Developing the content of two behavioural interventions: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1.
Evidence shows that antibiotics have limited effectiveness in the management of upper respiratory tract infection (URTI) yet GPs continue to prescribe antibiotics. Implementation research does not currently provide a strong evidence base to guide the choice of interventions to promote the uptake of such evidence-based practice by health professionals. While systematic reviews demonstrate that interventions to change clinical practice can be effective, heterogeneity between studies hinders generalisation to routine practice. Psychological models of behaviour change that have been used successfully to predict variation in behaviour in the general population can also predict the clinical behaviour of healthcare professionals. The purpose of this study was to design two theoretically-based interventions to promote the management of upper respiratory tract infection (URTI) without prescribing antibiotics.


METHODS
Interventions were developed using a systematic, empirically informed approach in which we: selected theoretical frameworks; identified modifiable behavioural antecedents that predicted GPs intended and actual management of URTI; mapped these target antecedents on to evidence-based behaviour change techniques; and operationalised intervention components in a format suitable for delivery by postal questionnaire.


RESULTS
We identified two psychological constructs that predicted GP management of URTI: "Self-efficacy," representing belief in one's capabilities, and "Anticipated consequences," representing beliefs about the consequences of one's actions. Behavioural techniques known to be effective in changing these beliefs were used in the design of two paper-based, interactive interventions. Intervention 1 targeted self-efficacy and required GPs to consider progressively more difficult situations in a "graded task" and to develop an "action plan" of what to do when next presented with one of these situations. Intervention 2 targeted anticipated consequences and required GPs to respond to a "persuasive communication" containing a series of pictures representing the consequences of managing URTI with and without antibiotics.


CONCLUSIONS
It is feasible to systematically develop theoretically-based interventions to change professional practice. Two interventions were designed that differentially target generalisable constructs predictive of GP management of URTI. Our detailed and scientific rationale for the choice and design of our interventions will provide a basis for understanding any effects identified in their evaluation.


BACKGROUND
Clinicaltrials.gov NCT00376142.
Hrisos
Susan
S
Institute of Health and Society, Newcastle University, UK. susan.hrisos@ncl.ac.uk
Eccles
Martin
M
Johnston
Marie
M
Francis
Jill
J
Kaner
Eileen F S
EF
Steen
Nick
N
Grimshaw
Jeremy
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006801:Humans; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011582:Psychological Theory; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000628:therapy*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents