Effect of attitudes and subjective norms on intention to provide oral care to patients receiving antineoplastic chemotherapy

Analysing the effect of resilience and perceived social environment on university students' intention to start sustainable ventures

The literature mostly has addressed the determinants of entrepreneurial intention in general and social entrepreneurship, without focusing specifically on sustainable entrepreneurial intention despite it has become highly relevant in addressing environmental degradation and social challenges. This study aims to contributes to the understanding of psychological and social factors that influence sustainable business, evaluating the effect of resilience, subjective norms, and perceived social support on sustainable entrepreneurial intention. We analysed the online survey responses of 433 students from Chile and Ecuador enrolled in business and engineering programs using Partial Least Squares Structural Equation Models (PLS-SEM), moreover, a multi-group analysis (MGA) has been conducted to assess gender differences. The findings have supported the positive effect of psychological resilience and subjective norms on perceived social support, besides, an important effect of social support on sustainable entrepreneurial intention was found. These results offer new evidence regarding the significance of the social environment, support networks, and resilience of university students in fostering the establishment of sustainable businesses with a focus on social well-being and environmental protection in Latin America. This is particularly pertinent as the countries in this region are grappling with social and environmental challenges that could be addressed through sustainable entrepreneurship.

Factors influencing oral care in intubated intensive care patients

BACKGROUND

The practice of oral care in intensive care settings remains inconsistent among intubated patients, yet these patients are at high risk of developing ventilator-associated pneumonia. Therefore, it is important to adopt safe professional behaviour based on clinical practice guidelines. This study was based on Ajzen's (1985) theory of planned behavior, a conceptual framework that allows a better understanding of how internal and external factors influence behaviour adoption.

AIMS AND OBJECTIVES

To study influential factors in how nurses practice oral care with intubated clients in intensive care settings, referring to the theory of planned behavior (TPB) constructs.

DESIGN

A cross-sectional descriptive correlational design was conducted through a provincial postal survey in Quebec, Canada.

METHODS

A questionnaire was completed by 375 nurses working in intensive care units (ICUs).

RESULTS

Perceived behavioural control and attitude were the most important determinants in the level of intention to engage in oral care. Knowledge, available human and material resources, and number of years of experience in critical care nursing also seemed to be significant influencing factors.

CONCLUSIONS

This study improved our understanding of the factors influencing the practice of oral care in intubated patients in the ICU, relying on TPB as an explanatory framework. It would be important to continue to study this professional behaviour and to work in collaboration with health care facilities to promote the importance of oral care as an imperative for the safety and quality of health care.

RELEVANCE TO CLINICAL PRACTICE

The results of this study represent a solid foundation for advancing continuing education programmes and intensive care orientation programmes tailored to the needs of nurses.

Correlates of attitudes and perceived behavioural control towards oral care provision among trained and untrained nursing home caregivers in Singapore

AIMS AND OBJECTIVES

To investigate the perspectives of nursing home caregivers towards oral care and the determinants of their attitudes and perceived behavioural control.

BACKGROUND

There are few studies analysing nursing home caregivers' perspectives on the provision of oral care and factors correlated with these perspectives.

DESIGN

Cross-sectional study.

METHODS

Interviewer-administered survey questionnaires were completed by caregivers from five nursing homes in Singapore (n = 94). The rating-scale questionnaire items explored caregivers' attitudes, subjective norms and perceived behavioural control, as guided by the theory of planned behaviour. Demographic characteristics, oral care training received, years of work experience, oral hygiene behaviour and dental visit frequency of the caregivers, as well as organisational characteristics such as a requirement for oral care and the number of patients under their care, were obtained.

RESULTS

Caregivers had very positive attitudes towards the provision of oral care. Half of the caregivers lacked confidence in providing oral care without harming the patients and this was not different by oral care training received. Multivariable linear regression analysis found that receiving oral care training and having a requirement by the nursing home to provide oral care were related to higher attitude scores but not perceived behaviour control. Having more residents under their care and on-the-job caregiver training were associated with lower perceived behavioural control.

