Can the collective intentions of individual professionals within healthcare teams predict the team's performance: developing methods and theory

Article English OPEN
Eccles, Martin P ; Hrisos, Susan ; Francis, Jillian J ; Steen, Nick ; Bosch, Marije ; Johnston, Marie (2009)
  • Publisher: BioMed Central
  • Journal: Implementation Science : IS, volume 4, pages 24-24 (eissn: 1748-5908)
  • Related identifiers: pmc: PMC2685119, doi: 10.1186/1748-5908-4-24
  • Subject: Health Policy | Research Article | Medicine(all) | Public Health, Environmental and Occupational Health | RA

Background: Within implementation research, using theory-based approaches to understanding the behaviours of healthcare professionals and the quality of care that they reflect and designing interventions to change them is being promoted. However, such approaches lead to a new range of methodological and theoretical challenges pre-eminent among which are how to appropriately relate predictors of individual's behaviour to measures of the behaviour of healthcare professionals. The aim of this study was to explore the relationship between the theory of planned behaviour proximal predictors of behaviour (intention and perceived behavioural control, or PBC) and practice level behaviour. This was done in the context of two clinical behaviours – statin prescription and foot examination – in the management of patients with diabetes mellitus in primary care. Scores for the predictor variables were aggregated over healthcare professionals using four methods: simple mean of all primary care team members' intention scores; highest intention score combined with PBC of the highest intender in the team; highest intention score combined with the highest PBC score in the team; the scores (on both constructs) of the team member identified as having primary responsibility for the clinical behaviour.\ud \ud Methods: Scores on theory-based cognitive variables were collected by postal questionnaire survey from a sample of primary care doctors and nurses from northeast England and the Netherlands. Data on two clinical behaviours were patient reported, and collected by postal questionnaire survey. Planned analyses explored the predictive value of various aggregations of intention and PBC in explaining variance in the behavioural data.\ud \ud Results: Across the two countries and two behaviours, responses were received from 37 to 78% of healthcare professionals in 57 to 93% practices; 51% (UK) and 69% (Netherlands) of patients surveyed responded. None of the aggregations of cognitions predicted statin prescription. The highest intention in the team (irrespective of PBC) was a significant predictor of foot examination.\ud \ud Conclusion: These approaches to aggregating individually-administered measures may be a methodological advance of theoretical importance. Using simple means of individual-level measures to explain team-level behaviours is neither theoretically plausible nor empirically supported; the highest intention was both predictive and plausible. In studies aiming to understand the behaviours of teams of healthcare professionals in managing chronic diseases, some sort of aggregation of measures from individuals is necessary. This is not simply a methodological point, but a necessary step in advancing the theoretical and practical understanding of the processes that lead to implementation of clinical behaviours within healthcare teams.
  • References (15)
    15 references, page 1 of 2

    1. Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behaviour of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol 2005, 58:107-112.

    2. The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG): Designing theoretically-informed implementation interventions. Implementation Science 2006, 1:4.

    3. Eccles MP, Grimshaw J, Johnston M, Steen IN, Pitts NB, Thomas R: Applying psychological theories to evidence-based clinical practice: Identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implementation Science 2007, 2:26.

    4. Eccles MP, Hrisos S, Francis J, Kaner E, Dickinson HO, Beyer F, Johnston M: Do self-reported intentions predict clinicians' behaviour: a systematic review. Implementation Science 2006, 1:28.

    5. Godin G, Belanger-Gravel A, Eccles M, Grimshaw J: Healthcare professionals' intentions and behaviours: A systematic review of studies based on social cognitive theories. Implementation Science 2008, 3(36):.

    6. Conner M, Armitage CJ: Extending the theory of planned behavior: a review and avenues for further research. J Appl Psychol 1998, 28(15):1429-1464.

    7. Ajzen I: The theory of planned behaviour. Organizational Behaviour and Human Decision Processes 1991, 50:179-211.

    8. West MA, Wallace M: Innovation in health care teams. Eur J Soc Psychol 1991, 21(4):303-315.

    9. Seddon ME, Marshall MN, Campbell SM, Roland MO: Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand. QHC 2001, 10(3):152-158.

    10. Eccles MP, Whitty PM, Speed C, Steen IN, Vanoli A, Hawthorne GC, Grimshaw JM, Wood LJ, McDowell D: A pragmatic cluster randomised controlled trial of a Diabetes REcall And Management system: the DREAM Trial. Implementation Science 2007, 2:6.

  • Metrics
    No metrics available
Share - Bookmark