A pre-post study of behavioural determinants and practice change in Ugandan Clinical Officers

Background: Understanding the drivers of ‘provider behaviour’ has been highlighted as one of the six domains of behaviour change in strengthening healthcare systems. Objectives: Our study sought to assess changes in healthcare provider behaviour i.e., the use of an ABCDE approach in acute illness management, after participating in a one-day course on the assessment and management of acutely ill patients. Further, 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 one-day training course from pre-course to follow-up one month later. We also measured psychological determinants of behaviour immediately pre- and post- and at one-month follow up. We explored if changes in psychological determinants were associated with change in practice one month later. Results: We found the following: Firstly, the use of the ABCDE approach increased at one-month post-course from a median percentage use of 50% to 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<.05). Finally, there were no other significant associations with practice change or with practice at follow up. Conclusions: We found that change in perceptions of availability of resource was associated with increased use of an ABCDE approach, but evidence was limited due to the pre-post design.