A pre-post study of behavioural determinants and practice change in Ugandan clinical officers

Abstract

Background. Understanding the drivers of ‘provider behaviour’ has been highlighted as one of the six domains of behaviour change in strengthening healthcare systems.

Objectives. To assess changes in healthcare provider behaviour, i.e. use of the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach in acute illness management, after participating in a 1-day course on the assessment and management of acutely ill patients. We aimed to assess whether changes in psychological determinants of the ABCDE approach were associated with changes in the use of the approach.

Methods. We used a pre-post design to study self-reported change in behaviour after a 1-day training course from pre-course to follow-up 1 month later. We also measured psychological determinants of behaviour immediately before and after and at 1-month follow-up. We explored if changes in psychological determinants were associated with change in practice 1 month later.

Results. We found the following: firstly, use of the ABCDE approach increased at 1 month post-course from a median use of 50 - 90%. Secondly, the increase in the ABCDE approach was associated with a positive change in only one of the determinants of practice from pre- to post-course: perception of environmental determinants (r=0.323; p<0.05). Finally, there were no other significant associations with practice change or practice at follow-up.

Conclusions. Change in perceptions of availability of resources was associated with increased use of an ABCDE approach, but evidence was limited owing to the pre-post design.