Intention to Encourage Complementary and Alternative Medicine Among General Practitioners and Medical Students

Godin, Gaston; Beaulieu, Denis; Touchette, Jean-Sébastien; Lambert, Léo-Daniel; Dodin, Sylvie

doi:10.3200/bmed.33.2.67-79

Cited by 25 publications

(36 citation statements)

References 3 publications

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“…Our review included 72 studies [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], …”

Section: Resultsmentioning

confidence: 99%

Development of a Simple 12-Item Theory-Based Instrument to Assess the Impact of Continuing Professional Development on Clinical Behavioral Intentions

Freitas²,

et al. 2014

Self Cite

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BackgroundDecision-makers in organizations providing continuing professional development (CPD) have identified the need for routine assessment of its impact on practice. We sought to develop a theory-based instrument for evaluating the impact of CPD activities on health professionals' clinical behavioral intentions.Methods and FindingsOur multipronged study had four phases. 1) We systematically reviewed the literature for instruments that used socio-cognitive theories to assess healthcare professionals' clinically-oriented behavioral intentions and/or behaviors; we extracted items relating to the theoretical constructs of an integrated model of healthcare professionals' behaviors and removed duplicates. 2) A committee of researchers and CPD decision-makers selected a pool of items relevant to CPD. 3) An international group of experts (n = 70) reached consensus on the most relevant items using electronic Delphi surveys. 4) We created a preliminary instrument with the items found most relevant and assessed its factorial validity, internal consistency and reliability (weighted kappa) over a two-week period among 138 physicians attending a CPD activity. Out of 72 potentially relevant instruments, 47 were analyzed. Of the 1218 items extracted from these, 16% were discarded as improperly phrased and 70% discarded as duplicates. Mapping the remaining items onto the constructs of the integrated model of healthcare professionals' behaviors yielded a minimum of 18 and a maximum of 275 items per construct. The partnership committee retained 61 items covering all seven constructs. Two iterations of the Delphi process produced consensus on a provisional 40-item questionnaire. Exploratory factorial analysis following test-retest resulted in a 12-item questionnaire. Cronbach's coefficients for the constructs varied from 0.77 to 0.85.ConclusionA 12-item theory-based instrument for assessing the impact of CPD activities on health professionals' clinical behavioral intentions showed adequate validity and reliability. Further studies could assess its responsiveness to behavior change following CPD activities and its capacity to predict health professionals' clinical performance.

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Section: Resultsmentioning

confidence: 99%

Development of a Simple 12-Item Theory-Based Instrument to Assess the Impact of Continuing Professional Development on Clinical Behavioral Intentions

Freitas²,

et al. 2014

Self Cite

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“…Linked to perceptions about role, is moral norm (i.e. GPs’ perceptions of their responsibilities) [12, 28]. Respondents who agreed that GPs should prescribe local and general exercise to every patient with CKP were more likely to report using exercise.…”

Section: Discussionmentioning

confidence: 99%

What influences general practitioners’ use of exercise for patients with chronic knee pain? Results from a national survey

et al. 2016

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BackgroundExercise is a recommended ‘core’ treatment for chronic knee pain (CKP), however it appears to be underused by general practitioners (GPs). While behavioural theories suggest that attitudes and beliefs influence behaviours, no single theory reliably predicts GPs’ behaviours. A theoretical analysis framework, developed from sociocognitive theories, was used to underpin investigation of the key influences associated with GPs’ use of exercise for patients with CKP, to inform future interventions to optimise GPs’ use of exercise.MethodsA cross-sectional postal questionnaire survey investigated UK GPs’ reported use of exercise based on a patient case vignette. Factors influencing GPs’ exercise use (behaviour) were examined using attitude statements, free-text questions and multiple response option questions related to factors within the analysis framework. Unadjusted logistic regression analyses explored the associations between GPs’ attitudes/beliefs and behaviour.ResultsFrom a total sample of 5000 GPs, 835 (17%) returned a questionnaire. Most respondents (n = 729, 87%) reported that they would use exercise. Factors significantly associated with exercise use (OR (95% CI)) included GPs’ beliefs about their role (belief that GPs should give information on type, duration and frequency of exercise (30.71 (5.02,188.01)), beliefs about consequences (agreement that knee problems are improved by local (3.23 (1.94,5.39)) and general exercise (2.63 (1.38,5.02))), moral norm (agreement that GPs should prescribe all patients local (3.08 (1.96,4.83)) and general exercise (2.63 (1.45,4.76))), and GP-related beliefs about capabilities (prior experience of insufficient expertise to give detailed exercise information (0.50 (0.33,0.76)). Whilst perceived time limitations were not associated with exercise use (1.00 (0.33,3.01)), GPs who disagreed that they experienced time limitations were more likely to suggest general (2.17 (1.04,4.55)), or demonstrate local (2.16 (1.06,4.42)), exercises.ConclusionGPs’ attitudes and beliefs are associated with their use of exercise for patients with CKP, particularly beliefs about role, responsibilities and skills in initiating exercise, and about the efficacy of exercise. Although the low response risks response bias, these results can inform future interventions to optimise GPs’ behaviour. The role of GP uncertainty and influences on clinical decision-making need further exploration, thus an amended analysis framework is suggested, which should be tested in future research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0570-4) contains supplementary material, which is available to authorized users.

