Background
Objective
Methods
Inclusion and exclusion criteria
Search strategy for identification of studies
Behaviour | Health professionals | Intention |
---|---|---|
Thesaurus headings: • BEHAVIOR • CHOICE BEHAVIOR • PLANNED BEHAVIOR • Behaviour?* • Clinician performance* • (Actor or abstainer) near behaviur* | (Intention or intend*) near behaviour?* Thesaurus headings: • HEALTH PERSONNEL • ATTITUDE OF HEALTH PERSONNEL • CLINICIANS Clinician* Counsellor* Dentist* Doctor* Family practition* General practition* GP*/FP* Gynaecologist* Haematologist* Health professional* Internist* Neurologist* Nurse* Obstetrician* Occupational therapist* Optometrist* OT* Paediatrician* Paramedic* Pharmacist* Physician* Physiotherapist* Primary care Psychiatrist* Psychologist* Radiologist* Social worker* Surgeon*/surgery Therapist* | Thesaurus heading: INTENTION • Intend* or intention* • Inclin* or disinclin* |
Review methods
Quality assessment
External validity
Internal validity
Reliability
Validity of the scoring checklist
Validity of the direct measure method
Simulated patients
Validity of the Proxy methods
Patient vignettes
Patient report and Clinician self-report
Appropriateness of the statistical methods used
Data extraction
Evidence synthesis
Results
Description of included studies
Study | Characteristics | Behaviour measured | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
1. Type of participants 2. Target population 3. Sampling strategy | Participants approached & analysed | Consultations/sessions/indications observed/vignettes completed & analysed | 1. Clinical area/s 2. Behaviour/s observed (No. of clinical actions scored) | No. of checklist items | Summarised (weighted) | |||||
N | n | % | N | n | % | |||||
Stange[5]
1998
| 1. Family practice physicians 2. Members of the Ohio Academy of FPs, practice within 50 miles radius of Cleveland & Youngstown 3. Convenience sample | 138 | 128 | 93 | 4454 | 4432 (MR) 3283 (PR) | 99 (MR) 74 (PR) | 1. Delivery of a range of outpatient medical services 2. Counselling (29), physical examination (16), screening (5), Lab tests (10), immunisation (7), Referral (4) | 79 | |
Flocke[6]
2004
| 1. Family physicians 2. Primary care physicians in North West Ohio 3. All physicians approached | 138 | 128 | 93 | 4454 | 2,670 | 60 | 1. Health promotion 2. Smoking (2), alcohol, exercise, diet, substance use, sun exposure, seatbelt use, HIV & STD prevention | 10 | |
Wilson[7]
1994
| 1. General practitioners (GPs) 2. 10 general practices in Nottinghamshire 3. Selection of GPs not reported. Minimum of two non-random consultations were recorded | 16 | 16 | 100 | 3324 | 516 (MR) 335 (PR) | 16 (MR) 10 (PR) | 1. Health promotion 2. Asked patient about 4 health behaviours: smoking (1), alcohol (1), diet & exercise (1); measurement of blood pressure (1) | 4 | |
Ward[8]
1996
| 1. Post-graduate trainees 2. Training general practices in New South Wales 3. Trainees who were having their first experience in supervised general practice | 34 | 34 | 100 | 1500 | 1075 | 72 | 1. Smoking cessation 2. Establish smoking status & provide smoking cessation counselling (2) | 2 | |
Zuckerman[9]
1975
| 1. Paediatricians 2. Physicians working in a university medical centre serving an inner-city population 3. All 3 staff physicians | 3 | 3 | 100 | 51 | 51 | 100 | 1. Paediatric consultation 2. Diagnosis and management (8), historical items (7) | 15 | |
Luck[10]
2000
| 1. Primary care physicians 2. 2 general internal medicine primary care outpatient clinics 3. Random sample of 10 physicians at each site | 20 | 20 | 100 | 160 | 160 | 100 | 1. Management of LBP, DM, COPD, CAD. 2. History, Physical exam, Tests ordered, Diagnosis & Treatment/management (21 for LBP) | NR | √ (w) |