CONCLUSIONS

This study found that nursing home caregivers had positive attitudes towards providing oral care, but more modest perspectives about their ability to perform that behaviour.

RELEVANCE TO CLINICAL PRACTICE

These findings have useful implications for the oral care training of nursing home caregivers. While attitudes towards the importance of oral care may be positive among nursing home caregivers, our study suggests that future interventions should include practical skills training for oral care management and consider organisational strategies for encouraging oral care provision.

Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions

BACKGROUND

Decision-makers in organizations providing continuing professional development (CPD) have identified the need for routine assessment of its impact on practice. We sought to develop a theory-based instrument for evaluating the impact of CPD activities on health professionals' clinical behavioral intentions.

METHODS AND FINDINGS

Our multipronged study had four phases. 1) We systematically reviewed the literature for instruments that used socio-cognitive theories to assess healthcare professionals' clinically-oriented behavioral intentions and/or behaviors; we extracted items relating to the theoretical constructs of an integrated model of healthcare professionals' behaviors and removed duplicates. 2) A committee of researchers and CPD decision-makers selected a pool of items relevant to CPD. 3) An international group of experts (n = 70) reached consensus on the most relevant items using electronic Delphi surveys. 4) We created a preliminary instrument with the items found most relevant and assessed its factorial validity, internal consistency and reliability (weighted kappa) over a two-week period among 138 physicians attending a CPD activity. Out of 72 potentially relevant instruments, 47 were analyzed. Of the 1218 items extracted from these, 16% were discarded as improperly phrased and 70% discarded as duplicates. Mapping the remaining items onto the constructs of the integrated model of healthcare professionals' behaviors yielded a minimum of 18 and a maximum of 275 items per construct. The partnership committee retained 61 items covering all seven constructs. Two iterations of the Delphi process produced consensus on a provisional 40-item questionnaire. Exploratory factorial analysis following test-retest resulted in a 12-item questionnaire. Cronbach's coefficients for the constructs varied from 0.77 to 0.85.

CONCLUSION

A 12-item theory-based instrument for assessing the impact of CPD activities on health professionals' clinical behavioral intentions showed adequate validity and reliability. Further studies could assess its responsiveness to behavior change following CPD activities and its capacity to predict health professionals' clinical performance.

Perceptions of testicular cancer and testicular self-examination among college men: a report on intention, vulnerability, and promotional material preferences

Testicular self-exam (TSE) is an important tool to prevent late-stage diagnosis of testicular cancer (TC). However, most young men remain unaware of their risk for TC despite a growing number of interventions promoting knowledge and awareness of the disease. Of those interventions, very few discuss perceived vulnerability, perceived value of health promotion, and/or preference for informational materials as viable predictors of behavioral change. In this study, 300 university males were surveyed on their perceptions of vulnerability, perceived value of health promotion methods, TC/TSE knowledge, and preference for health promotional information. The results indicated that men were generally unaware of TC and were unsure of their risk of developing the disease. Participants reported very positive responses to questions about the value of health promotion methods, particularly TSE, and indicated a high intention to perform health promotion behaviors. Most important, participants noted that they preferred personalized, tailored information to learn about TC and TSE. Significant predictors of intention to perform TSE include knowledge and awareness of TC/TSE, perceived value of health promotion, and attitudes. Significant predictors of promotional tool preferences differed among generalized pamphlets, personalized messages, and group training sessions. The authors recommend that researchers tailor promotional messages in TC/TSE awareness campaigns with an individual's preference for promotional tool.

Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories

BACKGROUND

There is an important gap between the implications of clinical research evidence and the routine clinical practice of healthcare professionals. Because individual decisions are often central to adoption of a clinical-related behaviour, more information about the cognitive mechanisms underlying behaviours is needed to improve behaviour change interventions targeting healthcare professionals. The aim of this study was to systematically review the published scientific literature about factors influencing health professionals' behaviours based on social cognitive theories. These theories refer to theories where individual cognitions/thoughts are viewed as processes intervening between observable stimuli and responses in real world situations.

