Influencing mechanism of the use behavior of clinical practice guidelines on antimicrobials: evidence from the integration of theory of reasoned action and organizational readiness for change

Abstract

Background To confront the serious challenge of antimicrobial resistance, using clinical practice guidelines (CPGs) standardizing the prescription behavior is vital. However, the overall mechanisms remains largely unknown as to how guidelines' use behavior can be improved. This study aimed to identify the determinants and investigate their relationship to bridge the knowledge gap of overall influencing mechanism of the use behavior of CPGs on antimicrobials. Methods By integrating theory of reasoned action (TRA) and organizational readiness for change (ORC), a structured questionnaire was developed to cover potential determinants that affect physicians’ use behaviors of CPGs on antimicrobials at the individual-level (attitude, subjective norm, and behavioral intention) and organizational-level (top management support and organizational resource allocation). A multi-stage random sampling was implemented to collect data from physicians in secondary and tertiary hospitals from eastern, central and western China. Structural equation model (SEM) was used to test the proposed hypotheses, and to analyze the relationship and mechanism among the factors. Result In total, 815 physicians were included. Most physicians demonstrated a positive tendency toward the use of CPGs on antimicrobials, with a mean score of 3.95 (SD = 0.70). The reliability and validity analysis showed the questionnaire constructed from the integrated theoretical model of TRA and ORC was acceptable. The SEM validation results also showed that the top management support (β = 0.688, P < 0.001), organizational resource allocation (β = 0.129, P < 0.001), individual attitudes (β = 0.164, P < 0.001), subjective norms (β = 0.322, P < 0.001), and behavioral intentions (β = 0.424, P < 0.001) were positively associated with physicians’ use behaviors of CPGs on antimicrobials. Besides, top management support, organizational resource allocation, attitudes and subjective norms showed their mediating effects on regarding use behavior, which was 0.305, 0.129, 0.164 and 0.201, respectively. Conclusions This study revealed the influence mechanism of the use of CPGs on antimicrobials from the individual and organizational perspectives. These findings will not only help formulate future strategies to promote the use of CPGs on antimicrobials, but also provide clues for more effective prescription interventions.

Effect of multifaceted social norms on physicians’ use of clinical practice guidelines on antimicrobials: Evidence from secondary and tertiary general hospitals in central-western China

“…TNSB believes that organizational criterion is one of the most important factors in uencing the behavior intention of organization members, which subsequently in uence the nal practice (14). Meanwhile, the indirect effect of organizational criterion on behavior intention with attitude as a key intermediate factor was also con rmed in previous studies (21,24).…”

“…Similar role are also played by attitude and perceived risk, while the former is an individual's positive or negative evaluation of particular behaviors, and the latter re ects the person's belief that an action is under his or her control, such as perceived risk (31,32). Additionally, many studies also showed that except for direct effects, subjective norms could in uence the behavioral intentions of the physicians though attitude (22)(23)(24).…”

“…Furthermore, by integrating TPB and other related theoretical models, Deng et al found that subjective norms had signi cant direct and indirect effects on intention to use CPGs on antimicrobials, and the impact of subjective norm on individual attitude was also con rmed (21). It is worth noting that although recently social norms have received special attention as determinants of antimicrobials prescribing behaviors or regarding CPGs compliance, most studies have only proposed a single level of social norms: either individual normative beliefs, or acceptance pressure at the social normative level (22)(23)(24)(25)(26). It may lead to failure of fully identifying the different roles of social norms at different levels.…”

Influencing factors of LDCT recommendation by physicians in Sichuan Province, China

“…According to some classical theory of framework, some personal factors and organizational factors were deemed to be the main factors to improve doctors’ compliance on recommending LDCT ( 15 ). And we combined with existing studies, the sociodemographic characteristics of doctors ( 16 ), the perceptions of barriers on LDCT ( 12 ) and medical conditions for practicing medicine ( 17 , 18 ) may influence medical personnel’s medical behavior decision.…”