Browsing by Author "Tetroe, Jacqueline"

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Looking inside the black box : a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada
(BioMed Central, 2007-11-26) Grimshaw, Jeremy; Zwarenstein, Merrick; Tetroe, Jacqueline; Godin, Gaston; Graham, Ian D.; Lemyre, Louise; Eccles, Martin P.; Johnston, Marie; Francis, Jillian Joy; Hux, Jan; O'Rourke, Keith; Legare, France; Presseau, Justin
Background: Randomised controlled trials of implementation strategies tell us whether (or not) an intervention results in changes in professional behaviour but little about the causal mechanisms that produce any change. Theory-based process evaluations collect data on theoretical constructs alongside randomised trials to explore possible causal mechanisms and effect modifiers. This is similar to measuring intermediate endpoints in clinical trials to further understand the biological basis of any observed effects (for example, measuring lipid profiles alongside trials of lipid lowering drugs where the primary endpoint could be reduction in vascular related deaths). This study protocol describes a theory-based process evaluation alongside the Ontario Printed Educational Message (OPEM) trial. We hypothesize that the OPEM interventions are most likely to operate through changes in physicians' behavioural intentions due to improved attitudes or subjective norms with little or no change in perceived behavioural control. We will test this hypothesis using a well-validated social cognition model, the theory of planned behaviour (TPB) that incorporates these constructs. Methods/design: We will develop theory-based surveys using standard methods based upon the TPB for the second and third replications, and survey a subsample of Ontario family physicians from each arm of the trial two months before and six months after the dissemination of the index edition of informed, the evidence based newsletter used for the interventions. In the third replication, our study will converge with the "TRY-ME" protocol (a second study conducted alongside the OPEM trial), in which the content of educational messages was constructed using both standard methods and methods informed by psychological theory. We will modify Dillman's total design method to maximise response rates. Preliminary analyses will initially assess the internal reliability of the measures and use regression to explore the relationships between predictor and dependent variable (intention to advise diabetic patients to have annual retinopathy screening and to prescribe thiazide diuretics for first line treatment of uncomplicated hypertension). We will then compare groups using methods appropriate for comparing independent samples to determine whether there have been changes in the predicted constructs (attitudes, subjective norms, or intentions) across the study groups as hypothesised, and will assess the convergence between the process evaluation results and the main trial results.
Looking inside the black box : results of a theory-based process evaluation exploring the results of a randomized controlled trial of printed educational messages to increase primary care physicians' diabetic retinopathy referrals [Trial registration number ISRCTN72772651]
(2014-08-06) Grimshaw, Jeremy M; Presseau, Justin; Tetroe, Jacqueline; Eccles, Martin P; Francis, Jill J; Godin, Gaston; Graham, Ian D; Hux, Janet E; Johnston, Marie; Légaré, France; Lemyre, Louise; Robinson, Nicole; Zwarenstein, Merrick; University of Aberdeen.Registry; University of Aberdeen.Other Applied Health Sciences
Printed educational messages fail to increase use of thiazides as first-line medication for hypertension in primary care : a cluster randomized controlled trial [ISRCTN72772651]
(2016-09-17) Zwarenstein, Merrick; Grimshaw, Jeremy M; Presseau, Justin; Francis, Jill J; Godin, Gaston; Johnston, Marie; Eccles, Martin P; Tetroe, Jacqueline; Shiller, Susan K; Croxford, Ruth; Kelsall, Diane; Paterson, J Michael; Austin, Peter C; Tu, Karen; Yun, Lingsong; Hux, Janet E; University of Aberdeen.Other Applied Health Sciences
Testing a TheoRY-inspired MEssage ('TRY-ME') : a sub-trial within the Ontario Printed Educational Message (OPEM) trial
(BioMed Central, 2007-11-26) Francis, Jillian Joy; Grimshaw, Jeremy; Zwarenstein, Merrick; Eccles, Martin P.; Shiller, Susan; Godin, Gaston; Johnston, Marie; O'Rourke, Keith; Presseau, Justin; Tetroe, Jacqueline; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Background: A challenge for implementation researchers is to develop principles that could generate testable hypotheses that apply across a range of clinical contexts, thus leading to generalisability of findings. Such principles may be provided by systematically developed theories. The opportunity has arisen to test some of these theoretical principles in the Ontario Printed Educational Materials (OPEM) trial by conducting a sub-trial within the existing trial structure. OPEM is a large factorial cluster-randomised trial evaluating the effects of short directive and long discursive educational messages embedded into informed, an evidence-based newsletter produced in Canada by the Institute for Clinical Evaluative Sciences (ICES) and mailed to all primary care physicians in Ontario. The content of educational messages in the sub-trial will be constructed using both standard methods and methods inspired by psychological theory. The aim of this study is to test the effectiveness of the TheoRY-inspired MEssage ('TRY-ME') compared with the 'standard' message in changing prescribing behaviour. Methods: The OPEM trial participants randomised to receive the short directive message attached to the outside of informed (an 'outsert') will be sub-randomised to receive either a standard message or a message informed by the theory of planned behaviour (TPB) using a two (long insert or no insert) by three (theory-based outsert or standard outsert or no outsert) design. The messages will relate to prescription of thiazide diuretics as first line drug treatment for hypertension (described in the accompanying protocol, "The Ontario Printed Educational Materials trial"). The short messages will be developed independently by two research teams. The primary outcome is prescription of thiazide diuretics, measured by routinely collected data available within ICES. The study is designed to answer the question, is there any difference in guideline adherence (i.e., thiazide prescription rates) between physicians in the six groups? A process evaluation survey instrument based on the TPB will be administered pre- and post-intervention (described in the accompanying protocol, "Looking inside the black box"). The second research question concerns processes that may underlie observed differences in prescribing behaviour. We expect that effects of the messages on prescribing behaviour will be mediated through changes in physicians' cognitions.