Adopting a theoretical framework throughout the clinical practice guideline (CPG) process (development, dissemination, implementation, and evaluation) can be useful in systematically identifying, addressing, and explaining behavioral influences impacting CPG uptake and effectiveness. This article argues that using a theoretical framework should increase the utility and probably the implementation of a CPG. A hypothetical scenario is provided using the theory of planned behavior (TPB) to aid in our explanation. While other theories may be viable, the TPB is chosen because it accounts for a wide spectrum of behavioral factors known to influence physician behavior, and because its flexibility allows it to be used for different populations (e.g., specialists), behaviors, and contexts (e.g., hospital, private clinic). In addition, evidence has indicated that the TPB can influence physician behavior. Empirical research examining whether CPG utility can be significantly improved by appropriately selecting and implementing theory throughout the CPG process is warranted.
This longitudinal study examined exercise behavior patterns (i.e., maintainers, irregular, and inactive) in cardiac patients, and investigate the sociodemographic, clinical, psychosocial, and environmental correlates of exercise patterns. 661 cardiac in-patients from 3 hospitals consented to participate (75% response rate) and were re-assessed 9 and 18 (81% retention) months postdischarge. Exercise patterns were assessed via the Health-Promoting Lifestyle Profile II subscale using a median split. Of 417 participants (mean age 63.1 ± 10.2) with complete data, 42.2% were classified as Exercise Maintainers, 21.3% as Irregular Exercisers, and 26.1% as Inactive. Multinomial logistic regression revealed that Exercise Maintainers were more likely to be male, have exercised prior to their diagnosis, attend cardiac rehabilitation, perceive fewer exercise barriers, and were less likely to be current-smokers, past-smokers, or attribute the cause of their disease to their own behavior. Patients more likely to maintain exercise have positive perceptions and utilize cardiac rehabilitation.
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