METHODS

We searched psycINFO, MEDLINE, EMBASE, CIHNAL, Index to theses, PROQUEST dissertations and theses and Current Contents for articles published in English only. We included studies that aimed to predict healthcare professionals' intentions and behaviours with a clear specification of relying on a social cognitive theory. Information on percent of explained variance (R(2)) was used to compute the overall frequency-weighted mean R(2) to evaluate the efficacy of prediction in several contexts and according to different methodological aspects. The cognitive factors most consistently associated with prediction of healthcare professionals' intention and behaviours were documented.

RESULTS

Seventy eight studies met the inclusion criteria. Among these studies, 72 provided information on the determinants of intention and 16 prospective studies provided information on the determinants of behaviour. The theory most often used as reference was the Theory of Reasoned Action (TRA) or its extension the Theory of Planned Behaviour (TPB). An overall frequency-weighted mean R(2) of 0.31 was observed for the prediction of behaviour; 0.59 for the prediction of intention. A number of moderators influenced the efficacy of prediction; frequency-weighted mean R(2) varied from 0.001 to 0.58 for behaviour and 0.19 to 0.81 for intention.

CONCLUSION

Our results suggest that the TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention. In addition, given the variations in efficacy of prediction, special care should be given to methodological issues, especially to better define the context of behaviour performance.

[Persuasive communications and regular blood donation: an experimental study]

This study aimed to: investigate yielding to the dependent variable "behavioral intent to become a regular blood donor", verify the impact of such communications on variance in the dependent variable, examine the single contribution of the external independent variable to the Rational Action Theory, and test the fit of the expanded Rational Choice Theory to the target behavior and sample. Only a post-test design and double-blinded procedure were used, randomly picking 405 university students for experimental groups 1 and 2, placebo control, and control only. The results showed: lack of yielding by the experimental groups; considerable percentage variance in the dependent variable explained by the independent variable in the experimental and placebo control groups; and satisfactory and significant correlations for variables in the expanded theory. Absence of yielding for the criterion variable was probably due to the time interval. The positive persuasive strategy accounted for the greatest variance in the dependent variable. Moral obligation showed the greatest impact on participants' intent to perform the behavior. The correlations corroborated the theoretical and methodological validity of the expanded theory.

Comparison of oral health assessments between nursing staff and patients on medical wards

The maintenance of good oral health is essential for nutrition, recovery and well-being. This requires the involvement of the nursing staff, especially in cases where oral care and any necessary dental treatment are vital to ensure medical treatment. The aim of this study was to evaluate the validity of oral assessments performed by nursing staff using the revised oral assessment guide (ROAG), using comparisons with patients' self-assessment of oral problems. When a comparison was made of how the staff and patients assessed their oral status, a high level of agreement was found. In these assessments, with the exception of oral mucosa and teeth, the percentage agreement was >80. The kappa coefficient revealed slight to moderate agreement. When there was a disagreement, the staff assessed the oral health as being significantly poorer than the patients did. In the present study, it was shown that few oral assessments performed by the nursing staff and patient disagreed. The ROAG may therefore be useful for the nursing staff to make the patients' oral health problems visible.

Factors influencing intentions to integrate tobacco education among advanced practice nursing faculty

