Using psychological theory to understand the clinical management of type 2 diabetes in Primary Care: a comparison across two European countries

Background: Long term management of patients with Type 2 diabetes is well established within Primary Care. However, despite extensive efforts to implement high quality care both service provision and patient health outcomes remain sub-optimal. Several recent studies suggest that psychological theories about individuals\u27 behaviour can provide a valuable framework for understanding generalisable factors underlying health professionals\u27 clinical behaviour. In the context of the team management of chronic disease such as diabetes, however, the application of such models is less well established. The aim of this study was to identify motivational factors underlying health professional teams\u27 clinical management of diabetes using a psychological model of human behaviour. Methods: A predictive questionnaire based on the Theory of Planned Behaviour (TPB) investigated health professionals\u27 (HPs\u27) cognitions (e. g., beliefs, attitudes and intentions) about the provision of two aspects of care for patients with diabetes: prescribing statins and inspecting feet. General practitioners and practice nurses in England and the Netherlands completed parallel questionnaires, cross-validated for equivalence in English and Dutch. Behavioural data were practice-level patient-reported rates of foot examination and use of statin medication. Relationships between the cognitive antecedents of behaviour proposed by the TPB and healthcare teams\u27 clinical behaviour were explored using multiple regression. Results: In both countries, attitude and subjective norm were important predictors of health professionals\u27 intention to inspect feet (Attitude: beta = .40; Subjective Norm: beta = .28; Adjusted R-2 = .34,