title: Reflective and automatic processes in health care professional behaviour: a dual process model tested across multiple behaviours.
abstract: BACKGROUND
  Clinicians' behaviours require deliberate decision-making in complex contexts and may involve both impulsive (automatic) and reflective (motivational and volitional) processes.
  
  
  OBJECTIVE
  The purpose of this study was to test a dual process model applied to clinician behaviours in their management of type 2 diabetes.
  
  
  METHODS
  The design used six nested prospective correlational studies. Questionnaires were sent to general practitioners and nurses in 99 UK primary care practices, measuring reflective (intention, action planning and coping planning) and impulsive (automaticity) predictors for six guideline-recommended behaviours: blood pressure prescribing (N = 335), prescribing for glycemic control (N = 288), providing diabetes-related education (N = 346), providing weight advice (N = 417), providing self-management advice (N = 332) and examining the feet (N = 218).
  
  
  RESULTS
  Respondent retention was high. A dual process model was supported for prescribing behaviours, weight advice, and examining the feet. A sequential reflective process was supported for blood pressure prescribing, self-management and weight advice, and diabetes-related education.
  
  
  CONCLUSIONS
  Reflective and impulsive processes predict behaviour. Quality improvement interventions should consider both reflective and impulsive approaches to behaviour change.
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK, justin.presseau@ncl.ac.uk.
authors.forename: Justin
authors.initials: J
authors.lastname: Presseau
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: Tarja
authors.initials: T
authors.lastname: Heponiemi
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.forename: Martin P
authors.initials: MP
authors.lastname: Eccles
authors.forename: Nick
authors.initials: N
authors.lastname: Steen
authors.forename: Susan
authors.initials: S
authors.lastname: Hrisos
authors.forename: Elaine
authors.initials: E
authors.lastname: Stamp
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawthorne
authors.forename: Falko F
authors.initials: FF
authors.lastname: Sniehotta
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009726:Nurses / Q000523:psychology*; D010346:Patient Care Management / Q000379:methods*; D011446:Prospective Studies