The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia.
BACKGROUND
The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work.


METHODS
We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors.


RESULTS
The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours.


CONCLUSIONS
It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.
Foy
Robbie
R
Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK. r.c.foy@ncl.ac.uk
Francis
Jillian J
JJ
Johnston
Marie
M
Eccles
Martin
M
Lecouturier
Jan
J
Bamford
Claire
C
Grimshaw
Jeremy
J
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000523:psychology; D001521:Behavior Therapy / Q000379:methods*; D003071:Cognition; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D004644:Emotions; D005852:Geriatric Psychiatry / Q000379:methods; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D033182:Intention; D007389:Internal-External Control; D008875:Middle Aged; D008960:Models, Psychological; D010344:Patient Advocacy / Q000523:psychology; D010348:Patient Care Team; D011369:Professional-Patient Relations; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D000078329:Workforce