The factors affecting implementing shared decision-making in clinical trials: a cross-sectional survey of clinical research coordinators' perceptions in Japan.

BACKGROUND: The shared decision-making model has been proposed as the ideal treatment decision-making process in medical encounters. However, the decision to participate in clinical trials rarely involves shared decision-making. In this study, we investigated the perceptions of Japanese clinical research coordinators who routinely support the informed consent process. METHODS: This study aimed to (1) identify clinical research coordinators' perceptions of the current status of shared decision-making implementation and its influencing factors, and (2) obtain suggestions to enhance the shared decision-making process in clinical trials. A cross-sectional survey was conducted using a web questionnaire based on the Theory of Planned behaviour. Invitations were sent to 1087 Japanese medical institutions, and responses from the participants were captured via the web. The shared decision-making process in clinical trials was defined according to the Shared Decision-Making Questionnaire for Doctors. The effect of the attitudes toward shared decision-making, clinical research coordinators' subjective norms towards its implementation, perceived barriers to autonomous decision-making, and the number of difficult steps in the shared decision-making process on the shared decision-making current status as the shared decision-making intention was assessed by multiple regression analysis. RESULTS: In total, 373 clinical research coordinators responded to the questionnaire. Many believed that they were already implementing shared decision-making. Attitudes toward shared decision-making (t = 3.400, p < .001), clinical research coordinators' subjective norms towards its implementation (t = 2.239, p = .026), perceived barriers to autonomous decision-making (t = 3.957, p < .001), and the number of difficult steps in the shared decision-making process (t = 3.317, p = .001) were found to significantly influence current status (Adjusted R2 = .123). However, results on perceived barriers to autonomous decision-making and the number of difficult steps in the shared decision-making process indicate a lack of knowledge of shared decision-making and decision-support skills among clinical research coordinators. CONCLUSIONS: Clinical research coordinators might positively perceive shared decision-making based on normative beliefs without sufficient knowledge of it. Therefore, providing appropriate training on shared decision-making to clinical research coordinators and increasing awareness among stakeholders could enable its improvement. TRIAL REGISTRATION: Not applicable.

Factors associated with intention of clinical pharmacists and candidates to provide pharmaceutical care: application of theory planned behaviour.

BACKGROUND: Postgraduate education programs in clinical pharmacy have become widespread in Türkiye. This study aimed to identify factors associated with the intention of Turkish clinical pharmacists and candidates (who were graduates and students of postgraduate clinical pharmacy programs) to provide pharmaceutical care. METHODS: This prospective observational study was conducted between June 2021 and May 2022. After searching relevant studies, an expert panel discussion, translation, cultural adaptation, and a pilot study developed a 52-item Turkish scale based on the Theory of Planned Behavior (TBP). Cronbach alpha for each construct was calculated after an explanatory factor and test-retest reliability analysis. An online survey link was sent to all graduates or candidates of postgraduate clinical pharmacy programs in Türkiye. After univariate regression analysis, the multiple linear regression model was performed. RESULTS: One hundred fifty-six participants completed the survey (response rate: 59.1%). The Cronbach's alpha for attitude (9 items), subjective norm (6 items), perceived behavioural control (5 items), self-efficacy (6 items), intention (11 items) and past behaviour (15 items) were 0.945, 0.720, 0.751, 0.864, 0.934 and 0.955 respectively. The multiple linear regression analysis found a higher score of the subjective norm (p = 0.016), a higher score of self-efficacy (p < 0.001), younger age (p < 0.001) and having PhD (p = 0.038) were associated with increased intention score. CONCLUSIONS: It was shown that higher self efficacy and positive beliefs of their peers and other healthcare professionals were associated with their higher intention score for providing pharmaceutical care. Younger age and having a PhD were other factors associated with their intention to provide pharmaceutical care.

Investigating oral health-related quality of life in patients with ischaemic stroke in China.

OBJECTIVE: The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen's oral health outcome model. BACKGROUND: Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke. MATERIALS AND METHODS: Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen's oral health outcome model. RESULTS: Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL. CONCLUSION: The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.

The risk-taking behavioural intentions of pilots in adverse weather conditions: an application of the theory of planned behaviour.

This paper examined pilots' risk-taking behavioural intentions based on the theory of planned behaviour, as well as the impact of experience on behavioural intentions in adverse weather conditions. Two hundred and seventy-three airline pilots and flying cadets were divided into two groups and asked to complete a questionnaire based on two decision-making scenarios. This questionnaire measured pilots' intentions to take risks, along with the attitude towards the behaviour, subjective norms, perceived behavioural control (PBC), risk perception, and self-identity. The results showed that attitude, subjective norm, PBC, and risk perception explained 52% of the variance in behavioural intentions. Additionally, pilots' risk-taking decisions can be influenced by experience. Inexperienced pilots had a relatively stronger intention to take risks and a more favourable attitude towards risky behaviour. Moreover, pilots were more likely to rely on their own direct experience in the decision-making process. Practitioner summary: This study examined the pilots' risk-taking intentions under adverse weather conditions using a questionnaire based on the TPB theory. Results demonstrated that the TPB model can be applied to the risk-taking scenario and that experience can influence pilots' decisions. These findings have implications for improving flight safety and lowering accident rates.

