Med Decis Making - Divergent intentions to use antibiotic guidelines: a theory of planned behavior survey.

Tópicos

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Resumo

CKGROUND: To improve physicians' antimicrobial practice, it is important to identify barriers to and facilitators of guideline adherence and assess their relative importance. The theory of planned behavior permits such assessment and has been previously used for evaluating antibiotic use. According to this theory, guideline use is fueled by 3 factors: attitude, subjective norm (perceived social pressure regarding guidelines), and perceived behavioral control (PBC; perceived ability to follow the guideline). The authors aim to explore factors affecting guideline use in their hospital.METHODS: Starting from their earlier observations, the authors constructed a questionnaire based on the theory of planned behavior, with an additional measure of habit strength. After pilot testing, the survey was distributed among physicians in a major teaching hospital.RESULTS: Of 393 contacted physicians, 195 completed questionnaires were received (50.5% corrected response rate). Using multivariate analysis, the overall intention toward using antibiotic guidelines was not very predictable (model R (2) = .134). Habit strength (relative weight = .391) and PBC (relative weight = .354) were the principal significant predictors. A moderator effect of respondents' position (staff member v. resident) was found, with staff members' intention being significantly influenced only by habit strength and residents' intention by PBC. Regarding previously identified barriers, education on antibiotics and guidelines was rated unsatisfactory.CONCLUSIONS: These divergent origins of influence on guideline adherence point to different approaches for improvement. As habits strongly influence staff members, methods that focus on changing habits (e.g., automated decision support systems) are possible interventions. As residents' intention seems to be guided mainly by external influences and experienced control, this may make feedback, convenient guideline formats, and guideline familiarization more suitable.

Resumo Limpo

ckground improv physician antimicrobi practic import identifi barrier facilit guidelin adher assess relat import theori plan behavior permit assess previous use evalu antibiot use accord theori guidelin use fuel factor attitud subject norm perceiv social pressur regard guidelin perceiv behavior control pbc perceiv abil follow guidelin author aim explor factor affect guidelin use hospitalmethod start earlier observ author construct questionnair base theori plan behavior addit measur habit strength pilot test survey distribut among physician major teach hospitalresult contact physician complet questionnair receiv correct respons rate use multivari analysi overal intent toward use antibiot guidelin predict model r habit strength relat weight pbc relat weight princip signific predictor moder effect respond posit staff member v resid found staff member intent signific influenc habit strength resid intent pbc regard previous identifi barrier educ antibiot guidelin rate unsatisfactoryconclus diverg origin influenc guidelin adher point differ approach improv habit strong influenc staff member method focus chang habit eg autom decis support system possibl intervent resid intent seem guid main extern influenc experienc control may make feedback conveni guidelin format guidelin familiar suitabl

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