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Using psychological theory to understand the clinical management of type 2 diabetes in Primary Care: a comparison across two European countries

Lookup NU author(s): Dr Susan Moloney, Professor Martin Eccles, Dr Jill Francis, Professor Eileen KanerORCiD, Dr Nick Steen



Background: Long term management of patients with Type 2 diabetes is well established within Primary Care. However, despite extensive efforts to implement high quality care both service provision and patient health outcomes remain sub-optimal. Several recent studies suggest that psychological theories about individuals' behaviour can provide a valuable framework for understanding generalisable factors underlying health professionals' clinical behaviour. In the context of the team management of chronic disease such as diabetes, however, the application of such models is less well established. The aim of this study was to identify motivational factors underlying health professional teams' clinical management of diabetes using a psychological model of human behaviour. Methods: A predictive questionnaire based on the Theory of Planned Behaviour (TPB) investigated health professionals' (HPs') cognitions (e. g., beliefs, attitudes and intentions) about the provision of two aspects of care for patients with diabetes: prescribing statins and inspecting feet. General practitioners and practice nurses in England and the Netherlands completed parallel questionnaires, cross-validated for equivalence in English and Dutch. Behavioural data were practice-level patient-reported rates of foot examination and use of statin medication. Relationships between the cognitive antecedents of behaviour proposed by the TPB and healthcare teams' clinical behaviour were explored using multiple regression. Results: In both countries, attitude and subjective norm were important predictors of health professionals' intention to inspect feet (Attitude: beta = .40; Subjective Norm: beta = .28; Adjusted R-2 = .34, p

Publication metadata

Author(s): Hrisos S, Eccles MP, Francis JJ, Bosch M, Dijkstra R, Johnston M, Grol R, Kaner EFS, Steen IN

Publication type: Article

Publication status: Published


Year: 2009

Volume: 9

Issue: 140

Date deposited: 21/10/2009

ISSN (print):

ISSN (electronic): 1472-6963

Publisher: BioMed Central Ltd.


DOI: 10.1186/1472-6963-9-140


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