1
|
Phutrakool P, Pongpirul K. Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis. Syst Rev 2022; 11:10. [PMID: 35027078 PMCID: PMC8759198 DOI: 10.1186/s13643-021-01882-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 12/27/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Complementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists. METHODS We conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. Each article was assessed by two screeners. Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. The pooled prevalence estimates were calculated using random-effects meta-analyses. This review followed both PRISMA and SWiM guidelines. RESULTS Of 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. Ten medical specialties were included: Internal Medicine (11 studies), Pediatrics (6 studies), Obstetrics and Gynecology (6 studies), Anesthesiology (4 studies), Surgery (3 studies), Family Medicine (3 studies), Physical Medicine and Rehabilitation (3 studies), Psychiatry and Neurology (2 studies), Otolaryngology (1 study), and Neurological Surgery (1 study). The overall acceptance of CAM was 52% (95%CI, 42-62%). Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. The overall use of CAM was 45% (95% CI, 37-54%). The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. Based on the studies, meta-regression showed no statistically significant difference across geographic regions, economic levels of the country, or sampling methods. CONCLUSION Acceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for strategic harmonization of CAM and conventional medicine practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019125628.
Collapse
Affiliation(s)
- Phanupong Phutrakool
- School of Global Health and Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Patumwan, Bangkok, 10330, Thailand
| | - Krit Pongpirul
- School of Global Health and Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Patumwan, Bangkok, 10330, Thailand. .,Department of International Health and Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Bumrungrad International Hospital, Bangkok, Thailand.
| |
Collapse
|
2
|
Schaub C, Bigoni C, Baumeler Q, Faouzi M, Alexandre K. The influence of psychosocial factors on the intention to incorporate complementary and integrative medicine into psychiatric clinical practices. Complement Ther Clin Pract 2021; 44:101413. [PMID: 33991959 DOI: 10.1016/j.ctcp.2021.101413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/07/2021] [Accepted: 05/01/2021] [Indexed: 11/18/2022]
Abstract
Complementary and integrative medicine (CIM) can be of great support to individuals suffering from psychiatric conditions; however, it is still rarely incorporated into clinical practice. OBJECTIVE To examine the influences of psychosocial and sociodemographic factors on health-care professionals' intention to use CIM in their psychiatric clinical practice. METHOD One-hundred-and-five participants completed a questionnaire developed from an adapted version of Triandis' Theory of Interpersonal Behavior (TIB). Intentions to use CIM (yes or no) were analyzed using logistic regression models. RESULTS The multivariate model retained three main factors: affect, perceived social norms, and conditions facilitating CIM. These predicted health-care professionals' intention to use CIM with an AUC = 94.7%. RESULTS underlined that positive affective attitudes towards CIM, feeling that CIM was congruent with professional and institutional goals, and having sufficient skills in CIM were essential to ensuring that health-care professionals would integrate CIM into their clinical practice.
Collapse
Affiliation(s)
- Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Avenue de Beaumont 21, CH-1011, Lausanne, Switzerland.
| | - Catherine Bigoni
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Avenue de Beaumont 21, CH-1011, Lausanne, Switzerland.
| | - Quentin Baumeler
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Avenue de Beaumont 21, CH-1011, Lausanne, Switzerland; The Swiss Peak LLC, Chemin des Epinettes 8, CH-1007, Lausanne, Switzerland.
| | - Mohamed Faouzi
- Biostatistics Unit, Center for Primary Care and Public Health(Unisanté), University of Lausanne, Route de Berne 113, CH-1010, Lausanne, Switzerland.
| | - Kétia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Avenue de Beaumont 21, CH-1011, Lausanne, Switzerland.
