AURA Takes you to the home page
 

Aberdeen University Research Archive >
6 - All research >
All research >

Please use this identifier to cite or link to this item: http://hdl.handle.net/2164/267

This item has been viewed 1 times in the last year. View Statistics

Files in This Item:

File Description SizeFormat
Francis2008.pdf333.92 kBAdobe PDFView/Open
Title: Explaining the effects of an intervention designed to promote evidence-based diabetes care : a theory-based process evaluation of a pragmatic cluster randomised controlled trial
Authors: Francis, Jillian Joy
Eccles, Martin P.
Johnston, Marie
Whitty, Paula
Grimshaw, Jeremy M.
Kaner, Eileen F.S.
Smith, Liz
Walker, Anne
Keywords: Diabetes Mellitus
Evidence-Based Practice
Randomised Controlled Trial
Issue Date: 19-Nov-2008
Publisher: BMC
Citation: Francis, J.J., Eccles, M.P., Johnston, M., Whitty, P, Grimshaw, J.M., Kaner, E.F.S., Smith, L., and Walker, A. (2008). Explaining the effects of an intervention designed to promote evidence-based diabetes care : a theory-based process evaluation of a pragmatic cluster randomised controlled trial. Implementation Science, 3 (50)
Abstract: Background The results of randomised controlled trials can be usefully illuminated by studies of the processes by which they achieve their effects. The Theory of Planned Behaviour (TPB) offers a framework for conducting such studies. This study used TPB to explore the observed effects in a pragmatic cluster randomised controlled trial of a structured recall and prompting intervention to increase evidence-based diabetes care that was conducted in three Primary Care Trusts in England. Methods All general practitioners and nurses in practices involved in the trial were sent a postal questionnaire at the end of the intervention period, based on the TPB (predictor variables: attitude; subjective norm; perceived behavioural control, or PBC). It focussed on three clinical behaviours recommended in diabetes care: measuring blood pressure; inspecting feet; and prescribing statins. Multivariate analyses of variance and multiple regression analyses were used to explore changes in cognitions and thereby better understand trial effects. Results Fifty-nine general medical practitioners and 53 practice nurses (intervention: n = 55, 41.98% of trial participants; control: n = 57, 38.26% of trial participants) completed the questionnaire. There were no differences between groups in mean scores for attitudes, subjective norms, PBC or intentions. Control group clinicians had 'normatively-driven' intentions (i.e., related to subjective norm scores), whereas intervention group clinicians had 'attitudinally-driven' intentions (i.e., related to attitude scores) for foot inspection and statin prescription. After controlling for effects of the three predictor variables, this group difference was significant for foot inspection behaviour (trial group × attitude interaction, beta = 0.72, p < 0.05; trial group × subjective norm interaction, beta = -0.65, p < 0.05). Conclusion Attitudinally-driven intentions are proposed to be more consistently translated into action than normatively-driven intentions. This proposition was supported by the findings, thus offering an interpretation of the trial effects. This analytic approach demonstrates the potential of the TPB to explain trial effects in terms of different relationships between variables rather than differences in mean scores. This study illustrates the use of theory-based process evaluation to uncover processes underlying change in implementation trials.
URI: http://hdl.handle.net/2164/267
ISSN: 1748-5908
Appears in Collections:Applied Health Sciences research
All research

SFX Query

Items in AURA are protected by copyright, with all rights reserved, unless otherwise indicated.

 


The University of Aberdeen
King's College
Aberdeen
AB24 3FX
Tel: +44 (0)1224-272000