Improving clinician self-efficacy does not increase asthma guideline use by primary care clinicians

Acad Pediatr. Jul-Aug 2012;12(4):312-8. doi: 10.1016/j.acap.2012.04.004. Epub 2012 May 26.


Objective: The purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing).

Methods: A 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy.

Results: At baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (relative rate [RR], 1.34; 95% confidence interval [CI], 1.04-1.72; P = .04) but not treatment plan development (RR, 0.63; 95% CI, 0.29-1.35; P = .23) or anti-inflammatory use (RR, 1.76; 95% CI, 0.92-3.35; P = .09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (P = .01) and more clinicians were in an action stage of change (P = .001) but these changes were not associated with changes in primary or secondary outcomes.

Conclusions: Self-efficacy scores correlated with program use at baseline and increased in the intervention arm, but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Asthma / therapy*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Nurse Practitioners / education
  • Nurse Practitioners / psychology
  • Pediatrics / education
  • Physician Assistants / education
  • Physician Assistants / psychology
  • Physicians, Primary Care / education*
  • Physicians, Primary Care / psychology
  • Quality Improvement
  • Reimbursement, Incentive
  • Self Efficacy*