Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
J Occup Rehabil. 2013 Mar;23(1):148-56. doi: 10.1007/s10926-012-9378-9.
To improve guideline adherence by insurance physicians (IPs), an implementation strategy was developed and investigated in a randomized controlled trial. This implementation strategy involved a multifaceted training programme for a group of IPs in applying the guidelines for depression. In this study we report the impact of the implementation strategy on the physicians' attitude, intention, self-efficacy, and knowledge and skills as behavioural determinants of guideline adherence. Any links between these self-reported behavioural determinants and levels of guideline adherence were also determined.
Just before and 3 months after the implementation of the multifaceted training, a questionnaire designed to measure behavioural determinants on the basis of the ASE (attitude, social norm, self-efficacy) model was completed by the intervention (n = 21) and the control group (n = 19). Items of the questionnaire were grouped to form scales of ASE determinants. Internal consistency of the scales was calculated using Cronbach's alphas. Differences between groups concerning changes in ASE determinants, and the association of these changes with improvements in guideline adherence, were analyzed using analysis of covariance.
The internal consistency of the scales of ASE determinants proved to be sufficiently reliable, with Cronbach's alphas of at least 0.70. At follow-up after 3 months, the IPs given the implementation strategy showed significant improvement over the IPs in the control group for all ASE determinants investigated. Changes in knowledge and skills were only weakly associated with improvements in guideline adherence.
The implementation strategy developed for insurance physicians can increase their attitude, intention, self-efficacy, and knowledge and skills when applying the guidelines for depression. These changes in behavioural determinants might indicate positive changes in IPs' behaviour towards the use of the guidelines for depression. However, only changes in knowledge and skills related to the use of the guidelines were associated with improvements in IPs' actual performance when applying the guidelines.
为了提高保险公司医生（IP）的指南依从性，我们在一项随机对照试验中制定并研究了一项实施策略。该实施策略涉及对一组应用抑郁指南的 IP 进行多方面的培训计划。在这项研究中，我们报告了实施策略对医生态度、意图、自我效能感以及知识和技能的影响，这些都是指南依从性的行为决定因素。还确定了这些自我报告的行为决定因素与指南依从性水平之间的任何联系。
在多方面培训实施前后 3 个月，干预组（n=21）和对照组（n=19）完成了一份基于 ASE（态度、社会规范、自我效能）模型设计的问卷，以衡量行为决定因素。问卷的项目被分组形成 ASE 决定因素量表。使用 Cronbach's alphas 计算量表的内部一致性。使用协方差分析分析组间 ASE 决定因素变化的差异，以及这些变化与指南依从性改善的关联。
ASE 决定因素量表的内部一致性被证明是可靠的，Cronbach's alphas 至少为 0.70。在 3 个月的随访时，接受实施策略的 IP 与对照组的 IP 相比，所有研究的 ASE 决定因素均有显著改善。知识和技能的变化与指南依从性的改善仅呈弱相关。
为保险公司医生制定的实施策略可以提高他们在应用抑郁指南时的态度、意图、自我效能感以及知识和技能。这些行为决定因素的变化可能表明 IP 对使用抑郁指南的行为发生了积极变化。然而，只有与使用指南相关的知识和技能变化与 IP 实际应用指南时的改善相关。
