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Nigel Pitts

Publications and source records attributed to Nigel Pitts.

10 recordsLinked to original sources
PubMed2005

Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings.

OBJECTIVE: The uptake of research findings into routine health care is a haphazard and unpredictable process. The usefulness of the results of implementation studies is limited, due in part to the lack of an underlying framework of the important dimensions of research studies in this area and the healthcare settings within which they are conducted and may subsequently be used. STUDY DESIGN AND SETTING: We explore the role for a theory-based framework and suggest some of the methods that would be needed to operationalize the framework in the context of designing and conducting interventions aimed at improving the use of research findings by individual healthcare professionals or teams. CONCLUSIONS: This research offers a framework for those who would seek to use the results of such studies in routine healthcare settings.

Diffusion of Innovation↗
PubMed2005

An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies.

OBJECTIVES: To compare the cost-effectiveness of four third molar guideline implementation strategies. METHODS: Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline. RESULTS: The effectiveness of the guideline depended crucially upon the type of patient treated. In particular, for a minority of patients (14%) with no clinical signals of their 'type', the implementation strategies generate potentially large gains in evidence-based practice. However, the cost per patient of achieving these gains is large given that the costs are incurred for all patients, but benefits accrue only to a minority. DISCUSSION: The results show that the type of patient presenting for treatment can influence the effectiveness, cost-effectiveness and therefore policy conclusions. Consequently, the design and analysis of studies need to be sufficiently sensitive to detect subtle interaction effects. This may explain the dearth of guideline implementation trials with significant findings. The results also suggest that a more cost-effective implementation method in primary care dentistry may be to subsidize treatment conditional upon patient type.

Cost-Benefit Analysis↗
PubMed2004

Guiding the design and selection of interventions to influence the implementation of evidence-based practice: an experimental simulation of a complex intervention trial.

A consistent finding in health services research is the report of uneven uptake of research findings. Implementation trials have a variable record of success in effectively influencing clinicians' behaviour. A more systematic approach may be to conduct Intervention Modelling Experiments before service-level trials, examining intervention effects on 'interim endpoints' representing clinical behaviour, derived from empirically supported psychological theories. The objectives were to: (1) Design Intervention Modelling Experiments by backward engineering a 'real-world' randomised controlled trial (NEXUS); (2) examine the applicability of psychological theories to clinical decision-making; (3) explore whether psychological theories can illuminate how interventions achieve their effects. A 2 x 2 factorial randomised controlled trial was designed with pre- and post-intervention data collection by postal questionnaire surveys. The first survey was used to generate feedback data and the interventions were delivered in the second survey. General medical practitioners (GPs) in England and Scotland participated. First survey respondents were randomised twice to receive or not audit and feedback and educational reminder messages. The main outcome measures included behavioural intention (general plan to refer for lumbar X-rays) and simulated behaviour (specific, scenario-based, decisions to refer for lumbar X-ray). Predictors were attitude, subjective norm, perceived behavioural control (theory of planned behaviour), self-efficacy (social cognitive theory) and decision difficulty. Both interventions significantly influenced simulated behaviour, but neither influenced behavioural intention. There were no interaction effects. All theoretically derived cognitions significantly predicted simulated behaviour. Only subjective norm was not predictive of behavioural intention. The effect of audit and feedback on simulated behaviour was mediated through perceived behavioural control. The results of this study suggest that Intervention Modelling Experiments, using psychological models to help isolate mediators of clinical decision-making, may be a means of developing more potent interventions, and selecting implementation interventions with a greater likelihood of success in a service-level randomised controlled trial.

Analysis of Variance↗
PubMed2004

Understanding the jigsaw of evidence-based dentistry. 3. Implementation of research findings in clinical practice.

Part one of this three-part series provided an overview of evidence-based dentistry (EBD), provided one definition of EBD and, having introduced the EBD matrix, concentrated on the research synthesis part of the jigsaw puzzle. Part two focused on the middle row of this puzzle, the dissemination of research results. This final article deals with perhaps the most vital but the most often overlooked element of the puzzle: implementation of research findings in clinical practice.

Dental Care↗
PubMed2003

PRIME--PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice.

BACKGROUND: Biomedical research constantly produces new findings but these are not routinely translated into health care practice. One way to address this problem is to develop effective interventions to translate research findings into practice. Currently a range of empirical interventions are available and systematic reviews of these have demonstrated that there is no single best intervention. This evidence base is difficult to use in routine settings because it cannot identify which intervention is most likely to be effective (or cost effective) in a particular situation. We need to establish a scientific rationale for interventions. As clinical practice is a form of human behaviour, theories of human behaviour that have proved useful in other similar settings may provide a basis for developing a scientific rationale for the choice of interventions to translate research findings into clinical practice. The objectives of the study are: to amplify and populate scientifically validated theories of behaviour with evidence from the experience of health professionals; to use this as a basis for developing predictive questionnaires using replicable methods; to identify which elements of the questionnaire (i.e., which theoretical constructs) predict clinical practice and distinguish between evidence compliant and non-compliant practice; and on the basis of these results, to identify variables (based on theoretical constructs) that might be prime targets for behaviour change interventions. METHODS: We will develop postal questionnaires measuring two motivational, three action and one stage theory to explore five behaviours with 800 general medical and 600 general dental practitioners. We will collect data on performance for each of the behaviours. The relationships between predictor variables (theoretical constructs) and outcome measures (data on performance) in each survey will be assessed using multiple regression analysis and structural equation modelling. In the final phase of the project, the findings from all surveys will be analysed simultaneously adopting a random effects approach to investigate whether the relationships between predictor variables and outcome measures are modified by behaviour, professional group or geographical location.

Biomedical Research↗