Applying psychological theories to evidence-based clinical practice: identifying factors predictive of placing preventive fissure sealants

BackgroundPsychological 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.MethodsMeasures 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 valueResultsBehavioural 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.SummaryThe 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.

[1]  T. Konrad,et al.  Reported response rates to mailed physician questionnaires. , 2001, Health services research.

[2]  J. Grimshaw,et al.  Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. , 2005, Journal of clinical epidemiology.

[3]  J. Dinsmoor.  Operant conditioning : an experimental analysis of behaviour , 1971 .

[4]  Keith Petrie,et al.  The Revised Illness Perception Questionnaire (IPQ-R) , 2002 .

[5]  I. Sanderson.  Getting Evidence into Practice , 2004 .

[6]  Martin Eccles,et al.  Implementation Science Healthcare Professionals' Intentions and Behaviours: a Systematic Review of Studies Based on Social Cognitive Theories , 2008 .

[7]  J M Grimshaw,et al.  Effectiveness and efficiency of guideline dissemination and implementation strategies , 2004, International Journal of Technology Assessment in Health Care.

[8]  Alexander J. Rothman,et al.  Stage theories of health behavior: conceptual and methodological issues. , 1998, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[9]  R Baker,et al.  What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review , 2005, BMC health services research.

[10]  C. Abraham,et al.  Making psychological theory useful for implementing evidence based practice: a consensus approach , 2005, Quality and Safety in Health Care.

[11]  J. Grimshaw,et al.  Closing the Gap Between Research and Practice: An Overview of Systematic Reviews of Interventions to Promote Implementation of Research Findings by Health Care Professionals , 1998 .

[12]  M. Conner,et al.  Efficacy of the Theory of Planned Behaviour: a meta-analytic review. , 2001, The British journal of social psychology.

[13]  M. Downer.  The British Association for the Study of Community Dentistry , 1998, British Dental Journal.

[14]  J. Grimshaw,et al.  Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers , 2004 .

[15]  S. Green.  How Many Subjects Does It Take To Do A Regression Analysis. , 1991, Multivariate behavioral research.

[16]  Martin P Eccles,et al.  Response rates in postal surveys of healthcare professionals between 1996 and 2005: An observational study , 2009, BMC health services research.

[17]  N. Pitts.  Preventing dental caries in children at high caries risk , 2000 .

[18]  R. Harker,et al.  Obvious Decay Experience Children's Dental Health in the United Kingdom , 2004 .

[19]  I. Ajzen.  The theory of planned behavior , 1991 .

[20]  J. Grimshaw,et al.  Changing Clinicians’ Behavior: a Randomized Controlled Trial of Fees and Education , 2008, Journal of dental research.

[21]  D. Trafimow,et al.  Evidence that perceived behavioural control is a multidimensional construct: perceived control and perceived difficulty. , 2002, The British journal of social psychology.

[22]  J. Grimshaw,et al.  Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs. , 2006, Social science & medicine.

[23]  M. Conner,et al.  The Theory of Planned Behaviour , 2004 .

[24]  P. Gollwitzer.  Goal Achievement: The Role of Intentions , 1993 .

[25]  Nick Steen,et al.  Applying psychological theories to evidence-based clinical practice: Identifying factors predictive of managing upper respiratory tract infections without antibiotics , 2007, Implementation science : IS.

[26]  C. Abraham,et al.  Interventions to change health behaviours: evidence-based or evidence-inspired? , 2004 .

[27]  Derek E. Blackman,et al.  Operant Conditioning: An Experimental Analysis of Behaviour , 1974 .

[28]  Nithin Chacko Thomas,et al.  The dental caries experience of 5-year-old children in Great Britain (2005/6). Surveys co-ordinated by the British Association for the study of community dentistry. , 2007, Community dental health.

[29]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[30]  A. Bandura.  Health promotion from the perspective of social cognitive theory , 1998 .

[31]  M. Johnston,et al.  Applying multiple models to predict clinicians’ behavioural intention and objective behaviour when managing children's teeth , 2009, Psychology & health.

[32]  Andrew D Oxman,et al.  Closing the gap between research and practice : an overview of systematic reviews of interventions to promote the implementation of research findings , 2011 .

[33]  J. Murray,et al.  British Society of Paediatric Dentistry: a policy document on fissure sealants in paediatric dentistry. , 2000 .

[34]  M. Johnston,et al.  Implementation Science BioMed Central Systematic Review Organizational interventions to implement improvements in , 2006 .

[35]  F. Strack,et al.  Reflective and Impulsive Determinants of Social Behavior , 2004, Personality and social psychology review : an official journal of the Society for Personality and Social Psychology, Inc.

[36]  R. Slayton.  Oral health promotion in children and adolescents. , 2005, Compendium of continuing education in dentistry.

[37]  M. Conner,et al.  The theory of planned behaviour and health behaviours. , 1996 .

[38]  N. Pitts.  The Scottish Inter-collegiate Guideline Network guideline 47. Preventing dental caries in children at high caries risk: targeted prevention of dental caries in the permanent teeth of 6–16 year olds presenting for dental care , 2002, Evidence-Based Dentistry.

[39]  H. Worthington,et al.  Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. , 2008, The Cochrane database of systematic reviews.

[40]  B. Chadwick,et al.  The reported impact of oral condition on children in the United Kingdom, 2003 , 2006, British Dental Journal.

[41]  C. Pine,et al.  The dental caries experience of 12-year-old children in England and Wales. Surveys coordinated by the British Association for the Study of Community Dentistry in 2000/2001. , 1988, Community dental health.

[42]  M. Raadal,et al.  EAPD guidelines for the use of pit and fissure sealants. , 2004, European journal of paediatric dentistry.

[43]  N. Weinstein.  The precaution adoption process. , 1988, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[44]  J. Grimshaw,et al.  PRIME – PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice , 2003, BMC health services research.