Page[11]
1980
| 1. Community pharmacists 2. Participants on a continuing education course in British Columbia, Canada 3. All participants | 30 | 30 | 100 | 58 | 58 | 100 | 1. Management of: Cold, Pain 2. Recommend either: non-prescription medication (cold = 17, pain = 15) or see physician (cold = 17, pain = 18) | 103 | √ (w) |
Gerbert[12]
1988
| 1. Primary care physicians 2. Primary care physicians serving 6 counties in California 3. Convenience sample | 63 | 63 | 100 | 197 | 197 | 100 | 1. Medication regimens in the management of COPD 2. Prescription of theophyllines (1), sympathomimetics (2), oral corticosteroids (1) | 4 | |
Pbert[13]
1999
| 1. Primary care physicians 2. Attending physicians & their patients at University medical centre in Massachusetts. 3. Convenience sample | 12 | 12 | 100 | 154 | 108 | 70 | 1. Smoking cessation 2. Cessation counselling (15) | 15 | √ |
Gerbert[14]
1986
| 1. Primary care physicians 2. NR 3. Convenience sample | 63 | 63 | 100 | 214 | 192 | 90 | 1. Management of COPD 2. Symptoms (8), signs (2), Tests (3), Treatments (3), Patient education (4) | 75 | √ |
Dresselhaus[15]
2000
| 1. Primary care physicians 2. 2 general internal medicine primary care outpatient clinics 3. Random sample of 10 physicians at each site | 20 | 20 | 100 | 160 | 160 | 100 | 1. Management of low back pain, diabetes mellitus, COPD, CAD. 2. Preventive care: tobacco screening (1), smoking cessation advice (1), prevention measures (1), alcohol screening (1), diet evaluation (1), exercise assessment (1) & exercise advice (1) | 7 | √ |
Rethans[16]
1987
| 1. GPs 2. GPs working in Maastricht 3. All participants | 55 | 25 | 46 | 27 | 25 | 93 | 1. Management of Urinary Tract Infection 2. History taking (8); Physical Examination (3); Instructions to patients (7); Treatment (2); Follow-up (4) | 24 | √ |
Rethans[17]
1994
| 1. GPs 2. Sampling strategy reported elsewhere. 3. Sampling strategy reported elsewhere | 39 | 35 | 90 | 140 | 101 | 72 | 1. Management of tension headache; acute diarrhoea; pain in the shoulder; check-up for non-insulin dependent diabetes. 2. History, Physical exam, Lab exam, Advice, Medication & follow-up (range over 4 conditions: 25–36) | 25–36 | √ |
Peabody[18]
2000
| 1. Primary care physicians 2. 2 general internal medicine primary care outpatient clinics 3. Random sample of 10 physicians at each site | 20 | 20 | 100 | 160 | 160 | 100 | 1. Management of low back pain (LBP), diabetes mellitus (DM), Chronic obstructive pulmonary disease (COPD) oronary artery disease (CAD). 2. History taking (7), Physical examination (3), lab tests (5), Diagnosis(2), Management (6) (Averaged 21 actions per case) | 168 | √ (w) |
O'Boyle[19]
2001
| 1. Nurses 2. ICU staff in 4 metropolitan teaching hospitals in "Mid-West" USA 3. ICUs with comparable patient populations | 124 | 120 | 97 | 120 | 120 | 100 | 1. Adherence to hand hygiene recommendations 2. Hand washing (for a maximum of 10 indications) | 1 | √ |
Clinical behaviours
Methods used for measuring clinical behaviour
Study | Proxy measure | Direct Measure (DM) | Analysis | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Description 1. Method V = Clinical vignette (No. of case simulations) CI/Q = Clinician interview/questionnaire MR = Medical Record review PI/Q = Patient interview/questionnaire 2. Timing | Clinician self report (SR) | Medical Record Review (MR) | Patient report (PR) | Description 1. Method SP = Simulated Patients DO = Direct Observation VR = Video recording AR = Audio recording 2. Timing | SP Training reported | Psychometrics (IRR) | Compared Item by Item | Compared Summary Scores | Agreement between measures: Co-efficient r; kappa (k); Structural equation modelling (SEM); Sensitivity (Sens) & Specificity (Spec) Difference between mean scores: ANOVA; T-test | P | |
