and perceived behavioural control explained 48.6{\%} of intention. Conclusion These psychological models can explain up to half of the variation in intention to perform key disclosure behaviours. This provides an empirically-supported, theoretical basis for the design of interventions to improve disclosure practice by targeting relevant predictive factors. Trial Registration ISRCTN15871014.",
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