title: Applying psychological theories to evidence-based clinical practice: identifying factors predictive of placing preventive fissure sealants.
abstract: BACKGROUND
  Psychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour -- the placing of fissure sealants.
  
  
  METHODS
  Measures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs) in Scotland. Outcomes were behavioural simulation (scenario decision-making), and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model, and knowledge (a non-theoretical construct). Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive value.
  
  
  RESULTS
  Behavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT), timeline acute (CS-SRM), and outcome expectancy (SCT) entered the equation, together explaining 38% of the variance. Behavioural intention - theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT) and attitude (TPB) entered the equation, together explaining 68% of the variance in intention.
  
  
  CONCLUSIONS
  The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that may predict clinical behaviour and so provide possible targets for knowledge translation interventions. Results suggest that more evidence-based behaviour may be achieved by influencing beliefs about the positive outcomes of placing fissure sealants and building a habit of placing them as part of patient management. However a number of conceptual and methodological challenges remain.
authors.affiliation: Dental Health Services Research Unit, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK. d.bonetti@cpse.dundee.ac.uk
authors.forename: Debbie
authors.initials: D
authors.lastname: Bonetti
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: Jan E
authors.initials: JE
authors.lastname: Clarkson
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grimshaw
authors.forename: Nigel B
authors.initials: NB
authors.lastname: Pitts
authors.forename: Martin
authors.initials: M
authors.lastname: Eccles
authors.forename: Nick
authors.initials: N
authors.lastname: Steen
authors.forename: Ruth
authors.initials: R
authors.lastname: Thomas
authors.forename: Graeme
authors.initials: G
authors.lastname: Maclennan
authors.forename: Liz
authors.initials: L
authors.lastname: Glidewell
authors.forename: Anne
authors.initials: A
authors.lastname: Walker