Table 1 Summary of the explanatory measures
Theory of Planned Behaviour (Ajzen, 1991) | |
|---|---|
   Constructs (number of questions) | Example Question(s) |
Behavioural intention (3) | I intend to refer patients with back pain for an X-ray as part of their management |
Attitude: Direct (3); Indirecta (8 behavioural beliefs (bb) multiplied by 8 outcome evaluations (oe). The score was the mean of the summed multiplicatives.) | Direct: In general, the possible harm to the patient of a lumbar spine X-ray is outweighed by its benefits; Indirect: In general, referring patients with back pain for an X-ray would reassure them (bb) x reassuring patients with back pain is (oe: un/important) |
Subjective Norm: Indirect (4 normative beliefs (nb) multiplied by 4 motivation to comply (mtc) questions. The score was the mean of the summed multiplicatives). | I feel under pressure from the NHS not to refer patients for an X-ray (nb) x How motivated are you to do what the NHS thinks you should (mtc: very much/not at all) |
Perceived Behavioural Control: Direct (4); Indirect/power (14)c | Direct: Whether I refer patients for a lumbar X-ray is entirely up to me. Indirect: Without an X-ray, how confident are you in your ability to treat patients with back pain who expect me to refer them for an X-ray |
Social Cognitive Theory (Bandura,1998) | |
Risk Perception (3) | It is highly likely that patients with back pain will be worse off if I do not refer them for an X-ray. |
Outcome Expectancies Self (2x2), Behaviour (8x8). The score was the mean of the summed multiplicatives. | Self: If I refer a patient with back pain for an X-ray, then I will think of myself as a competent GP x Thinking of myself as a competent GP is (Un/Important) Behaviour: See Attitude (Theory of Planned Behaviour) |
Self Efficacy: General: Generalized Self-Efficacy Scale (Schwarzer, 1992) (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 treat back problems without using an X-ray report |
Implementation Intention (Gollwitzer, 1993) | |
Action planning (3) | Currently, my standard method of managing patients with back pain does not include referring them for an X-ray |
Operant Learning Theory (Skinner, Blackman, 1974) | |
Anticipated consequences (3) | If I start routinely referring patients with back pain then, on balance, my life as a GP will be easier in the long run |
Evidence of habit (2) | When I see a patient with back pain, I automatically consider referring them for an X-ray |
Experienced (rewarding and punishing) consequences (4: more likely to refer (score = 1); less likely (score=-1); unchanged/not sure/never occurred (score = 0)). Scores were summed. | Think about the last time you referred a patient for a lumbar spine X-ray and felt pleased that you had done so. Do you think the result of this episode has made you: Think about the last time you decided not to refer a patient for a lumbar spine X-ray and felt sorry that you had not done so. Do you think the result of this episode has made you: |
Common Sense Self-regulation Model d (Leventhal et al., 1984) | |
Perceived identity (3) | Back pain as seen in general practice is generally of an intense nature |
Perceived cause (8) | Back pain is caused by stress or worry |
Perceived controllability (7) | What the patient does can determine whether back pain gets better or worse, What I do can determine whether the patient's back pain gets better or worse |
Perceived duration (5) | Back pain as seen in general practice is very unpredictable |
Perceived consequences (3) | Back pain does not have much effect on a patient's life |
Coherence (2) | I have a clear picture or understanding of back pain |
Emotional response (4) | Seeing patients with back pain does not worry me |
Precaution Adoption Process (Stage model)(Weinstein, 1988; Weinstein, Rothman & Sutton, 1998) | |
Current stage of change. A single statement is ticked to indicate the behavioural stage | Unmotivated (3): I have not yet thought about changing the number of lumbar X-rays I currently request. It has been a while since I have thought about changing the number of lumbar X-rays I request. Motivated (2): I have thought about it and decided that I will not change the number of lumbar X-rays I request. I have decided that I will request more lumbar X-rays. I have decided that I will request less lumbar X-rays. Action (1): I have already done something about increasing the number of lumbar X-rays I request I have already done something about decreasing the number of lumbar X-rays I request |
Other Measures | |
Knowledge (5) (True/False/Not Sure) | The presence of spondolytic changes on a lumbar spine X-ray correlates well with back pain |
Demographic | Post code, gender, time qualified, number of other doctors in practice, trainer status, hours per week, list size |