Can the collective intentions of individual professionals within healthcare teams predict the teams performance: developing methods and theoryReport as inadecuate




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Implementation Science

, 4:24

First Online: 05 May 2009Received: 01 December 2008Accepted: 05 May 2009DOI: 10.1186-1748-5908-4-24

Cite this article as: Eccles, M.P., Hrisos, S., Francis, J.J. et al. Implementation Sci 2009 4: 24. doi:10.1186-1748-5908-4-24

Abstract

BackgroundWithin implementation research, using theory-based approaches to understanding the behaviours of healthcare professionals and the quality of care that they reflect and designing interventions to change them is being promoted. However, such approaches lead to a new range of methodological and theoretical challenges pre-eminent among which are how to appropriately relate predictors of individual-s behaviour to measures of the behaviour of healthcare professionals. The aim of this study was to explore the relationship between the theory of planned behaviour proximal predictors of behaviour intention and perceived behavioural control, or PBC and practice level behaviour. This was done in the context of two clinical behaviours – statin prescription and foot examination – in the management of patients with diabetes mellitus in primary care. Scores for the predictor variables were aggregated over healthcare professionals using four methods: simple mean of all primary care team members- intention scores; highest intention score combined with PBC of the highest intender in the team; highest intention score combined with the highest PBC score in the team; the scores on both constructs of the team member identified as having primary responsibility for the clinical behaviour.

MethodsScores on theory-based cognitive variables were collected by postal questionnaire survey from a sample of primary care doctors and nurses from northeast England and the Netherlands. Data on two clinical behaviours were patient reported, and collected by postal questionnaire survey. Planned analyses explored the predictive value of various aggregations of intention and PBC in explaining variance in the behavioural data.

ResultsAcross the two countries and two behaviours, responses were received from 37 to 78% of healthcare professionals in 57 to 93% practices; 51% UK and 69% Netherlands of patients surveyed responded. None of the aggregations of cognitions predicted statin prescription. The highest intention in the team irrespective of PBC was a significant predictor of foot examination.

ConclusionThese approaches to aggregating individually-administered measures may be a methodological advance of theoretical importance. Using simple means of individual-level measures to explain team-level behaviours is neither theoretically plausible nor empirically supported; the highest intention was both predictive and plausible. In studies aiming to understand the behaviours of teams of healthcare professionals in managing chronic diseases, some sort of aggregation of measures from individuals is necessary. This is not simply a methodological point, but a necessary step in advancing the theoretical and practical understanding of the processes that lead to implementation of clinical behaviours within healthcare teams.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-5908-4-24 contains supplementary material, which is available to authorized users.

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Author: Martin P Eccles - Susan Hrisos - Jillian J Francis - Nick Steen - Marije Bosch - Marie Johnston

Source: https://link.springer.com/







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