| |
Collapse
|
3
|
Wilson LM, White KM, Hamilton K. Predicting Psychologists' Intentions to Integrate Complementary and Alternative Therapies Into Their Practice. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2011.00058.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lee‐ann M Wilson
- School of Psychology and Counselling, Queensland University of Technology
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology
| | - Kyra Hamilton
- School of Psychology and Counselling, Queensland University of Technology
| |
Collapse
|
4
|
Adekpedjou R, Haesebaert J, Stacey D, Brière N, Freitas A, Rivest LP, Légaré F. Variations in factors associated with healthcare providers' intention to engage in interprofessional shared decision making in home care: results of two cross-sectional surveys. BMC Health Serv Res 2020; 20:203. [PMID: 32164669 PMCID: PMC7069220 DOI: 10.1186/s12913-020-5064-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers’ level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention. Methods We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals’ clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering. Results Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5–6.5) and factors associated with intention were social influence (β = 0.27, P < 0.0001), beliefs about one’s capabilities (β = 0.43, P < 0.0001), moral norm (β = 0.31, P < 0.0001) and beliefs about consequences (β = 0.21, P < 0.0001). At exit, median intention level was 5.5 (IQR: 4.5–6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = − 0.39, P = 0.018) and working as a technician (β = − 0.41, P = 0.069) (compared to as a social worker). Conclusion Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances. Trial registration Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.
Collapse
Affiliation(s)
- Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Julie Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France
| | - Dawn Stacey
- Ottawa Hospital Research Institute and Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nathalie Brière
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Université Laval, Quebec, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada. .,Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525, chemin de la Canardière, Quebec, G1J 0A4, Canada.
| |
Collapse
|
5
|
Primary care practitioner perceptions and attitudes of complementary medicine: a content analysis of free-text responses from a survey of non-metropolitan Australian general practitioners. Prim Health Care Res Dev 2018; 19:246-255. [PMID: 29417914 DOI: 10.1017/s1463423617000664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AimThis study examines GP perceptions, attitudes and knowledge of complementary medicine (CM), and to understand contextual factors that influence these perceptions, attitudes and knowledge. BACKGROUND CM use is increasing, and its influence on primary care becoming increasingly significant. Although general practitioners (GPs) often have central primary care gate-keeper roles within health systems, few studies have looked specifically at GPs' perceptions, attitudes and knowledge of CM. METHODS A questionnaire was mailed to all 1486 GPs registered as practicing in non-metropolitan areas of New South Wales. The survey included one free-text qualitative question, where respondents were invited to highlight issues associated with CM in their own words. Free-text responses were analyzed qualitatively using thematic analysis.FindingsIn total, 585 GPs responded to the survey (adjusted response rate 40.1%), with 152 (26.0%) filling in the free-text question. Central themes which emerged were risk as a primary concern; opposition to, resistance to and the inappropriateness of complementary therapies; struggles with complexity and ambivalent tolerance. CONCLUSION GPs in Australia have a wide variety of perceptions toward CM. A minority of GPs have absolute views on CM, with most GPs having numerous caveats and qualifications of individual CM. Efficacy is only one aspect of CM critically evaluated by GPs when gauging support for individual therapies - risk, alignment with medical principles and an openness to exploring new avenues of treatment where others have failed, all appear to be equally important considerations when GPs form their views around CM.
Collapse
|
6
|
Shamblen SR, Atwood K, Scarbrough W, Collins DA, Rindfleisch A, Kligler B, Gaudet T. Perceived Behavioral Control as a Key to Integrative Medicine. J Evid Based Integr Med 2018; 23:2515690X18801581. [PMID: 30295047 PMCID: PMC6176530 DOI: 10.1177/2515690x18801581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/25/2018] [Indexed: 12/30/2022] Open
Abstract
The purpose of the present study was to identify the factors that are the strongest predictors of intentions and use of integrative medicine approaches in clinical practice. Ajzen's theory of planned behavior was used to guide our examination of these questions. Health care professionals exposed to a Veterans Health Administration program (N = 288) who completed survey instruments prior to and immediately after the program and 3 months later were the participants for this study. Findings suggest that the theory of planned behavior performs reasonably well in explaining our data showing the integration of integrative medicine approaches into clinical practice. We found that self-efficacy to use integrative health approaches and perceived preparedness to discuss nonpharmaceutical approaches with patients were the strongest predictors of intentions to use integrative health approaches and self-reported change in clinical practice. The implications of these findings are discussed.
