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

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

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

Purpose

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

Methods

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).

Results

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.

Conclusions

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

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Acknowledgments

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).

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Authors and Affiliations

  1. Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK

    Justin Presseau Ph.D., Martin P. Eccles MBBS, MD, FMedSci, FRCP, Nick Steen PhD, Susan Hrisos MPhil, Elaine Stamp MMathStat & Gillian Hawthorne MBBCH, PhD, FRCP

  2. Institute of Applied Health Sciences, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK

    Marie Johnston PhD

  3. National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland

    Tarja Heponiemi PhD & Marko Elovainio PhD

  4. Institute of Behavioural Sciences, University of Helsinki, P.O Box 9, 00014, Helsinski, Finland

    Marko Elovainio PhD

  5. School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK

    Jill J. Francis PhD

  6. Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, The Ottawa Hospital - General Campus, 501 Smyth Road, Box 711, Ottawa, ON, K1H 8L6, Canada

    Jeremy M. Grimshaw MBChB, PhD, FRCGP, FCAHS

  7. Fuse, The UK Clinical Research Collaboration Centre of Excellence in Translational Research in Public Health, Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK

    Falko F. Sniehotta PhD

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  1. Justin Presseau Ph.D.
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  2. Marie Johnston PhD
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  10. Jeremy M. Grimshaw MBChB, PhD, FRCGP, FCAHS
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Correspondence to Justin Presseau Ph.D..

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Presseau, J., Johnston, M., Heponiemi, T. et al. Reflective and Automatic Processes in Health Care Professional Behaviour: a Dual Process Model Tested Across Multiple Behaviours. ann. behav. med. 48, 347–358 (2014). https://doi.org/10.1007/s12160-014-9609-8

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  • DOI: https://doi.org/10.1007/s12160-014-9609-8

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