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Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects

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Interventions to enhance the implementation of evidence-based practice have a varied success rate. This may be due to a lack of understanding of the mechanism by which interventions achieve results.


Use psychological models to further an understanding of trial effects by piggy-backing on a randomised controlled trial testing 2 interventions (Audit & Feedback and Computer-aided Learning) in relation to evidence-based third molar management.


All participants of the parent trial (64 General Dental Practitioners across Scotland), regardless of intervention group, were invited to complete a questionnaire assessing knowledge and predictive measures from Theory of Planned Behaviour and Social Cognitive Theory. The main outcome was evidence-based extracting behaviour derived from patient records.


Neither intervention significantly influenced behaviour in the parent trial. This study revealed that the interventions did enhance knowledge, but knowledge did not predict extraction behaviour. However, the interventions did not influence variables that did predict extraction behaviour (attitude, perceived behavioural control, self-efficacy). Results suggest both interventions failed because neither influenced possible mediating beliefs for the target behavior.


Using psychology models elucidated intervention effects and allowed the identification of factors associated with evidence based practice, providing the basis for improving future intervention design.

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Gratefully acknowledged are Maryam Bahrami, Marilyn Laird, and participating dentists. This project was supported by Scottish Executive’s Chief Scientists Office and NHS R&D Programme (Trial R2-64).

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Correspondence to D. Bonetti.

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Bonetti, D., Johnston, M., Pitts, N.B. et al. Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects. Int.J. Behav. Med. 16, 287–293 (2009).

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