Annals of Behavioral Medicine

, Volume 48, Issue 3, pp 347–358 | Cite as

Reflective and Automatic Processes in Health Care Professional Behaviour: a Dual Process Model Tested Across Multiple Behaviours

  • Justin Presseau
  • Marie Johnston
  • Tarja Heponiemi
  • Marko Elovainio
  • Jill J. Francis
  • Martin P. Eccles
  • Nick Steen
  • Susan Hrisos
  • Elaine Stamp
  • Jeremy M. Grimshaw
  • Gillian Hawthorne
  • Falko F. Sniehotta
Original Article



Clinicians’ behaviours require deliberate decision-making in complex contexts and may involve both impulsive (automatic) and reflective (motivational and volitional) processes.


The purpose of this study was to test a dual process model applied to clinician behaviours in their management of type 2 diabetes.


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).


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.


Reflective and impulsive processes predict behaviour. Quality improvement interventions should consider both reflective and impulsive approaches to behaviour change.


Clinician behaviour Dual process Diabetes Motivation Volition Automaticity 



The research was supported by a grant from Diabetes UK (06/0003342). JMG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. FFS is funded by Fuse, the UK Clinical Research Collaboration Centre for Translational Research in Public Health, a UKCRC Public Health Research Centre of Excellence. Funding for Fuse from the British Heart Foundation, Cancer Research UK, UK Economic and Social Research Council, UK Medical Research Council, and the UK National Institute for Health Research.

Author’s Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Justin Presseau, Marie Johnston, Tarja Heponiemi, Marko Elovainio, Jill J Francis, Martin P Eccles, Nick Steen, Susan Hrisos, Elaine Stamp, Jeremy M Grimshaw, Gillian Hawthorne, and Falko F Sniehotta declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

All participants provided signed informed consent. Ethics approval was granted by the Newcastle and North Tyneside 2 Research Ethics Committee (07/H0907/102).

Supplementary material

12160_2014_9609_MOESM1_ESM.pdf (116 kb)
ESM 1 (PDF 116 kb)


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Copyright information

© The Society of Behavioral Medicine 2014

Authors and Affiliations

  • Justin Presseau
    • 1
  • Marie Johnston
    • 2
  • Tarja Heponiemi
    • 3
  • Marko Elovainio
    • 3
    • 4
  • Jill J. Francis
    • 5
  • Martin P. Eccles
    • 1
  • Nick Steen
    • 1
  • Susan Hrisos
    • 1
  • Elaine Stamp
    • 1
  • Jeremy M. Grimshaw
    • 6
  • Gillian Hawthorne
    • 1
  • Falko F. Sniehotta
    • 7
  1. 1.Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
  2. 2.Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
  3. 3.National Institute for Health and WelfareHelsinkiFinland
  4. 4.Institute of Behavioural SciencesUniversity of HelsinkiHelsinskiFinland
  5. 5.School of Health SciencesCity University LondonLondonUK
  6. 6.Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of OttawaOttawaCanada
  7. 7.Fuse, The UK Clinical Research Collaboration Centre of Excellence in Translational Research in Public Health, Institute of Health and Society, Newcastle UniversityNewcastle upon TyneUK

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