Triggering anti-smoking advice by GPs: mode of action of an intervention stimulating smoking cessation advice by GPs.
OBJECTIVE
To assess the mode of action of an intervention (GP desktop resource, GDR) that increased the frequency of general practitioner (GP) advice to stop smoking.


METHODS
Analyses were undertaken to differentiate between three hypotheses regarding the mode of action of the GDR. That the GDR acts: (1) by altering GPs' attitudes, (2) independently of attitudes in prompting GPs to intervene with smokers or (3) by altering the relationship between attitudes and behaviour.


RESULTS
The GDR was an independent predictor of the number of patients advised to stop smoking (beta = .345, p < .001). Concern about the doctor-patient relationship was the only attitude variable that independently predicted advice giving, in this case negatively (beta = -.465, p < .001). Possession of the GDR did not alter GPs' views on whether intervening with smokers harmed the doctor-patient relationship, but did weaken the relationship between this attitude item and the number of patients advised to stop smoking (beta = .595, p < .001 for the interaction).


CONCLUSIONS
This study is the first to show that concern over the doctor-patient relationship was an independent predictor of advice giving while in other studies it has merely been noted as something that GPs express concern about. A simple device designed to trigger action on the part of GPs appeared to work by mitigating the negative effect of an attitudinal barrier to action. It would be interesting to explore this phenomenon more generally in relation to health promotion activities on the part of health professionals.


CONCLUSIONS
Recommendations that GPs engage in health promotion activities with their patients need to consider that GPs' concerns over harming the doctor-patient relationship may deter them from making such interventions. The GDR appears to be effective in prompting GPs to advise their smoking patients to stop and its widespread distribution to GPs should be considered.
McEwen
Andy
A
Cancer Research UK Health Behaviour Unit, 2-16 Torrington Place, University College London, London WC1E 6BT, UK. andy.mcewen@ucl.ac.uk
West
Robert
R
Preston
Andrew
A
D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003657:Decision Making; D004739:England; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education / Q000458:organization & administration / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012044:Regression Analysis; D017010:Reminder Systems / Q000592:standards*; D012649:Self Concept; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D013664:Teaching Materials / Q000592:standards