Doctors' use of clinical guidelines: two applications of the Theory of Planned Behaviour

This paper reports three studies looking at guideline use by hospital doctors. The first study involved unstructured interviews with a randomly selected group of doctors to find out what factors they believe influence their use of clinical guidelines. The second study used a questionnaire based on the Theory of Planned Behaviour and incorporated the factors elicited during the initial interviews to explain and predict the intentions of junior doctors to use a guideline for the management of acute asthma in Accident and Emergency departments in England and Wales. The third study extended the second study by using a sample of more senior doctors and a guideline for the use of antibiotics. Factors thought by interviewees to be most influential in their decision to use a clinical guideline were whether the guideline was: (a) 'useful', (b) based on strong 'evidence', but (c) did not deny the 'individuality' of the patient. Subjective norm was the strongest predictor of intention to use the asthma guideline; attitude was the strongest predictor of intention to use the antibiotic guideline. Further research is needed to clarify whether these findings reflect differences between the guidelines or the status of the doctors included in each study.