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Implementation Science
Published in: Implementation Science 1/2010

Open Access 01-12-2010 | Research article

Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

Authors: Tiina Kortteisto, Minna Kaila, Jorma Komulainen, Taina Mäntyranta, Pekka Rissanen

Published in: Implementation Science | Issue 1/2010

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Abstract

Background

Finnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour.

Methods

A cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252) included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions.

Results

The results indicated that all theory-based variables--the attitude toward the behaviour, the subjective norm, and the perceived behaviour control--were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p < 0.01) effects on this intention in comparison to other professionals. In the similar models for all professions, the strongest factor for the physicians was the perceived behaviour control, while the key factor for the nurses and the other professionals was the subjective norm. This means that context- and guideline-based factors either facilitate or hinder the intention to use clinical guidelines among physicians and, correspondingly, normative beliefs related to social pressures do so for nurses and other healthcare professionals.

Conclusions

The results confirm suggestions that the theory of planned behaviour is a suitable theoretical basis for implementing clinical guidelines in healthcare practices. Our new finding was that, in general, profession had an effect on intention to use clinical guidelines in patient care. Therefore, the study reaffirms the general contention that different strategies need to be in place when clinical guidelines are targeted at different professional groups.
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Literature
1.
Davis DA, Taylor-Vaisey A: Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997, 157 (4): 408-416.PubMedPubMedCentral
2.
Varonen H, Jousimaa J, Helin-Salmivaara A, Kunnamo I: Electronic primary care guidelines with links to Cochrane reviews--EBM Guidelines. Fam Pract. 2005, 22 (4): 465-469. 10.1093/fampra/cmi029.CrossRefPubMed
3.
Hamalainen P, Reponen J, Winblad I: eHealth of Finland. Check point 2006. 2007, Helsinki: Stakes, Report 1, 1-55.
4.
Kuronen R, Jallinoja P, Ilvesmaki V, Patja K: [Implementing current care clinical guidelines associated with cardiovascular diseases]. Suomen Laakarilehti. 2006, 61 (44): 4571-4577.
5.
Makinen M, Castren M, Nurmi J, Pappinen J, Niemi-Murola L: [Factors associated with uptake of the resuscitation guideline: a primary healthcare survey]. Finnanest. 2005, 38 (5): 481-
6.
Miilunpalo S, Toropainen E, Moisio P: Implementation of guidelines in primary healthcare. A challenge for the municipal health centres in Finland. Scand J Prim HealthCare. 2001, 19 (4): 227-231. 10.1080/02813430152706738.CrossRef
7.
Roine RP, Kaila M, Nuutinen M, Mantyranta T, Nuutinen L, Auvinen O, Mustajoki P: The execution of current treatment praxis recommendations in the specialized healthcare. Duodecim. 2003, 119 (5): 399-406.PubMed
8.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282 (15): 1458-1465. 10.1001/jama.282.15.1458.CrossRefPubMed
9.
Grimshaw JM, Eccles MP: Is evidence-based implementation of evidence-based care possible?. Med J Aust. 2004, 180 (6 Suppl): S50-51.PubMed
10.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8 (6): iii-iv. 1-72CrossRefPubMed
11.
Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003, 362 (9391): 1225-1230. 10.1016/S0140-6736(03)14546-1.CrossRefPubMed
12.
Moulding NT, Silagy CA, Weller DP: A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines. Qual HealthCare. 1999, 8 (3): 177-183. 10.1136/qshc.8.3.177.CrossRef
13.
Grimshaw JM, Eccles MP, Walker AE, Thomas RE: Changing physicians' behavior: what works and thoughts on getting more things to work. J Contin Educ Health Prof. 2002, 22 (4): 237-243. 10.1002/chp.1340220408.CrossRefPubMed
14.
Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M: Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007, 85 (1): 93-138. 10.1111/j.1468-0009.2007.00478.x.CrossRefPubMedPubMedCentral
15.
