Potthoff Sebastian, Presseau Justin, Sniehotta Falko F, Johnston Marie, Elovainio Marko, Avery Leah
Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
Implement Sci. 2017 Feb 21;12(1):24. doi: 10.1186/s13012-017-0551-6.
Gaps in the quality of care provided to people with type 2 diabetes are regularly identified. Healthcare professionals often have a strong intention to follow practice guidelines during consultations with people with type 2 diabetes; however, this intention does not always translate into action. Action planning (planning when, where and how to act) and coping planning (planning how to overcome pre-identified barriers) have been hypothesised to help with the enactment of intentions by creating mental cue-response links that promote habit formation. This study aimed to investigate whether habit helps to better understand how action and coping planning relate to clinical behaviour in the context of type 2 diabetes care.
The study utilised a prospective correlational design with six nested sub-studies. General practitioners and practice nurses (n = 427 from 99 UK primary care practices) completed measures of action planning, coping planning and habit at baseline and then self-reported their enactment of guideline-recommended advising, prescribing and examining behaviours 12 months later. Bootstrapped mediation analyses were used to test the indirect effect of action and coping planning on healthcare professionals' clinical behaviour via their relationship with habit.
Healthcare professionals who reported higher degrees of action or coping planning for performing six guideline recommended behaviours in the context of type 2 diabetes care were more likely to report performing these behaviours in clinical practice. All 12 bootstrapped mediation analyses showed that the positive relationship between planning (action and coping planning) and healthcare professionals' clinical behaviour operated indirectly through habit.
These findings suggest that habit mediates the relationship between planning (action and coping planning) and healthcare professional behaviour. Promoting careful action and coping planning may support routinised uptake of guideline-recommended care by healthcare professionals in the primary care setting. Given the competing demands on healthcare professionals, exploring the behavioural processes involved in promoting more routinisation of behaviours where possible and appropriate could free up cognitive capacity for clinical behaviours that rely on more deliberation.
为2型糖尿病患者提供的护理质量差距经常被发现。医疗保健专业人员在与2型糖尿病患者会诊时通常有强烈的意愿遵循实践指南；然而，这种意愿并不总是转化为行动。行动规划（规划何时、何地以及如何行动）和应对规划（规划如何克服预先确定的障碍）被认为有助于通过创建促进习惯形成的心理线索-反应联系来帮助实现意图。本研究旨在调查习惯是否有助于更好地理解行动和应对规划与2型糖尿病护理背景下临床行为之间的关系。
本研究采用前瞻性相关设计，包含六个嵌套子研究。全科医生和执业护士（来自英国99家基层医疗诊所的427人）在基线时完成行动规划、应对规划和习惯的测量，然后在12个月后自我报告他们对指南推荐的建议、处方和检查行为的实施情况。采用自抽样中介分析来测试行动和应对规划通过与习惯的关系对医疗保健专业人员临床行为的间接影响。
在2型糖尿病护理背景下，报告对六种指南推荐行为进行更高程度行动或应对规划的医疗保健专业人员更有可能报告在临床实践中实施这些行为。所有12项自抽样中介分析表明，规划（行动和应对规划）与医疗保健专业人员临床行为之间的积极关系通过习惯间接起作用。
这些发现表明习惯介导了规划（行动和应对规划）与医疗保健专业人员行为之间的关系。促进仔细的行动和应对规划可能支持基层医疗环境中的医疗保健专业人员常规采用指南推荐的护理。鉴于医疗保健专业人员面临的相互竞争的需求，探索在可能和适当的情况下促进更多行为常规化所涉及的行为过程，可能会释放出用于依赖更多深思熟虑的临床行为的认知能力。
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