The Intention to Choose Antidiabetic Agents for Type 2 Poor-Control Diabetic Patients: A Survey of Physicians in the Institutions of Diabetes Health Promotion
Date Issued
2008
Date
2008
Author(s)
Liu, Yuan-Ching
Abstract
The purpose of this study was to explore the physicians’ intentions to choose antidiabetic agents in the next six months by applying the Ajzen’s theory of planned behavior. A clinical vignette was designed to elicit physicians’ opinions: for type 2 diabetic patients who have had hygiene education and guidance, active diet and exercise control, and taking the maximum dosage for two oral antidiabetic agents, whose A1C is still ≧7.5%, to determine the intention for choosing antidiabetic agents. The sample population was selected from the physicians who take care of ambulatory diabetic patients in the 136 Institutions of Diabetes Health Promotion. The design of research instrument was based on the results of an open-ended questionnaire and telephone interviews from the sample population, and then to elicit salient beliefs. According to salient beliefs, the structured questionnaire was developed, and then structured questionnaires were mailed to collect data. The total number of valid questionnaires was 214, distributed to 92 institutions, and the overall valid response rate was 43.8%. n the study, attitude, subjective norm, perceived behavioral control, and behavioral intention were measured to get scores about choosing insulin and OAD by respondents respectively. Then, two scores were subtracted, creating a differential score which presented the views of respondents. This method was different from the traditional method of the theory, which was generally applied to explain one-choice behavior. The results show: (1) All three of the constructs in the theory—differential attitude, differential subjective norm, and differential perceived behavioral control could effectively explain 24% of variance of the differential intention to prescribe antidiabetic agents . Of which, differential attitude have the greatest influence for differential intention, followed by differential subjective norm and differential perceived behavioral control;（2）Regarding differential attitude, 45.8% of respondents had a more positive attitude toward prescribing insulin than OAD, because most of them believed prescribing insulin was more appropriate and effective. But 37.4% of respondents also had a more positive attitude toward prescribing OAD than insulin, most of them believed prescribing OAD was less inconvenient and more safer; (3)Regarding differential subjective norm, 42.1% of respondents felt most of the important referents expected he/she should prescribe insulin. Only 12.6% of respondents felt most of the important referents expected he/she should prescribe OAD. Besides, 45.3% of respondents felt most of the important referents agreed no matter what kind of drugs was prescribed by them; (4)Regarding differential perceived behavioral control, 75.7% of respondents believed the autonomy of prescribing OAD was higher than that for insulin, of which more respondents believed that in prescribing OAD, they were more confident, had more influence over treatment opinion, fewer obstacles, and such obstacles was easier to overcome; (5)The differential attitude of respondents toward prescribing intention was positively related to the sum of the product of differential behavioral beliefs multiplied by outcome evaluations（Σ（b1-b2）ii‧ei). The differential subjective norm of respondents toward prescribing intention was positively related to the sum of the product of differential normative beliefs multiplied by motivations to comply(Σ（nb1-nb2）i‧mc). The differential perceived behavioral control of respondents toward prescribing intention was also positively related to the sum of the product of differential control beliefs (Σ（cb1-cb2）i). These results were also consistent with the theory of planned behavior; (6)According to differential behavioral intention, excluding the 73 neutrals, respondents were divided into insulin-oriented and OAD-oriented group. There were significant differences in differential beliefs between these tow groups. For instance: 1.Regarding differential behavioral beliefs, the insulin-oriented group was more likely to agree insulin was more effective, could decrease the risk of diabetes-related complications, delay the failure of βcell function, decrease the interaction of oral agents, improve insulin resistance, adjust the dosage flexibly, and improve patients’ quality of life. 2.Regarding differential normative beliefs, though both groups felt important referents, ex: hospitals, metabolism specialists, diabetes-related institutions, diabetes educators, and evidenced-based research, support them to prescribe insulin, the insulin-oriented group felt stronger support than the OAD-oriented group. Both groups felt patients support them to prescribe OAD, but the OAD-oriented group felt stronger support than insulin-oriented group. 3.Regarding differential control beliefs, the insulin-oriented group was more likely to agree the occurred-complications would get them to prescribe insulin; (7)The social demographic variables were not correlated with the differential intention to prescribe antidiabetic agents; In addition, (8) In choice intention, 57.0% of respondents intended to choose insulin, and 32.7% intended to choose the 3rd OAD in the next six months.ccording to above results, the conclusion was made: all three of the constructs in the theory — attitude, subjective norm, perceived behavioral control, made significant contributions to predict respondents’ intentions to prescribe antidiabetic agents. Among them, attitude and subjective norm were the main effective variables; For the group with different intentions in prescriptions, there were also significant differences in belief composites that are assumed to determine attitude, subjective norm, and perceived behavioral control. In addition, based on the results, the researcher proposed suggestions to health care and educational institutions.
Subjects
Theory of planned behavior
prescribing intentions
antidiabetic agents
attitude
subjective norm
perceived behavioral control
SDGs
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