Doctors' maintenance of professional competence: a qualitative study informed by the theory of planned behaviour.

BACKGROUND: Medical regulators worldwide have implemented programmes of maintenance of professional competence (MPC) to ensure that doctors, throughout their careers, are up to date and fit to practice. The introduction of MPC required doctors to adopt a range of new behaviours. Despite high enrolment rates on these programmes, it remains uncertain whether doctors engage in the process because they perceive benefits like improvements in their practice and professional development or if they solely meet the requirements to retain medical registration. In this study, we aimed to explore the relationship between doctors' beliefs, intention and behaviour regarding MPC through the lens of the Theory of Planned Behaviour (TPB) to make explicit the factors that drive meaningful engagement with the process. METHODS: We conducted a qualitative study using semi-structured interviews. From a pool of 1258 potential participants, we purposively selected doctors from multiple specialities, age groups, and locations across Ireland. We used thematic analysis, and the TPB informed the analytic coding process. RESULTS: Forty-one doctors participated in the study. The data analysis revealed doctors' intention and behaviour and the factors that shape their engagement with MPC. We found that attitudes and beliefs about the benefits and impact of MPC mediated the nature of doctors' engagement with the process. Some participants perceived positive changes in practice and other gains from participating in MPC, which facilitated committed engagement with the process. Others believed MPC was unfair, unnecessary, and lacking any benefit, which negatively influenced their intention and behaviour, and that was demonstrated by formalistic engagement with the process. Although participants with positive and negative attitudes shared perceptions about barriers to participation, such perceptions did not over-ride strongly positive beliefs about the benefits of MPC. While the requirements of the regulator strongly motivated doctors to participate in MPC, beliefs about patient expectations appear to have had less impact on intention and behaviour. CONCLUSIONS: The findings of this study broaden our understanding of the determinants of doctors' intention and behaviour regarding MPC, which offers a basis for designing targeted interventions. While the barriers to engagement with MPC resonate with previous research findings, our findings challenge critical assumptions about enhancing doctors' engagement with the process. Overall, our results suggest that focused policy initiatives aimed at strengthening the factors that underpin the intention and behaviour related to committed engagement with MPC are warranted.

Students' online collaborative intention for group projects: Evidence from an extended version of the theory of planned behaviour.

Given the increasing use of web technology for teaching and learning, this study developed and examined an extended version of the theory of planned behaviour (TPB) model, which explained students' intention to collaborate online for their group projects. Results indicated that past experience predicted the three antecedents of intention, while past behaviour was predictive of subjective norm and perceived behavioural control. Moreover, the three antecedents (attitude towards e-collaboration, subjective norm and perceived behavioural control) were found to significantly predict e-collaborative intention. This study explored the use of the "remember" type of awareness (i.e. past experience) and evaluated the value of the "know" type of awareness (i.e. past behaviour) in the TPB model.

Examining the predictive utility of an extended theory of planned behaviour model in the context of specific individual safe food-handling.

BACKGROUND: In order to minimise the occurrence of food-borne illness, it is recommended that individuals perform safe food-handling behaviours, such as cooking food properly, cleaning hands and surfaces before preparing food, keeping food at the correct temperature, and avoiding unsafe foods. Previous research examining the determinants of safe food-handling behaviour has produced mixed results; however, this may be due to the fact that this research examined these behaviours as a totality, rather than considering the determinants of each behaviour separately. As such, the objective for the present study was to examine the predictors of the four aforementioned safe food-handling behaviours by applying an extended theory of planned behaviour to the prediction of each distinct behaviour. METHOD: Participants were 170 students who completed theory of planned behaviour measures, with the addition of moral norm and habit strength at time 1, and behaviour measures one week later. RESULTS: While the influence of injunctive and descriptive norm and perceived behavioural control differed between behaviours, it appeared that moral norm was an important predictor of intention to engage in each of the four behaviours. Similarly, habit strength was an important predictor of each of the behaviours and moderated the relationship between intention and behaviour for the behaviour of avoiding unsafe food. CONCLUSION: The implication of these findings is that examining safe food-handling behaviours separately, rather than as a totality, may result in meaningful distinctions between the predictors of these behaviours.

Knowledge, attitudes and behaviour of Egyptians towards antibiotic use in the community: can we do better?