Ajzen I: The theory of planned behaviour. Organ Behav Hum Decis Process. 1991, 50: 179-211. 10.1016/0749-5978(91)90020-T.CrossRef
16.
Armitage CJ, Conner M: Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol. 2001, 40 (Pt 4): 471-499. 10.1348/014466601164939.CrossRefPubMed
17.
18.
Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, Hoagwood KE: Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know?. Psychiatr Serv. 2007, 58 (3): 342-348. 10.1176/appi.ps.58.3.342.CrossRefPubMed
19.
Godin G, Belanger-Gravel A, Eccles M, Grimshaw J: Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci. 2008, 3: 36-10.1186/1748-5908-3-36.CrossRefPubMedPubMedCentral
20.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005, 58 (2): 107-112. 10.1016/j.jclinepi.2004.09.002.CrossRefPubMed
21.
Foy R, Walker A, Ramsay C, Penney G, Grimshaw J, Francis J: Theory-based identification of barriers to quality improvement: induced abortion care. Int J Qual HealthCare. 2005, 17 (2): 147-155. 10.1093/intqhc/mzi017.CrossRef
22.
Pessoa-Silva CL, Posfay-Barbe K, Pfister R, Touveneau S, Perneger TV, Pittet D: Attitudes and perceptions toward hand hygiene among healthcare workers caring for critically ill neonates. Infect Control Hosp Epidemiol. 2005, 26 (3): 305-311. 10.1086/502544.CrossRefPubMed
23.
Maue SK, Segal R, Kimberlin CL, Lipowski EE: Predicting physician guideline compliance: an assessment of motivators and perceived barriers. Am J Manag Care. 2004, 10 (6): 383-391.PubMed
24.
Eccles MP, Hrisos S, Francis J, Kaner EF, Dickinson HO, Beyer F, Johnston M: Do self-reported intentions predict clinicians' behaviour: a systematic review. Implement Sci. 2006, 1: 28-10.1186/1748-5908-1-28.CrossRefPubMedPubMedCentral
25.
Sheeran P: Intention-behavior relations: a conceptual and empirical review. Eur Rev Soc Psychol. 2002, 12: 1-36. 10.1080/14792772143000003.CrossRef
26.
Harrison S, Dowswell G, Wright J: Practice nurses and clinical guidelines in a changing primary care context: an empirical study. J Adv Nurs. 2002, 39 (3): 299-307. 10.1046/j.1365-2648.2002.02277.x.CrossRefPubMed
27.
Mazza D, Russell SJ: Are GPs using clinical practice guidelines?. Aust Fam Physician. 2001, 30 (8): 817-821.PubMed
28.
Langley C, Faulkner A, Watkins C, Gray S, Harvey I: Use of guidelines in primary care-practitioners' perspectives. Fam Pract. 1998, 15 (2): 105-111. 10.1093/fampra/15.2.105.CrossRefPubMed
29.
Carlsen B, Norheim OF: 'What lies beneath it all?' - an interview study of GPs' attitudes to the use of guidelines. BMC Health Serv Res. 2008, 8: 218-10.1186/1472-6963-8-218.CrossRefPubMedPubMedCentral
30.
31.
32.
Varonen H, Kaila M, Kunnamo I, Komulainen J, Mantyranta T: Computerised decision support: the way towards advisory patient record. Duodecim. 2006, 122 (10): 1174-1181.PubMed
33.
McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, Steen N, Thomas R, Harvey E, Garratt A, Bond J: Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technol Assess. 2001, 5 (31): 1-256.CrossRefPubMed
34.
Elovainio M, Eccles M, Makela M: Attitudes towards guidelines and a scale for measuring them. Changing Professional Practice: Theory and practice of clinical guidelines implementation. Edited by: Thorsen T, Makela M. 1999, Copenhagen: DSI Danish Institute for Health Services Research and Development = DSI Institut for Sundhedsvaesen, 153-167.
35.
36.
37.
Ajzen I: The principle of compatibility. Attitudes, Personality and behavior. 1988, Illinois: The Dorsey Press, 92-111.
38.
Fishbein M, Ajzen I: Belief, attitude, intention and behaviour. 1975, Massachusetts: Addison-Wesley Publishing Company, 288-334.
39.
Walker AE, Grimshaw JM, Armstrong EM: Salient beliefs and intentions to prescribe antibiotics for patients with a sore throat. Br J Health Psychol. 2001, 6 (Part 4): 347-360. 10.1348/135910701169250.CrossRefPubMed
40.
Puffer S, Rashidian A: Practice nurses' intentions to use clinical guidelines. J Adv Nurs. 2004, 47 (5): 500-509. 10.1111/j.1365-2648.2004.03129.x.CrossRefPubMed
41.
Mantyranta T, Kaila M, Varonen H, Makela M, Roine R, Lappalainen J: Implementation of guidelines. The Finnish Medical Society Duodecim. 2003
42.
Tabachnick BG, Fidell LS: Principal components and factor analysis. Using Multivariate Statistics. 2001, Boston: Allyn and Bacon, 582-652. 4
43.
44.
