Research article

The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Robbie Foy¹ , Jillian J Francis² , Marie Johnston³ , Martin Eccles¹ , Jan Lecouturier¹ , Claire Bamford¹ and Jeremy Grimshaw⁴

¹Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK

²Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK

³School of Psychology, College of Life Sciences and Medicine, William Guild Building, University of Aberdeen, Aberdeen AB24 2UB, UK

⁴Clinical Epidemiology Program, Ottawa Health Research Institute, 725 Parkdale Avenue, Ottawa ON K1Y 4E9, Canada

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BMC Health Services Research 2007, 7:207doi:10.1186/1472-6963-7-207

Published:	19 December 2007

Abstract

Background

The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work.

Methods

We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors.

Results

The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours.

Conclusion

It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.