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“…Although the TPB has been used to explain intentions to use CAM, 37, 38 we were interested to find that it did not account for all of the factors that women described as affecting their intentions to use acupuncture. The TPB, like much of traditional health behavior theory, is based on the underlying notion of rational thought in which patients are assumed to be highly motivated to maintain or return to a universally agreed upon definition of good health.…”

Section: Discussionmentioning

confidence: 99%

“…34 This model has been used in numerous research settings to understand the decisions about specific health behaviors such as mammogram use 35, 36 and also in the context of Complementary and Alternative Medicine (CAM) research. 37, 38 The interview questions were pilot tested and revised for clarity. Interviewers were all trained and supervised in semi-structured interviewing techniques by the study medical anthropologist (Barg).…”

Section: Methodsmentioning

confidence: 99%

Acupuncture for Hot Flashes: Decision Making by Breast Cancer Survivors

Mao

Leed²,

Bowman³

et al. 2012

The Journal of the American Board of Family Medicine

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Purpose Hot flashes (HFs) are a particularly common and distressing symptom in breast cancer survivors (BCS). Given its low rate of side effects, acupuncture shows promise as a therapeutic approach for HFs but little is known about BCS’s decision-making about use of acupuncture. This study seeks to identify attitudes and beliefs about using acupuncture for HFs by BCS. Methods Using the Theory of Planned Behavior (TPB) as a conceptual framework, we conducted semi-structured interviews among women with stage I–III breast cancer who had finished primary treatment and were currently experiencing HFs. Interviews were taped, transcribed, and coded. We used a modified grounded theory approach to analyze the data. Results Twenty-five BCS (13 Caucasian/12 African American) participated in the study. Respondents stated that their intended use of acupuncture for HFs would be dependent on: 1) Expected therapeutic effects (e.g. pain relief, energy); 2) Practical concerns (e.g. fear of needles, practitioner experience, time commitment); and 3) Source of decision support/validation (e.g. family members, physicians, self). Although constructs in the TPB accounted for many decision factors, respondents identified two major themes outside of the TPB: 1) Viewing acupuncture as a natural alternative to medications, and 2) Assessing the degree of HFs as bothersome enough in the context of other medical co-morbidities to trigger the need for therapy. Conclusion BCS expressed varied expected therapeutic benefits, practical concerns, and decision support, emphasizing the “natural appeal” and symptom appraisal as key determinants in using acupuncture for HFs. Incorporating these factors in counseling BCS may promote patient-centered communication leading to improved hot flash management and quality of life.

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Intention to Encourage Complementary and Alternative Medicine Among General Practitioners and Medical Students

Cited by 25 publications

References 3 publications

Development of a Simple 12-Item Theory-Based Instrument to Assess the Impact of Continuing Professional Development on Clinical Behavioral Intentions

Development of a Simple 12-Item Theory-Based Instrument to Assess the Impact of Continuing Professional Development on Clinical Behavioral Intentions

What influences general practitioners’ use of exercise for patients with chronic knee pain? Results from a national survey

Acupuncture for Hot Flashes: Decision Making by Breast Cancer Survivors

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