Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

Abstract

BackgroundFinnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour.MethodsA cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252) included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions.ResultsThe results indicated that all theory-based variables--the attitude toward the behaviour, the subjective norm, and the perceived behaviour control--were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p < 0.01) effects on this intention in comparison to other professionals. In the similar models for all professions, the strongest factor for the physicians was the perceived behaviour control, while the key factor for the nurses and the other professionals was the subjective norm. This means that context- and guideline-based factors either facilitate or hinder the intention to use clinical guidelines among physicians and, correspondingly, normative beliefs related to social pressures do so for nurses and other healthcare professionals.ConclusionsThe results confirm suggestions that the theory of planned behaviour is a suitable theoretical basis for implementing clinical guidelines in healthcare practices. Our new finding was that, in general, profession had an effect on intention to use clinical guidelines in patient care. Therefore, the study reaffirms the general contention that different strategies need to be in place when clinical guidelines are targeted at different professional groups.

Determinants of physicians’ intention to collect data exhaustively in registries: an exploratory study in Bamako’s community health centres

“…20 , 22 For example, Kortteisto et al have shown that the most important factor in the prediction of doctors' intention to use clinical practice guideline was perception of control, whereas the most important factor in the prediction of nurses' intention to use it was subjective norm. 20 Rashidian and Russel have shown that physicians' intention to respect the guidelines of recommended prescriptions was explained by perception of control and attitude, but not by subjective norm. 22 However, these results should be compared to our results with caution, because the targeted behaviours are different and are studied in different contexts.…”

“…14,16,[18][19][20][21] For example, Kortteisto et al indicate that subjective norms were a key factors in the prediction of healthcare professionals' intention to use clinical practice guidelines in their speciality field to make decisions concerning patients care. 20 Foy et al indicate that subjective norms contribute to predict healthcare professionals' intention to determine patients' knowledge, to use explicit terminologies and to investigate the meaning of diagnoses for patients. 14 Wu et al found that subjective norms had the biggest effect on healthcare professionals' intention to use a report system of unwanted events.…”

Factors affecting speech pathologists’ implementation of stroke management guidelines: a thematic analysis

“…The majority of KTE research is in the medical and nursing literature [31] and research into the allied health professions has focussed on physiotherapists and occupational therapists [35,36]. This is particularly problematic given that the factors affecting CPG implementation have been found to vary with profession [37], and because speech pathologists have distinctive responsibilities for the swallowing and communication function of stroke patients.…”

An explorative study of the beliefs of staff of psychogeriatric nursing homes regarding the use of dynamic lighting systems

“…Moreover, if people are given an adequate amount of control over a given behaviour, it is expected that they will execute their intentions when the opportunity emerges 6 . In this study, TPB is used as a basis for the study of care professionals [7][8][9], but as it leaves little space for the affective aspects of behaviour, an aspect which in healthcare is an important part of intention, we have chosen to include the factor 'moral norm' to the conceptual model used in this study ( Figure 2). Given this conceptual model, there are two relevant factors: (1) the intention of the care professional to optimally use the DLS, and (2) the control the care professionals believe to perceive in order to come to the execution of certain behaviour.…”