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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

Lookup NU author(s): Dr Jill Francis, Professor Martin Eccles, Dr Paula Whitty, Professor Jeremy Grimshaw, Professor Eileen Kaner

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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 x attitude interaction, beta = 0.72, p


Publication metadata

Author(s): Francis JJ, Eccles MP, Johnston M, Whitty P, Grimshaw JM, Kaner EFS, Smith L, Walker A

Publication type: Article

Publication status: Published

Journal: Implementation Science

Year: 2008

Volume: 3

Issue: 1

Pages: 50

ISSN (print):

ISSN (electronic): 1748-5908

Publisher: BioMed Central Ltd.

URL: http://dx.doi.org/10.1186/1748-5908-3-50

DOI: 10.1186/1748-5908-3-50


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