Department of Family Practice, University of Marburg, Germany & Bioethics-Clinical Ethics, University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
Patient Educ Couns. 2010 Feb;78(2):169-76. doi: 10.1016/j.pec.2009.06.010. Epub 2009 Aug 7.
To assess the feasibility and outcome of measuring the theory of planned behaviour (TPB) in patients receiving routine counselling versus counselling with a decision aid (DA) during primary care consultation on cardiovascular risk prevention.
A DA was developed, based on models of shared decision-making (SDM) and the TPB. We evaluated the impact of the intervention in a randomized controlled trial. Main outcomes were previously reported. To assess the intermediate social cognitive processes and our theoretical framework, we evaluated the impact of the intervention on a TPB scale.
The TPB scale showed satisfactory measurement properties. Factor analysis (main component analysis, confirmatory model) could mostly replicate the assumptions of the model. 44% of variance of the behavioural intention to adhere to the decision after counselling was explained in linear regression models. Of the TPB components, only attitude towards the decision and moral norm were significantly more positive in the intervention. No difference was found with regard to intention to adhere to the decision. High risk resulted in higher values of the TPB components in both groups.
Most DAs are developed and tested without explicitly referring to a theoretical model of psychosocial processes. The TPB may serve as a useful theoretical framework.
Trials on DAs demonstrate positive effects on psychological outcomes of patients without leading to better objective health results. Our study might contribute to an explanation: DAs might not cause stronger adherence to decisions even though one's attitude towards the decision becomes more positive.
评估在初级保健咨询中，对接受常规咨询的患者和接受决策辅助（DA）咨询的患者进行计划行为理论（TPB）测量的可行性和结果，以预防心血管风险。
基于共享决策（SDM）和 TPB 模型开发了一个 DA。我们在一项随机对照试验中评估了干预的效果。主要结果已在之前报道过。为了评估中间的社会认知过程和我们的理论框架，我们评估了干预对 TPB 量表的影响。
TPB 量表显示出良好的测量特性。因子分析（主成分分析，验证模型）可以在很大程度上复制模型的假设。线性回归模型解释了咨询后坚持决策的行为意向的 44%方差。在 TPB 成分中，只有对决策的态度和道德规范在干预组中更为积极。在坚持决策的意向方面没有发现差异。高风险导致两组的 TPB 成分值更高。
大多数 DAs 是在没有明确参考心理社会过程理论模型的情况下开发和测试的。TPB 可以作为一个有用的理论框架。
DA 的试验显示对患者的心理结果有积极影响，而不会导致更好的客观健康结果。我们的研究可能有助于解释：尽管人们对决策的态度变得更加积极，但 DA 可能不会导致对决策的更强的坚持。
