Browsing by Author "Steen, Nick"

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Applying psychological theories to evidence-based clinical practice : identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice
(2011) Grimshaw, Jeremy M; Eccles, Martin P; Steen, Nick; Johnston, Marie; Pitts, Nigel B; Glidewell, Elizabeth; Maclennan, Graeme; Thomas, Ruth Elizabeth; Bonetti, Debbie Lee; Walker, Anne Elizabeth; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Medicine, Medical Sciences & Nutrition; University of Aberdeen.Institute of Applied Health Sciences
Applying psychological theories to evidence-based clinical practice : Identifying factors predictive of managing upper respiratory tract infections without antibiotics
(2007-08-03) Eccles, Martin P; Grimshaw, Jeremy M; Johnston, Marie; Steen, Nick; Pitts, Nigel B; Thomas, Ruth; Glidewell, Elizabeth; Maclennan, Graeme; Bonetti, Debbie; Walker, Anne; University of Aberdeen.Medicine, Medical Sciences & Nutrition; University of Aberdeen.Psychology; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Applying psychological theories to evidence-based clinical practice : identifying factors predictive of placing preventive fissure sealants
(2010-04-08) Bonetti, Debbie; Johnston, Marie; Clarkson, Jan E.; Grimshaw, Jeremy; Pitts, Nigel B.; Eccles, Martin; Steen, Nick; Thomas, Ruth; Maclennan, Graeme; Glidewell, Elizabeth; Walker, Anne Elizabeth; University of Aberdeen.Medicine, Medical Sciences & Nutrition; University of Aberdeen.Psychology; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Applying psychological theory to evidence-based clinical practice : identifying factors predictive of managing upper respiratory tract infections without antibiotics
(BioMed Central, 2007-08-03) Eccles, Martin P.; Grimshaw, Jeremy; Johnston, Marie; Steen, Nick; Pitts, Nigel; Thomas, Ruth Elizabeth; Glidewell, Liz; MacLennan, Graeme Stewart; Bonetti, Debbie; Walker, Anne
Background: Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. Methods: Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results: All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe. In the cross theory analysis, perceived behavioural control (TPB), evidence of habitual behaviour (OLT), CS-SRM cause (chance/bad luck), and intention entered the equation, together explaining 36% of the variance. When predicting intention, at the theory level, the proportion of variance explained was: TPB, 30%; SCT, 29%; CS-SRM 27%; OLT, 43%. GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics. In the cross theory analysis, OLT evidence of habitual behaviour, TPB attitudes, risk perception, CS-SRM control by doctor, TPB perceived behavioural control and CS-SRM control by treatment entered the equation, together explaining 49% of the variance in intention. Cnclusion: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the reation of a replicable methodology for identifying factors that predict clinical behaviour. Hwever, a number of conceptual and methodological challenges remain.
Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs.
(Elsevier, 2006-10) Bonetti, Debbie; Pitts, Nigel; Eccles, Martin P.; Grimshaw, Jeremy; Johnston, Marie; Steen, Nick; Glidewell, Liz; Thomas, Ruth Elizabeth; MacLennan, Graeme Stewart; Clarkson, J.; Walker, Anne
This study applies psychological theory to the implementation of evidence-based clinical practice. The first objective was to see if variables from psychological frameworks (developed to understand, predict and influence behaviour) could predict an evidence-based clinical behaviour. The second objective was to develop a scientific rationale to design or choose an implementation intervention. Variables from the Theory of Planned Behaviour, Social Cognitive Theory, Self-Regulation Model, Operant conditioning, Implementation Intentions and the Precaution Adoption Process were measured, with data collection by postal survey. The primary outcome was the number of intra oral radiographs taken per course of treatment collected from a central fee claims database. Participants were 214 Scottish General Dental Practitioners. At the theory level, the Theory of Planned Behaviour explained 13% variance in the number of radiographs taken, Social Cognitive Theory explained 7%, Operant Conditioning explained 8%, Implementation Intentions explained 11%. Self-regulation and Stage theory did not predict significant variance in radiographs taken. Perceived behavioural control, action planning and risk perception explained 16% of the variance in number of radiographs taken (F(3,160) = 11.33, p<.001). Knowledge did not predict number of radiographs taken. The results suggest an intervention targeting predictive psychological variables could increase the implementation of this evidence-based practice; influencing knowledge is unlikely to. Measures which predicted number of radiographs taken also predicted intention to take radiographs, and intention accounted for significant variance in behaviour (Adjusted R2 = 5%: F (1, 166) = 10.28, p<.01), suggesting intention may be a possible proxy for behavioural data when testing an intervention prior to a service-level trial. Since psychological frameworks incorporate methodologies to measure and change component variables, taking a theory-based approach enabled the creation of a replicable methodology for identifying factors predictive of clinical behaviour and for the design and choice of interventions to modify practice as new evidence emerges.