Toothaker LE: Multiple comparisons procedures. 1993, Thousand Oaks CA: Sage PublicationsCrossRef
45.
Campbell MJ, Machin D: Medical Statistics: a commonsense approach. 2002, Chichester: John Wiley & Sons Ltd, 3
46.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf HealthCare. 2005, 14 (1): 26-33. 10.1136/qshc.2004.011155.CrossRef
47.
Leeman J, Baernholdt M, Sandelowski M: Developing a theory-based taxonomy of methods for implementing change in practice. J Adv Nurs. 2007, 58 (2): 191-200. 10.1111/j.1365-2648.2006.04207.x.CrossRefPubMed
48.
Bonetti D, Pitts NB, Eccles M, Grimshaw J, Johnston M, Steen N, Glidewell L, Thomas R, Maclennan G, Clarkson JE: Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs. Soc Sci Med. 2006, 63 (7): 1889-1899. 10.1016/j.socscimed.2006.04.005.CrossRefPubMed
49.
Millstein SG: Utility of the theories of reasoned action and planned behavior for predicting physician behavior: a prospective analysis. Health Psychol. 1996, 15 (5): 398-402. 10.1037/0278-6133.15.5.398.CrossRefPubMed
50.
Limbert C, Lamb R: Doctors' use of clinical guidelines: two applications of the Theory of Planned Behaviour. Psychology, Health & Medicine. 2002, 7 (3): 301-310.CrossRef
51.
McKenna H, Ashton S, Keeney S: Barriers to evidence based practice in primary care: a review of the literature. Int J Nurs Stud. 2004, 41 (4): 369-378. 10.1016/j.ijnurstu.2003.10.008.CrossRefPubMed
52.
Varonen H, Kortteisto T, Kaila M: What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians. Fam Pract. 2008, 25 (3): 162-167. 10.1093/fampra/cmn020.CrossRefPubMed
53.
Kaila M, Rintanen H, Saalasti-Koskinen U: [Uptake of Current Care guidelines in primary healthcare]. Suomen Laakarilehti. 2006, 61 (19): 2142-2143.
54.
Lehtomaki L: [From national guidelines to house rules of health centre]. Ph.D. Thesis. 2009, University of Tampere
55.
Goossens A, Bossuyt PM, de Haan RJ: Physicians and nurses focus on different aspects of guidelines when deciding whether to adopt them: an application of conjoint analysis. Med Decis Making. 2008, 28 (1): 138-145. 10.1177/0272989X07308749.CrossRefPubMed
56.
Scott IA, Denaro CP, Bennett CJ, Mudge AM: Towards more effective use of decision support in clinical practice: what the guidelines for guidelines don't tell you. Intern Med J. 2004, 34 (8): 492-500. 10.1111/j.1445-5994.2004.00604.x.CrossRefPubMed
57.
Randell R, Mitchell N, Thompson C, McCaughan D, Dowding D: Supporting nurse decision making in primary care: exploring use of and attitude to decision tools. Health Informatics J. 2009, 15 (1): 5-16. 10.1177/1460458208099864.CrossRefPubMed
58.
Francke AL, Smit MC, de Veer AJ, Mistiaen P: Factors influencing the implementation of clinical guidelines for healthcare professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008, 8: 38-10.1186/1472-6947-8-38.CrossRefPubMedPubMedCentral
59.
Hrisos S, Eccles MP, Francis JJ, Dickinson HO, Kaner EF, Beyer F, Johnston M: Are there valid proxy measures of clinical behaviour? a systematic review. Implement Sci. 2009, 4: 37-10.1186/1748-5908-4-37.CrossRefPubMedPubMedCentral
60.
Bosnjak M, Tuten TL: Classifying response behaviors in web-based surveys. Journal of Computer-Mediated Communication. 2001, 6 (3):
61.
Lusk C, Delclos GL, Burau K, Drawhorn DD, Aday LA: Mail versus internet surveys: determinants of method of response preferences among health professionals. Eval Health Prof. 2007, 30 (2): 186-201. 10.1177/0163278707300634.CrossRefPubMed
62.
VanGeest JB, Johnson TP, Welch VL: Methodologies for improving response rates in surveys of physicians: a systematic review. Eval Health Prof. 2007, 30 (4): 303-321. 10.1177/0163278707307899.CrossRefPubMed
63.
Eccles MP, Hrisos S, Francis JJ, Steen N, Bosch M, Johnston M: Can the collective intentions of individual professionals within healthcare teams predict the team's performance: developing methods and theory. Implement Sci. 2009, 4: 24-10.1186/1748-5908-4-24.CrossRefPubMedPubMedCentral
Metadata
Title
Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour
Authors
Tiina Kortteisto
Minna Kaila
Jorma Komulainen
Taina Mäntyranta
Pekka Rissanen
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2010
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-5-51

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