title: 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.
abstract: 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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00376142.
authors.affiliation: Institute of Health and Society, Newcastle University, UK. susan.hrisos@ncl.ac.uk
authors.forename: Susan
authors.initials: S
authors.lastname: Hrisos
authors.forename: Martin
authors.initials: M
authors.lastname: Eccles
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: Jill
authors.initials: J
authors.lastname: Francis
authors.forename: Eileen F S
authors.initials: EF
authors.lastname: Kaner
authors.forename: Nick
authors.initials: N
authors.lastname: Steen
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grimshaw
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001519:Behavior; D003071:Cognition; D003657:Decision Making; D005194:Family Practice / Q000193:education* / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010821:Physicians, Family / Q000523:psychology*; D011582:Psychological Theory; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000628:therapy*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents