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Table 4

From: Applying psychological theories to evidence-based clinical practice: Identifying factors predictive of managing upper respiratory tract infections without antibiotics

Constructs (number of questions) Example Question(s)
Theory of Planned Behaviour [23]  
Behavioural intention (3) I intend to prescribe antibiotics for patients who present with an URTI as part of their management
Attitude: Direct (3); Indirect (8 behavioural beliefs (bb) multiplied by 8 outcome evaluations (oe). The score was the mean of the summed multiplicatives.) Direct: In general: The possible harms of antibiotics to patients with an URTI outweighs their benefits;
Indirect: In general, prescribing an antibiotic for a patient with an URTI would reassure them (bb) × reassuring the patient is (oe: un/important)
Subjective Norm: Indirect (5 normative beliefs (nb) multiplied by 5 motivation to comply (mtc) questions. The score was the mean of the summed multiplicatives). When managing URTIs, I feel under pressure not to prescribe an antibiotic: from published literature (nb) × How motivated are you to do what the published literature states that you should (mtc: very much/not at all)
Perceived Behavioural Control: Direct (4); Indirect/power (7)c Direct: Whether I manage an URTI without prescribing an antibiotic is entirely up to me
Indirect: I find it difficult to manage patients presenting with an URTI without prescribing an antibiotic who: Expect me to prescribe an antibiotic
Social Cognitive Theory [26]  
Risk Perception (3) It is highly likely that patients with an URTI will be worse off if I do not prescribe an antibiotic.
Outcome Expectancies Self (2 × 2), Behaviour (8 × 8). The score was the mean of the summed multiplicatives. Self: If I do not prescribe an antibiotic for a patient with an URTI, then I will think of myself as a competent GP × Thinking of myself as a competent GP is (Un/Important) Behaviour: See Attitude (Theory of Planned Behaviour)
Self-Efficacy: General: Generalized Self-Efficacy Scale [43] (10: 4 point scale, not at all true/exactly true); Specific (7) General: I can always manage to solve difficult problems if I try hard enough
Specific: How confident are you in your ability to manage patients with URTIs symptomatically
Implementation Intention [29]  
Action planning (1) Currently, my standard method of managing patients with an URTI does not include prescribing an antibiotic
Operant Learning Theory [28]; BF Skinner Foundation [44]  
Anticipated consequences (3) If I do not routinely prescribe antibiotics for URTIs then, on balance, my life as a GP will be easier in the long run
Evidence of habit (2) When I see patients with URTIs, I automatically consider managing them without an antibiotic
Experienced (rewarding and punishing) consequences (4: more likely to prescribe (score = 1); less likely (score = -1); unchanged/not sure/never occurred (score = 0)). Scores were summed. Think about the last time you prescribed an antibiotic for a patient with an URTI and felt pleased/sorry:
Think about the last time you decided not to prescribe an antibiotic for a patient with an URTI and felt pleased/sorry that you had not done so':
Common Sense Self-Regulation Model [30]  
Perceived identity (3) URTIs as seen in general practice generally have symptoms of an intense nature
Perceived cause (5) Getting a URTI is determined by stress
Perceived controllability (patient, doctor, treatment) (6) What the patient does can determine whether an URTI gets better or worse
Perceived duration (acute/chronic; cyclical) (3) URTIs as seen in general practice are very unpredictable
Perceived consequences (3) An URTI does not have much effect on a patient's life
Coherence (2) I have a clear picture or understanding of URTIs
Emotional response (4) Seeing patients with an URTI does not worry me
Stage Model [31,32]  
Current stage of change. A single statement is ticked to indicate the behavioural stage Unmotivated (2): I have not/it has been a while since I have thought about changing my management of URTIs to try to avoid the use of antibiotics. Motivated (2): I have decided that I will/will not change my management of URTIs to try to avoid the use of antibiotics. Action (1): I have already changed my management of URTIs to try to avoid the use of antibiotics.
Other Measures  
Knowledge (5) (True/False/Not Sure)
Demographics
The presence of pus on the tonsils suggests a bacterial infection
post code, gender, time qualified, number of other doctors in practice, trainer status, hours per week, list size
  1. aAll indirect measures consist of specific belief questions identified in the preliminary study as salient to the management of upper respiratory tract infections.
  2. bThese individuals and groups were identified in the preliminary study as influential in the management of upper respiratory tract infections
  3. cAn indirect measure of perceived behavioural control usually would be the sum of a set of multiplicatives (control beliefs × power of each belief to inhibit/enhance behaviour). However, the preliminary study demonstrated that it proved problematic to ask clinicians meaningful questions which used the word 'control' as clinicians tended to describe themselves as having complete control over the final decision to perform the behaviour. Support for measuring perceived behavioural control using only questions as to the ease or difficulty of performing the outcome behaviour was derived from a metanalysis which suggested that perceived ease/difficulty questions were sensitive predictors of behavioural intention and behaviour [45].
  4. dIllness representation measures were derived from the Revised Illness Perception Questionnaire [34]