Collapse
Affiliation(s)
| | - Katharine Atwood
- Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | | | - David A. Collins
- Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | | | | | - Tracy Gaudet
- Veterans Health Administration, Washington, DC, USA
| |
Collapse
|
7
|
Cottrell E, Roddy E, Rathod T, Porcheret M, Foster NE. What influences general practitioners' use of exercise for patients with chronic knee pain? Results from a national survey. BMC FAMILY PRACTICE 2016; 17:172. [PMID: 27993126 PMCID: PMC5168590 DOI: 10.1186/s12875-016-0570-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022]
Abstract
Background Exercise is a recommended ‘core’ treatment for chronic knee pain (CKP), however it appears to be underused by general practitioners (GPs). While behavioural theories suggest that attitudes and beliefs influence behaviours, no single theory reliably predicts GPs’ behaviours. A theoretical analysis framework, developed from sociocognitive theories, was used to underpin investigation of the key influences associated with GPs’ use of exercise for patients with CKP, to inform future interventions to optimise GPs’ use of exercise. Methods A cross-sectional postal questionnaire survey investigated UK GPs’ reported use of exercise based on a patient case vignette. Factors influencing GPs’ exercise use (behaviour) were examined using attitude statements, free-text questions and multiple response option questions related to factors within the analysis framework. Unadjusted logistic regression analyses explored the associations between GPs’ attitudes/beliefs and behaviour. Results From a total sample of 5000 GPs, 835 (17%) returned a questionnaire. Most respondents (n = 729, 87%) reported that they would use exercise. Factors significantly associated with exercise use (OR (95% CI)) included GPs’ beliefs about their role (belief that GPs should give information on type, duration and frequency of exercise (30.71 (5.02,188.01)), beliefs about consequences (agreement that knee problems are improved by local (3.23 (1.94,5.39)) and general exercise (2.63 (1.38,5.02))), moral norm (agreement that GPs should prescribe all patients local (3.08 (1.96,4.83)) and general exercise (2.63 (1.45,4.76))), and GP-related beliefs about capabilities (prior experience of insufficient expertise to give detailed exercise information (0.50 (0.33,0.76)). Whilst perceived time limitations were not associated with exercise use (1.00 (0.33,3.01)), GPs who disagreed that they experienced time limitations were more likely to suggest general (2.17 (1.04,4.55)), or demonstrate local (2.16 (1.06,4.42)), exercises. Conclusion GPs’ attitudes and beliefs are associated with their use of exercise for patients with CKP, particularly beliefs about role, responsibilities and skills in initiating exercise, and about the efficacy of exercise. Although the low response risks response bias, these results can inform future interventions to optimise GPs’ behaviour. The role of GP uncertainty and influences on clinical decision-making need further exploration, thus an amended analysis framework is suggested, which should be tested in future research. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0570-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elizabeth Cottrell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Trishna Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| |
Collapse
|
8
|
Templeman K, Robinson A, McKenna L. Student identification of the need for complementary medicine education in Australian medical curricula: A constructivist grounded theory approach. Complement Ther Med 2015; 23:257-64. [DOI: 10.1016/j.ctim.2015.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 12/29/2022] Open
|
9
|
Lavoie M, Godin G, Vézina-Im LA, Blondeau D, Martineau I, Roy L. Psychosocial determinants of physicians' intention to practice euthanasia in palliative care. BMC Med Ethics 2015; 16:6. [PMID: 25609036 PMCID: PMC4417253 DOI: 10.1186/1472-6939-16-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/12/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians' intention to practice euthanasia in palliative care and verifying whether respecting the patient's autonomy is important for physicians. METHODS A validated anonymous questionnaire based on an extended version of the Theory of Planned Behavior was mailed to a random sample of 445 physicians from the province of Quebec, Canada. RESULTS The response rate was 38.3% and the mean score for intention was 3.94 ± 2.17 (range: 1 to 7). The determinants of intention among physicians were: knowing patients' wishes (OR = 10.77; 95%CI: 1.33-86.88), perceived behavioral control-physicians' evaluation of their ability to adopt a given behavior-(OR = 4.35; 95%CI: 1.44-13.15), moral norm-the appropriateness of adopting a given behavior according to one's personal and moral values-(OR = 3.22; 95%CI: 1.29-8.00) and cognitive attitude-factual consequences of the adoption of a given behavior-(OR = 3.16; 95%CI: 1.20-8.35). This model correctly classified 98.8% of physicians. Specific beliefs that might discriminate physicians according to their level of intention were also identified. For instance, physicians' moral norm was related to the ethical principle of beneficence. CONCLUSIONS Overall, physicians have weak intentions to practice euthanasia in palliative care. Nevertheless, respecting patients' final wishes concerning euthanasia seems to be of particular importance to them and greatly affects their motivation to perform euthanasia.