We report on the findings of a national survey that examined factors that influence faculty's intentions to integrate tobacco education in their advanced practice nursing curricula. The addiction component of tobacco use is taking its toll on the health of 48 million smokers in the United States. Several national health authorities recommend and/or mandate that tobacco prevention and tobacco cessation be addressed at every point of entry in the health care delivery system. However, there is increasing evidence that health care providers may not be adequately prepared to meet national goals and/or standards. One hundred sixty-one advanced practice nursing faculty in the United States completed an 88-item survey regarding external factors (e.g., personal history of tobacco use, clinical practice, and current tobacco topics taught) and components of the Theory of Reasoned Action model (including perceived self-efficacy, behavioral beliefs, subjective norms, and control beliefs related to tobacco education). Descriptive statistics, chi(2) analysis, Pearson correlation, and linear regression were used to analyze the data. The findings revealed that sex (chi(2) = 7.949, P = .024), level of education (chi(2) = 26.853, P = .0005), years of academic teaching (chi(2) = 19.418, P = .013), and combined clinical and course responsibility (chi(2) = 10.430, P = .0236) were significant external (demographic) factors and that behavioral beliefs (attitude about tobacco education) demonstrated the strongest relationship with intention scores (r = 0.876, P < .0005). Overall, 62.7% of nurse practitioners reported high scores (>or=5, on a scale of 1-7) for intentions to integrate tobacco education, as compared with 37.5% of nurse midwives, 30.3% of clinical nurse specialists, and 8.7% of nurse anesthetists. This study adds to the growing body of evidence that nursing curricular gaps with tobacco education exist and that national efforts are needed to ensure that widespread changes occur to help reduce the morbidity and mortality related to tobacco use.

Evaluation of a developmental care training programme for neonatal nurses

Although the impact of developmental care on premature infants has been investigated at length, often the issue of professional development and training related to this type of care has not been examined. The aim of the present study was to evaluate the impact of a developmental care training programme on nurses' behaviours and cognitive attributes with regard to the prevention of overstimulation of premature infants. The Theory of Reasoned Action (TRA) was the framework underlying the study. This programme evaluation used a quasi-experimental one group pre-test/post-test design. Participants were nurses working in a neonatal intensive care unit. Data were collected by self-administered questionnaires. Significantly higher post-test scores were observed for knowledge and for a variety of theoretical constructs. The results of this study showed the potential of such training programmes to help nurses implement developmental care.

Factors affecting quality of oral care in intensive care units

AIMS

This paper presents a study to assess to nurses' attitudes and practices concerning oral care and to determine predictors of the quality of oral care in intensive care units.

BACKGROUND

The oropharynx of critically ill patients becomes colonized with potential respiratory pathogens; oral care has been shown to reduce oropharyngeal bacteria and ventilator-associated pneumonia.

METHODS

In April 2002, a random and national sample of 420 intensive care unit directors was asked to participate in the survey. Of invited directors, 126 (30%) agreed to participate and were sent questionnaires to be completed anonymously by their staff, and 102 institutions returned 556 surveys. This gave a response rate of 83% of those who consented to participate.

RESULTS

The path model shows that nurses' oral care education, having sufficient time to provide care, prioritizing oral care, and not viewing oral care as unpleasant had direct effects on the quality of provided care. Intensive care unit experience, oral care education, and having sufficient time had indirect effects.

CONCLUSION

Improving the quality of oral care in intensive care units is a multi-layered task. Reinforcing proper oral care in education programmes, de-sensitizing nurses to the often-perceived unpleasantness of cleaning oral cavities, and working with hospital managers to allow sufficient time to attend to oral care are recommended.

Oral health care education and its effect on caregivers' knowledge and attitudes: a randomised controlled trial

OBJECTIVES

The effect of an oral health care education programme (OHCE) upon nursing home caregivers was assessed in a randomised controlled trial.

METHODS

A self-administered questionnaire assessed oral health care knowledge and attitudes at baseline among 369 caregivers working in 22 nursing homes. Homes were randomly allocated to two groups. The intervention was a workplace OHCE. Caregivers assessed the value of the presentations. Questionnaires were re-administered 1 month (time 2) and 6 months (time 3) after the OHCE was delivered. The knowledge and attitude score means of the groups were compared. Open-ended questions solicited qualitative data.

RESULTS

Questionnaire response rates at the three time points ranged from 76.3% to 85.4%. Two-thirds of caregivers employed at the time of the intervention attended the presentations. The OHCE was favourably assessed in 79% of responses. The intervention group significantly improved their scores over the control group at times 2 and 3 for knowledge (P<0.003) and attitude (P<0.001). Analysed across both arms at baseline, the main predictors for knowledge and attitude scores were age and dental attendance pattern. Qualitative responses showed an acceptance of caregivers' roles in oral health care and criticism of existing provision within homes.

