Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs.

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.The development of this study was supported by the UK Medical Research Council Health Services Research Collaboration. It was funded by a grant from the UK Medical Research Council (G0001325). The Health Services Research Unit and the Dental Health Research Unit are funded by the Chief Scientist Office of the Scottish Executive. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Ruth Thomas is funded by the Wellcome Trust (GR063790MA)