Collapse
Affiliation(s)
- Mireille Lavoie
- Faculty of Nursing, Laval University, Québec, G1V 0A6, Canada.
- Équipe de Recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs (ERMOS), Centre de recherche du CHU de Québec - Hôtel-Dieu de Québec, Québec, Canada.
| | - Gaston Godin
- Faculty of Nursing, Laval University, Québec, G1V 0A6, Canada.
| | | | | | | | - Louis Roy
- CHU de Québec - Hôpital Enfant-Jésus, Quebec, Canada.
| |
Collapse
|
10
|
Lavoie M, Godin G, Vézina-Im LA, Blondeau D, Martineau I, Roy L. Psychosocial determinants of nurses’ intention to practise euthanasia in palliative care. Nurs Ethics 2014; 23:48-60. [DOI: 10.1177/0969733014557117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical. Research objective: The purpose of this study was to identify the psychosocial determinants of nurses’ intention to practise euthanasia in palliative care if it were legalised. Research design: A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. Participants and research context: A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study. Ethical considerations: The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec. Findings: The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1–7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50–6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58–5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified. Discussion: Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses’ moral norm was related to beneficence, an ethical principle. Conclusion: To our knowledge, this is the first study to identify nurses’ motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses’ moral norm and intention.
Collapse
Affiliation(s)
- Mireille Lavoie
- Laval University, Canada; Research Centre of the University Hospital of Québec, Canada
| | | | | | | | | | | |
Collapse
|
11
|
Kim HK, Niederdeppe J, Guillory J, Graham M, Olson C, Gay G. Determinants of Pregnant Women's Online Self-Regulatory Activities for Appropriate Gestational Weight Gain. HEALTH COMMUNICATION 2014; 30:922-932. [PMID: 25205417 PMCID: PMC4535434 DOI: 10.1080/10410236.2014.905900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study examined psychosocial and sociodemographic factors associated with pregnant women's use of Web-based tools to set and monitor personal goals for healthy diet and physical activity. These tools were made available to women participating in a randomized trial testing a Web-based intervention to promote appropriate gestational weight gain. We used data from a baseline survey of pregnant women assigned to the intervention group and log data on women's use of various intervention features (N = 873). Women who believed that appropriate gestational weight gain would lead to healthy outcomes for their child were more likely to engage in online goal-setting and self-monitoring. Less positive outcome expectancy beliefs about the relationship between their own weight and baby's health partially explains why some at risk subpopulations (e.g., African-American women) were less likely to utilize online self-regulatory tools. This study specifies key psychosocial and motivational factors that guide the construction and monitoring of goals among pregnant women. These findings offer guidance for the design of interventions to promote self-regulatory techniques by identifying groups for whom those features are most likely to be useful, as well as psychological determinants of their use.