Stange[5]
1998
| 1. MR; PQ 2. At end of consultation | √ | √ | DO | 0.39 to 1.00 (kappa) | √ | MR Sens = 8% (diet advice) – 92% (Lab tests) Spec = 83% (social history) – 100% (counselling services, physical exam, lab tests) k = 0.12 to 0.92 (79 comparisons) PR Sens = 17% (mammogram) – 89% (Pap test) Spec = 85% (in-office referral) – 99% (immunisation, physical exam, lab tests) k = 0.03 to 0.86 (53 comparisons) | NR | |||
Flocke[6]
2004
| 1. PQ 2. At end of consultation (24%) or postal return (76%) | √ | DO | NR | √ | Sens* = 11% (substance use) – 76% (smoking cessation) | NA | ||||
Wilson[7]
1994
| 1. MR; PQ 2. At end of consultation | √ | √ | AR | 0.79 to 1.00 | √ | MR Sens = 31%, Spec* = 99% 28.6 (Alcohol) Sens = 29%, Spec* = 100% 83.3 (BP) Sens = 83%, Spec* = 93% % agreement between DM & MR: 45.5 (Smoking) PR Sens = 74%, Spec* = 94% 75.0 (Alcohol) Sens = 75%, Spec* = 94% 100 (BP) Sens = 100%, Spec* = 90% % agreement between DM & PR: 81.8 (Smoking) | NA | |||
Ward[8]
1996
| 1. PQ 2. Questionnaire mailed to patient within 2 days of consultation | √ | AR | 0.74 to 0.94 (kappa) | √ | Sens = 93% (smoking status) Spec = 79% Sens = 92% (cessation advice) Spec = 82% | NA | ||||
Zuckerman[9]
1975
| 1. MR 2. At end of consultation | √ | AR | NR | √ | Sens* = 0% (side effects) – 100% (Diagnosis) Spec* = 9% (Diagnosis) – 100% (side effects) | NA | ||||
Luck[10]
2000
| 1. MR 2. At end of consultation | √ | SP (27) each role-playing 1 of 8 case simulations | √ | NR | √ | √ | ANOVA (4-way) Necessary care: Sens = 70%, Spec = 81% Unnecessary care: Sens = 65%' Spec = 64%. | <0.0001 NA | ||
Page[11]
1980
| 1. V (4) 2. Upto 6 weeks before or 3 weeks after SP visit | √ | SP (4) each role-playing 1 case simulation | √ | 0.76 | √ | √ | r = .56 & .68 r = .26 & .37 "Must do" actions Sens* = 97%, Spec* = 33% "Must not do" actions Sens* = 30%, Spec* = 98% | >0.05 <0.05 | ||
Gerbert[12]
1988
| 1. CI; MR; PI 2. At end of consultation | √ | √ | √ | √R | NR | √ | k = 0.67 (SR) k = 0.54 (MR) k = 0.50 (PR) | <0.001 <0.001 <0.001 | ||
Pbert[13]
1999
| 1. CI; PI 2. At end of consultation | √ | √ | AR. | NR | √ | √ | r = 0.77 (SR) r = 0.67 (PR) | <0.0001 <0.0001 | ||
Gerbert[14]
1986
| 1. CI; MR; PI 2. At end of consultation | √ | √ | √ | √R | 0.52 to 0.93 (kappa) | √ | Median % agreement (All categories): 0.84 (SR) 0.88 (MR) 0.86 (PR) | NA | ||
Dresselhaus[15]
2000
| 1.V (8); MR 2. NR | √ | √ | SP (4) each role-playing a simple and complex case presentation | √ | NA | √ | ANOVA (3-way) | <0.01 | ||
Rethans[16]
1987
| 1. V (1). 2. Completed 2 months after SP visit | √ | SP (3) each role-playing same case simulation | √ | 0.78 to 1.0 (kappa) | √ | √ | T-test: Overall "Obligatory" "Intermediate" "Superfluous" | ns <0.005 <0.05 <0.05 | ||
Rethans[17]
1994
| 1. MR 2. Charts reviewed two years after SP visit. | √ | SP (4) each role-playing 1 of 4 case simulations | √ | 0.93 (kappa) | √ | √ | r = 0.54 (Overall) r = 0.17 (History taking) r = 0.45 (Physical exam) r = 0.75 (Lab exam) r = 0.50 (Advice) r = 0.43 (Medication) r = -0.04 (Follow-up) | <0.05) ns ns <0.01 <0.05 ns ns | ||
Peabody[18]
2000
| 1. V (8); MR 2. Completed "several weeks" after SP visit | √ | √ | SP (4) each role-playing a simple and complex case presentation | √ | NA | √ | ANOVA (4-way) | <0.001 | ||
O'Boyle[19]
2001
| 1. % time practiced hand hygiene 2. Up to one month prior to observation period | √ | DO Nurses observed for 2 hours or until 10 indications for handwashing had occurred | 0.94 to 0.98 | √ | r = 0.21 SEM = 0.201 | <0.05 <0.05 |