Can the collective intentions of individual professionals within healthcare teams predict the team's performance : developing methods and theory
(2009-05-05) Eccles, Martin P; Hrisos, Susan; Francis, Jillian; Steen, Nick; Bosch, Marije; Johnston, Marie; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Medicine, Medical Sciences & Nutrition; University of Aberdeen.Psychology
Cluster randomised controlled trial of a theory-based multiple behaviour change intervention aimed at healthcare professionals to improve their management of Type 2 diabetes in primary care
(2018-05-02) Presseau, Justin; Mackintosh, Joan; Hawthorne, Gillian; Francis, Jill J.; Johnston, Marie; Grimshaw, Jeremy M.; Steen, Nick; Coulthard, Tom; Brown, Heather; Kaner, Eileen; Elovainio, Marko; Sniehotta, Falko F.; University of Aberdeen.Other Applied Health Sciences
Developing the content of two behavioural interventions : using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1
(BioMed Central, 2008-01-14) Hrisos, Susan; Eccles, Martin P.; Johnston, Marie; Francis, Jillian Joy; Kaner, Eileen F.; Steen, Nick; Grimshaw, Jeremy
Background: Evidence shows that antibiotics have limited effectiveness in the management of upper respiratory tract infection (URTI) yet GPs continue to prescribe antibiotics. Implementation research does not currently provide a strong evidence base to guide the choice of interventions to promote the uptake of such evidence-based practice by health professionals. While systematic reviews demonstrate that interventions to change clinical practice can be effective, heterogeneity between studies hinders generalisation to routine practice. Psychological models of behaviour change that have been used successfully to predict variation in behaviour in the general population can also predict the clinical behaviour of healthcare professionals. The purpose of this study was to design two theoretically-based interventions to promote the management of upper respiratory tract infection (URTI) without prescribing antibiotics. Method: Interventions were developed using a systematic, empirically informed approach in which we: selected theoretical frameworks; identified modifiable behavioural antecedents that predicted GPs intended and actual management of URTI; mapped these target antecedents on to evidence-based behaviour change techniques; and operationalised intervention components in a format suitable for delivery by postal questionnaire. Results: We identified two psychological constructs that predicted GP management of URTI: "Self-efficacy," representing belief in one's capabilities, and "Anticipated consequences," representing beliefs about the consequences of one's actions. Behavioural techniques known to be effective in changing these beliefs were used in the design of two paper-based, interactive interventions. Intervention 1 targeted self-efficacy and required GPs to consider progressively more difficult situations in a "graded task" and to develop an "action plan" of what to do when next presented with one of these situations. Intervention 2 targeted anticipated consequences and required GPs to respond to a "persuasive communication" containing a series of pictures representing the consequences of managing URTI with and without antibiotics. Conclusion: It is feasible to systematically develop theoretically-based interventions to change professional practice. Two interventions were designed that differentially target generalisable constructs predictive of GP management of URTI. Our detailed and scientific rationale for the choice and design of our interventions will provide a basis for understanding any effects identified in their evaluation. Trial registration: Clinicaltrials.gov NCT00376142
Diabetes care provision in UK primary care practices
(2012-07-30) Hawthorne, Gillian; Hrisos, Susan; Stamp, Elaine; Elovainio, Marko; Francis, Jill J; Grimshaw, Jeremy M; Hunter, Margaret; Johnston, Marie; Presseau, Justin; Steen, Nick; Eccles, Martin P; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Psychology
Do incentives, reminders or reduced burden improve healthcare professional response rates in postal questionnaires? : two randomised controlled trials
(2012-08-14) Glidewell, Liz; Thomas, Ruth; MacLennan, Graeme; Bonetti, Debbie; Johnston, Marie; Eccles, Martin P.; Edlin, Richard; Pitts, Nigel B.; Clarkson, Jan; Steen, Nick; Grimshaw, Jeremy M.; University of Aberdeen.Geosciences; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Explaining clinical behaviors using multiple theoretical models
(2012-10-17) Eccles, Martin P.; Grimshaw, Jeremy M.; MacLennan, Graeme; Bonetti, Debbie; Glidewell, Liz; Pitts, Nigel B.; Steen, Nick; Thomas, Ruth Elizabeth; Walker, Anne; Johnston, Marie; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Improving Diabetes care through Examining, Advising, and prescribing (IDEA) : protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals
(2014-05-24) Presseau, Justin; Hawthorne, Gillian; Sniehotta, Falko F; Steen, Nick; Francis, Jill J; Johnston, Marie; Mackintosh, Joan; Grimshaw, Jeremy M; Kaner, Eileen; Elovainio, Marko; Deverill, Mark; Coulthard, Tom; Brown, Heather; Hunter, Margaret; Eccles, Martin P; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Psychology; University of Aberdeen.Medicine, Medical Sciences & Nutrition
Improving professional practice in the disclosure of a diagnosis of dementia : a modeling experiment to evaluate a theory-based intervention
(2009-12) Eccles, Martin P; Francis, Jill; Foy, Robbie; Johnston, Marie; Bamford, Claire; Grimshaw, Jeremy M; Hughes, Julian; Lecouturier, Jan; Steen, Nick; Whitty, Paula M; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Psychology; University of Aberdeen.Medicine, Medical Sciences & Nutrition
Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study
(2011) Eccles, Martin P; Hrisos, Susan; Francis, Jill J; Stamp, Elaine; Johnston, Marie; Hawthorne, Gillian; Steen, Nick; Grimshaw, Jeremy M; Elovainio, Marko; Presseau, Justin; Hunter, Margaret; University of Aberdeen.Other Applied Health Sciences
An intervention modelling experiment to change GPs’ intentions to implement evidence-based practice : using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #2
(2008-01-14) Hrisos, Susan; Eccles, Martin; Johnston, Marie; Francis, Jill; Kaner, Eileen F S; Steen, Nick; Grimshaw, Jeremy; University of Aberdeen.Other Applied Health Sciences
Reflective and automatic processes in healthcare professional behavior : A dual process model tested across multiple behaviors
(2014-12) Presseau, Justin; Johnston, Marie; Heponiemi, Tarja; Elovainio, Marko; Francis, Jill J; Eccles, Martin P; Steen, Nick; Hrisos, Susan; Stamp, Elaine; Grimshaw, Jeremy M; Hawthorne, Gillian; Sniehotta, Falko F; University of Aberdeen.Psychology; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Psychology; University of Aberdeen.Medicine, Medical Sciences & Nutrition
Theory-based predictors of multiple clinician behaviors in the management of diabetes
(2014-08) Presseau, Justin; Johnston, Marie; Francis, Jill J; Hrisos, Susan; Stamp, Elaine; Steen, Nick; Hawthorne, Gillian; Grimshaw, Jeremy M; Elovainio, Marko; Hunter, Margaret; Eccles, Martin P; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Psychology
Translating clinicians' beliefs into implementation interventions (TRACII) : a protocol for an intervention modeling experiment to change clinicians' intentions to implement evidence-based practice
(BioMed Central, 2007-08-16) Eccles, Martin P.; Johnston, Marie; Hrisos, Susan; Francis, Jillian Joy; Grimshaw, Jeremy; Steen, Nick; Kaner, Eileen F.
Background: Biomedical research constantly produces new findings, but these are not routinely incorporated into health care practice. Currently, a range of interventions to promote the uptake of emerging evidence are available. While their effectiveness has been tested in pragmatic trials, these do not form a basis from which to generalise to routine care settings. Implementation research is the scientific study of methods to promote the uptake of research findings, and hence to reduce inappropriate care. As clinical practice is a form of human behaviour, theories of human behaviour that have proved to be useful in other settings offer a basis for developing a scientific rationale for the choice of interventions. Aims: The aims of this protocol are 1) to develop interventions to change beliefs that have already been identified as antecedents to antibiotic prescribing for sore throats, and 2) to experimentally evaluate these interventions to identify those that have the largest impact on behavioural intention and behavioural simulation. Design: The clinical focus for this work will be the management of uncomplicated sore throat in general practice. Symptoms of upper respiratory tract infections are common presenting features in primary care. They are frequently treated with antibiotics, and research evidence is clear that antibiotic treatment offers little or no benefit to otherwise healthy adult patients. Reducing antibiotic prescribing in the community by the "prudent" use of antibiotics is seen as one way to slow the rise in antibiotic resistance, and appears safe, at least in children. However, our understanding of how to do this is limited. Participants will be general medical practitioners. Two theory-based interventions will be designed to address the discriminant beliefs in the prescribing of antibiotics for sore throat, using empirically derived resources. The interventions will be evaluated in a 2 × 2 factorial randomised controlled trial delivered in a postal questionnaire survey. Two outcome measures will be assessed: behavioural intention and behavioural simulation.