Collapse
Affiliation(s)
- Hye Kyung Kim
- a Wee Kim Wee School of Communication and Information, Nanyang Technological University
| | | | | | | | | | | |
Collapse
|
12
|
Légaré F, Borduas F, Freitas A, Jacques A, Godin G, Luconi F, Grimshaw J. Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions. PLoS One 2014; 9:e91013. [PMID: 24643173 PMCID: PMC3958345 DOI: 10.1371/journal.pone.0091013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/05/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Decision-makers in organizations providing continuing professional development (CPD) have identified the need for routine assessment of its impact on practice. We sought to develop a theory-based instrument for evaluating the impact of CPD activities on health professionals' clinical behavioral intentions. METHODS AND FINDINGS Our multipronged study had four phases. 1) We systematically reviewed the literature for instruments that used socio-cognitive theories to assess healthcare professionals' clinically-oriented behavioral intentions and/or behaviors; we extracted items relating to the theoretical constructs of an integrated model of healthcare professionals' behaviors and removed duplicates. 2) A committee of researchers and CPD decision-makers selected a pool of items relevant to CPD. 3) An international group of experts (n = 70) reached consensus on the most relevant items using electronic Delphi surveys. 4) We created a preliminary instrument with the items found most relevant and assessed its factorial validity, internal consistency and reliability (weighted kappa) over a two-week period among 138 physicians attending a CPD activity. Out of 72 potentially relevant instruments, 47 were analyzed. Of the 1218 items extracted from these, 16% were discarded as improperly phrased and 70% discarded as duplicates. Mapping the remaining items onto the constructs of the integrated model of healthcare professionals' behaviors yielded a minimum of 18 and a maximum of 275 items per construct. The partnership committee retained 61 items covering all seven constructs. Two iterations of the Delphi process produced consensus on a provisional 40-item questionnaire. Exploratory factorial analysis following test-retest resulted in a 12-item questionnaire. Cronbach's coefficients for the constructs varied from 0.77 to 0.85. CONCLUSION A 12-item theory-based instrument for assessing the impact of CPD activities on health professionals' clinical behavioral intentions showed adequate validity and reliability. Further studies could assess its responsiveness to behavior change following CPD activities and its capacity to predict health professionals' clinical performance.
Collapse
Affiliation(s)
- France Légaré
- Public Health and Practice-Changing Research Group, CHUQ Research Centre (CRCHUQ), Quebec, Quebec, Canada
| | - Francine Borduas
- Office of the Vice-Dean of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Adriana Freitas
- Public Health and Practice-Changing Research Group, CHUQ Research Centre (CRCHUQ), Quebec, Quebec, Canada
| | - André Jacques
- Practice Enhancement Division, Collège des médecins du Québec, Montreal, Quebec, Canada
| | - Gaston Godin
- Faculty of Nursing, Université Laval, Quebec, Quebec, Canada
| | - Francesca Luconi
- Continuing Health Professional Education Office, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
13
|
Thompson-Leduc P, Clayman ML, Turcotte S, Légaré F. Shared decision-making behaviours in health professionals: a systematic review of studies based on the Theory of Planned Behaviour. Health Expect 2014; 18:754-74. [PMID: 24528502 PMCID: PMC5060808 DOI: 10.1111/hex.12176] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 02/02/2023] Open
Abstract
Background Shared decision making (SDM) requires health professionals to change their practice. Socio‐cognitive theories, such as the Theory of Planned Behaviour (TPB), provide the needed theoretical underpinnings for designing behaviour change interventions. Objective We systematically reviewed studies that used the TPB to assess SDM behaviours in health professionals to explore how theory is being used to explain influences on SDM intentions and/or behaviours, and which construct is identified as most influential. Search strategy We searched PsycINFO, MEDLINE, EMBASE, CINAHL, Index to theses, Proquest dissertations and Current Contents for all years up to April 2012. Inclusion criteria We included all studies in French or English that used the TPB and related socio‐cognitive theories to assess SDM behavioural intentions or behaviours in health professionals. We used Makoul & Clayman's integrative SDM model to identify SDM behaviours. Data extraction and synthesis We extracted study characteristics, nature of the socio‐cognitive theory, SDM behaviour, and theory‐based determinants of the SDM behavioural intention or behaviour. We computed simple frequency counts. Main results Of 12 388 titles, we assessed 136 full‐text articles for eligibility. We kept 20 eligible studies, all published in English between 1996 and 2012. Studies were conducted in Canada (n = 8), the USA (n = 6), the Netherlands (n = 3), the United Kingdom (n = 2) and Australia (n = 1). The determinant most frequently and significantly associated with intention was the subjective norm (n = 15/21 analyses). Discussion There was great variance in the way socio‐cognitive theories predicted SDM intention and/or behaviour, but frequency of significance indicated that subjective norm was most influential.
