Increasing Physician Involvement in Cholesterol-Lowering Practices: the Role of Knowledge, Attitudes and Perceptions

Summary

The study evaluated a multifaceted educational intervention systematically designed to increase physician involvement in cholesterol-lowering practices. We hypothesized that knowledge, perceptions and behaviours would be enhanced in participating physicians, compared with controls. Method: Fifty-one family physicians were assigned randomly to three groups; the two experimental groups attended a training workshop, received physician and patient education materials and ongoing consultant support. One experimental group also received a “cueing ” intervention. The control group received no interventions. Outcome measures included knowledge and attitude scores, self-efficacy perceptions, physician dietary counselling behaviour, and patient serum lipid levels. Measures were taken at pretest, 6 weeks and 15 months later. Results: Intervention group physicians achieved significantly higher knowledge scores than the control group at the six-week test; the differences disappeared at 15 months. Attitudes, self-reported practices and overall self-efficacy scores were similar across groups. Within group variation was highly significant. In contrast, physician dietary counselling scores were significantly higher in their intervention groups (p=.0001) and patients of physicians in those groups demonstrated significantly greater LDL lowering (p=. 02). Some associations were seen among knowledge, attitude, self-efficacy and dietary counselling scores. Conclusion: Physician behaviour change may not be entirely dependent upon knowledge, attitudes and perceptions.