CONCLUSIONS

The OHCE was well received and resulted in improved oral health care knowledge and attitudes. When viewed with separately reported trial results of clients' oral health status, knowledge and attitude score improvements coincided with improved delivery of oral health care.

Oral care for patients with cancer: a review of the literature

Mouth care is an integral part of nursing practice. However, it has become a ritualistic and banal activity, a topic of conflicting advice and subjective conclusions from sporadic research. Rarely do experts teach it, and it frequently is delegated to the most junior members of the nursing staff. Many cancer treatments result in unavoidable oral toxicity, and the significant prevalence of oral complications in oncology makes mouth care a particular priority for cancer nurses. The confusion and conflict that surrounds best nursing practice in relation to delivering appropriate mouth care should be redressed. This review article details pertinent research to date regarding oral care, with an aim to clarify intervention options, and to identify and promote best nursing practice.

Oral care in cancer nursing

The present study describes the perception of education, self-rated knowledge and attitudes towards oral care, performed oral care and co-operation with dentistry among nurses and enrolled nurses in charge of patients with haematological malignancies, lung cancer and head and neck cancer. A total of 137 nurses and enrolled nurses participated in a semi-structured interview based on a 43-item questionnaire. Nurses had less education in oral care and rated their knowledge on oral care lower than did enrolled nurses. Both groups reported a need for continuing education. Knowledge in oral care was rated to be poorest concerning oral status, oral signs and symptoms and fluorides. Nurses gave out information on oral complications and instruction in oral hygiene to a greater extent and examined the oral cavity more often than did enrolled nurses. A total of 18% felt uncomfortable in discussing oral hygiene with the patients and 45% objected to examining the oral cavity and stated patient integrity as the main reason. A majority reported that they received sufficient help from dentistry. There is a need for continuing education in oral care among nurses and enrolled nurses, which must be a responsibility of and in co-operation with dentistry.

Predicting intentions to obtain a Pap smear among African American and Latina women: testing the theory of planned behavior

OBJECTIVE

To determine the empirical adequacy of the theory of planned behavior (TPB) to explain Pap smear use intentions in African American and Latina women.

METHOD

A correlational design was used, and a convenience sample of 108 African American and 96 Latina adult women were recruited from urban community-based agencies located in a large mid-Atlantic metropolitan area. The Pap Smear Questionnaire (PSQ) was designed and used. The Demographic Assessment Survey collected demographic information (age and socioeconomic status for both groups; and level of acculturation for the Latinas).

RESULTS

Direct relationships between attitude and perceived behavioral control and intention to obtain an annual Pap smear were found for African American and Latina women. The subjective norm did not significantly predict intention. Attitude (beta = .58; p < .001) provided the best explanation of intention among African American women to obtain an annual Pap smear, followed by perceived behavioral control (beta = .30; p < .001). Among Latinas, the findings reflected those of the African American sample. However, attitude (beta = .40; p < .001) and perceived behavioral control (beta = .35; p < .001) were weighted similarly. The external variables of age and income had indirect effects on intention for African American and Latina women, respectively.

CONCLUSION

The study findings did not support the empirical adequacy of the TPB for either of the ethnic groups. Future studies should test a modified version of the TPB that includes measures of both social support and subjective norms. Direct measure items of subjective norm, group-specific measures of perceptions of control, and other measures of acculturation should be added to the PSQ and further tested.

Acute pain reduction strategies used by well older adults

Thirty older adults, without chronic pain, were interviewed about the acute pain reduction strategies that they used at home and strategies that they might use if hospitalized. Verbatim transcripts from the audiotapes were content analyzed. Successful pain reduction strategies included taking a mild analgesic and positioning. If hospitalized, 16 (53.3%) would request analgesics; four (13.3%) would talk with a health care provider; five (16.7%) would continue their own pain reduction strategies; four (13.3%) provided no pain reduction strategies. Results suggest that many older adults possess pain reduction strategies that may be helpful to incorporate in their pain management when hospitalized.