Collapse
Affiliation(s)
| | - Marla L Clayman
- Division of General Internal Medicine, Northwestern University, Chicago, IL, USA
| | - Stéphane Turcotte
- Centre of the Centre Hospitalier Universitaire de Québec, St-François d'Assise Hospital, Québec City, QC, Canada
| | - France Légaré
- Université Laval, Québec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC, Canada
| |
Collapse
|
14
|
Abstract
PURPOSE Hot flashes (HFs) are a particularly common and distressing symptom among breast cancer survivors (BCSs). Given its low rate of side effects, acupuncture shows promise as a therapeutic approach for HFs, but little is known about BCS's decision making about the use of acupuncture. This study seeks to identify attitudes and beliefs about using acupuncture for HFs by BCSs. METHODS Using the Theory of Planned Behavior (TPB) as a conceptual framework, we conducted semistructured interviews among women with stage I-III breast cancer who had finished primary treatment and were currently experiencing HFs. Interviews were taped, transcribed, and coded. We used a modified grounded theory approach to analyze the data. RESULTS Twenty-five BCSs (13 whites/12 African American) participated in the study. Respondents stated that their intended use of acupuncture for HFs would be dependent on (1) expected therapeutic effects (eg, pain relief, energy); (2) practical concerns (eg, fear of needles, practitioner experience, time commitment); and (3) source of decision support/validation (eg, family members, physicians, self). Although constructs in the TPB accounted for many decision factors, respondents identified 2 major themes outside of the TPB: (1) viewing acupuncture as a natural alternative to medications, and (2) assessing the degree of HFs as bothersome enough in the context of other medical comorbidities to trigger the need for therapy. CONCLUSION BCSs expressed varied expected therapeutic benefits, practical concerns, and decision support, emphasizing the "natural appeal" and symptom appraisal as key determinants when using acupuncture for HFs. Incorporating these factors in counseling BCSs may promote patient-centered communication, leading to improved hot flash management and quality of life.
Collapse
|
15
|
Desylvia D, Stuber M, Fung CC, Bazargan-Hejazi S, Cooper E. The knowledge, attitudes and usage of complementary and alternative medicine of medical students. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:728902. [PMID: 19073778 PMCID: PMC3137293 DOI: 10.1093/ecam/nen075] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 10/03/2008] [Accepted: 10/22/2008] [Indexed: 12/19/2022]
Abstract
The increasing use of CAM by patients has led to an increase in teaching about CAM in medical school in the US. In preparation for initiation of a new curriculum in Integrative Medicine at the David Geffen School of Medicine at UCLA a cross sectional survey was used to assess medical students': (i) familiarity, (ii) opinions, (iii) personal use and (iv) willingness to recommend specific CAM modalities, using a five point Likert scale of an established measure. A total of 263 first, second and third year medical students at UCLA completed surveys. Third year students reported less personal use of CAM and less favorable attitudes towards CAM than first year students. Since this was a cross-sectional rather than longitudinal study this may be a cohort effect. However, it may reflect the increased curricular emphasis on evidenced-based medicine, and subsequent student dependence on randomized clinical trials to influence and guide practice. This will need to be addressed in curricular efforts to incorporate Integrative Medicine.