BACKGROUND: Infectious diseases are among the leading causes of death worldwide. This is concerning because of the increasing capacity of the pathogens to develop antibiotic resistance. Antibiotic overuse and misuse remain the main drivers of resistance development. In the USA and Europe, annual campaigns raise awareness of antibiotic misuse hazards and promote their judicial use. Similar efforts are lacking in Egypt. This study assessed the knowledge of the public in Alexandria, Egypt of antibiotic misuse risks and their habits towards antibiotic use, in addition to conducting a campaign to increase awareness of the safe use of antibiotics. METHODS: A questionnaire assessing knowledge, attitudes and behaviour towards antibiotics was used to collect responses from study participants at various sports clubs in Alexandria in 2019. An awareness campaign to correct misconceptions and a post awareness survey followed. RESULTS: Most of the participants were well-educated (85%), in their middle age (51%) and took antibiotics last year (80%). 22% would take an antibiotic for common cold. This dropped to 7% following the awareness. There was a 1.6 time increase in participants who would start an antibiotic on a healthcare professional's advice following the campaign. A 1.3 time increase in participants who would finish an antibiotic regimen was also observed. The campaign made all participants recognize that unwise antibiotic use is harmful to them or others; and 1.5 more participants would spread the word about antibiotic resistance. Despite learning of the risks of antibiotic use, there was no change in how often participants thought they should take antibiotics. CONCLUSIONS: Although awareness of antibiotic resistance is rising, some wrong perceptions hold fast. This highlights the need for patient and healthcare-tailored awareness sessions as part of a structured and national public health program directed to the Egyptian population.

Theory of planned behaviour, psychological stressors and intention to avoid violating traffic rules: A Multi-Level modelling analysis.

This study applies a multilevel model approach to test the predictive effect of the theory of planned behaviour (TPB) plus moral norm, past behaviour and crash history to account for intentions to avoid traffic violations within the context of commuting to or from work. This study also extended the theory by adding psychological stressors of perceived stress and work-family conflict. In this study, we systematically tested the direct and mediated models. A sample of Malaysian drivers (N = 482; 44.6% were men and 55.4% women), with the average age of 36.7 years (SD = 10.0) was surveyed. The self-report questionnaire contained multiple observations nested within individual drivers, with respect to 3 different driving violations. As predicted, multi-level modelling showed that within-person predictor variables of all the TPB components emerged as independent predictors, with injunctive norm being the most predictive variable, followed by self-efficacy and cognitive attitude. Intention was also predicted by moral norms and crash history. Between-person variables, gender, commuting hours and work-family conflict also had direct influences on intention (i.e., men and those with longer commuting hours and higher work-family conflict reported lower intentions). Substantial support for the mediation model was found, confirming that stressors indirectly influence intentions through effects on the social cognitive components. The implications of the linkage between the social cognition and stressors for developing potential broader interventions focusing on multiple violation behaviours and designing appropriate safety policies to reduce commuting crashes are discussed.

Knowledge, training and willingness to perform bystander cardiopulmonary resuscitation among university students in Chongqing, China: a cross-sectional study.

OBJECTIVE: To evaluate knowledge of cardiopulmonary resuscitation (CPR) among Chinese college students and their attitude towards participating in CPR training and willingness to perform bystander CPR. DESIGN: A cross-sectional study. PARTICIPANTS: A total of 1128 college students were selected through a multistage stratified random sampling method from 12 universities in Chongqing, China. PRIMARY AND SECONDARY OUTCOMES: Primary outcomes included CPR knowledge and willingness to participate in training and perform bystander CPR; secondary outcomes included CPR training experience and obstacles to training and performing CPR. RESULTS: The average score on CPR knowledge was 2.078 (±1.342). Only 45.5% of the respondents were willing to participate in CPR training. Women, respondents who were postgraduate or above, with liberal arts as major and with high CPR knowledge level were more willing to participate in CPR training. A total of 47.2% of the respondents were willing to provide simple assistance, such as checking the consciousness and breathing of the patient and dialling 120 (medical emergency call). Only 34.1% indicated their willingness to perform bystander CPR on strangers. Perceived behavioural control, behavioural attitudes and subjective norms are positive predictors of willingness to provide bystander CPR. CONCLUSIONS: CPR knowledge and training rate were low among Chongqing college students. Willingness to participate in training and perform bystander CPR was also low. Improving legislation, strengthening training programmes, incorporating CPR training into the school curriculum and reshaping the social and public culture of offering timely help to those in need are recommended strategies to improve bystander CPR performance.

Health Professionals' Perceptions and Reactions to ICT-Related Patient Safety Incidents.

Patient incident reporting is an important way to promote safer health care. The barriers for reporting can be organizational (leadership, culture, lack of feedback, etc.) or individual (time pressure, perceived competence, attitude, etc.). In this study, we examined what kinds of ICT-related incidents health professionals observe in Finland, how they react to them and the reasons for non-reporting. Our data was collected using a nationwide survey during the Spring of 2020. The theory of planned behaviour by Ajzen served as our framework for explaining non-reporting behaviour. While we found that attitudes, subjective norms and perceived behavioural control all explain non-reporting, our factor model based on our confirmatory factor analysis did not directly match Ajzen's theory.