Abstract
Background
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.
Purpose
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.
Method
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.
Results
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.
Conclusion
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bero L, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote implementation of research findings by health care professionals. Br Med J. 1998;317:465–8.
Grimshaw JM, Shirran L, Thomas RE, Mowatt G, Fraser C, Bero, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001;39:II2–45.
Grimshaw JM, Thomas RE, Maclennan G, Matowe L, Shirran L, Wensing M, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Int J Technol Assess Health. 2004;8(6):1–72.
Oxman AD, Thomson MA, Davis DA, Haynes B. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. Can Med Assoc J. 1995;153:1423–31.
Davies P, Walker A, Grimshaw J. Theories of behavior change in studies of guideline implementation. Proc Br Psychol Soc. 2003;11:120.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts NB. Changing the behaviour of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005;58:107–12.
Eccles M, Hrisos S, Francis J, Kaner EF, O Dickinson H, Beyer F, et al. Do self-reported intentions predict clinicians’ behaviour: a systematic review. Implement Sci. 2006;1:28.
Ajzen I. The theory of planned behaviour. Org Behav Hum Decis Process. 1991;50:179–211.
Bandura A. Self-efficacy—the exercise of control. New York: Freeman; 1997.
Bonetti D, Johnston M, Pitts N, Deery C, Ricketts I, Bahrami M, et al. Can psychological models bridge the gap between clinical guidelines and clinicians’ behaviour? A randomised controlled trial of an intervention to influence dentists’ intention to implement evidence-based practice. Br Dent J. 2003;195:602–6.
Bonetti D, Eccles M, Johnston M, Steen N, Grimshaw J, Baker R, et al. Implementation of evidence-based practice: experimental simulation of complex intervention trials. Soc Sci Med. 2005;60:2135–47.
Bonetti D, Pitts NB, Eccles M, Grimshaw J, Johnston M, Steen N, et al. Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs. Soc Sci Med. 2006;63:1889–99.
Conner M, Norman P. Predicting health behaviour. Buckingham: Open University Press; 1996.
Eccles MP, Grimshaw JM, Johnston M, Steen N, Pitts NB, Thomas R, et al. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implement Sci. 2007;2:26.
Hardeman W, Johnston M, Johnston D, Bonetti D, Wareham N, Kinmouth A. Application of the theory of planned behaviour in behaviour change interventions: a systematic review. Psychol Health. 2002;17(2):123–58.
Walker AE, Grimshaw JM, Armstrong E. Salient beliefs and intentions to prescribe antibiotics for patients with a sore throat. Br J Health Psychol. 2001;6:347–60.
Bahrami M, Deery C, Clarkson JE, Pitts NB, Johnston M, Ricketts I, et al. Effectiveness of strategies to disseminate and implement clinical guidelines for the management of impacted and unerupted third molars in primary dental care. Br Dent J. 2004;197:691–6.
Scottish Intercollegiate Guidelines Network (SIGN). Management of unerupted and impacted third molar teeth. A National Clinical Guideline, 43; 2000.
Conner M, Sparks P. The theory of planned behaviour and health behaviours. In: Conner M, Norman P, editors. Predicting health behaviour. Research and practice with social cognition models. Buckingham: Open University Press; 1996. p. 121–62.
Faul F, Erdfelder E. GPOWER: a priori, post-hoc, and compromise power analyses for MS-DOS [computer program]. Bonn, FRG: Bonn University, Department of Psychology; 1992.
Thomson-O’Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. Audit and feedback to improve health professional practice and health care outcomes: part I. In: Bero L, Grilli R, Grimshaw J, Oxman A, editors. Collaboration on effective professional practice module of the Cochrane Database of systematic reviews (updated 01 December 1997). Oxford: Cochrane; 1997.
Medical Research Council. A framework for development and evaluation of RCTs for complex interventions to improve health. London: Medical Research Council; 2000.
Acknowledgments
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).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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). https://doi.org/10.1007/s12529-008-9017-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12529-008-9017-1