Collapse
Affiliation(s)
- Dawn Desylvia
- David Geffen School of Medicine, University of California, Los Angeles, CA 90024-1759, USA
| | | | | | | | | |
Collapse
|
16
|
Tourigny J, Chartrand J, Massicotte J. Health Professionals' Beliefs Related to Parental Involvement in Ambulatory Care: An International Inquiry. ACTA ACUST UNITED AC 2009; 31:89-101. [DOI: 10.1080/01460860802023539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci 2008; 3:36. [PMID: 18631386 PMCID: PMC2507717 DOI: 10.1186/1748-5908-3-36] [Citation(s) in RCA: 614] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/16/2008] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is an important gap between the implications of clinical research evidence and the routine clinical practice of healthcare professionals. Because individual decisions are often central to adoption of a clinical-related behaviour, more information about the cognitive mechanisms underlying behaviours is needed to improve behaviour change interventions targeting healthcare professionals. The aim of this study was to systematically review the published scientific literature about factors influencing health professionals' behaviours based on social cognitive theories. These theories refer to theories where individual cognitions/thoughts are viewed as processes intervening between observable stimuli and responses in real world situations. METHODS We searched psycINFO, MEDLINE, EMBASE, CIHNAL, Index to theses, PROQUEST dissertations and theses and Current Contents for articles published in English only. We included studies that aimed to predict healthcare professionals' intentions and behaviours with a clear specification of relying on a social cognitive theory. Information on percent of explained variance (R(2)) was used to compute the overall frequency-weighted mean R(2) to evaluate the efficacy of prediction in several contexts and according to different methodological aspects. The cognitive factors most consistently associated with prediction of healthcare professionals' intention and behaviours were documented. RESULTS Seventy eight studies met the inclusion criteria. Among these studies, 72 provided information on the determinants of intention and 16 prospective studies provided information on the determinants of behaviour. The theory most often used as reference was the Theory of Reasoned Action (TRA) or its extension the Theory of Planned Behaviour (TPB). An overall frequency-weighted mean R(2) of 0.31 was observed for the prediction of behaviour; 0.59 for the prediction of intention. A number of moderators influenced the efficacy of prediction; frequency-weighted mean R(2) varied from 0.001 to 0.58 for behaviour and 0.19 to 0.81 for intention. CONCLUSION Our results suggest that the TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention. In addition, given the variations in efficacy of prediction, special care should be given to methodological issues, especially to better define the context of behaviour performance.
Collapse
Affiliation(s)
- Gaston Godin
- Canada Research Chair on Behaviour and Health, Laval University, Québec, Canada
| | - Ariane Bélanger-Gravel
- Research Group on Behaviour and Health, Faculty of Nursing, Laval University, Québec, Canada
| | - Martin Eccles
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
- Department of Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
18
|
Elder WG, Hustedde C, Rakel D, Joyce J. CAM Curriculum Activities to Enhance Professionalism Training in Medical Schools. ACTA ACUST UNITED AC 2008; 13:127-133. [PMID: 19412352 DOI: 10.1177/1533210107313917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Enhancing the professionalism of graduates is a major objective of most health care education institutions today. Educating conventional health care providers about complementary and alternative medicine (CAM) may directly and indirectly improve trainee professionalism by expanding trainees' knowledge and appreciation of diverse health care beliefs and practices, improving physician-patient communication, enhancing self-care, and increasing sense of competence and job satisfaction. A survey based on professional competencies proposed by the Consortium of Academic Health Centers for Integrative Medicine was administered to the grantees of the National Institutes of Health, National Center for Complementary and Alternative Medicine R-25 CAM education project initiative. The survey's aim was to identify project activities that taught professionalism skills. All projects reported curricular features that enhanced trainee professionalism, with substantial percentages of project effort directed toward professionalism-related activities.
Collapse
Affiliation(s)
- W G Elder
- Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky (WGE, CH, JJ); and the Department of Family Medicine, University of Wisconsin, Madison, Wisconsin (DR)
| | | | | | | |
Collapse
|