Dianne Parker

Making psychological theory useful for implementing evidence based practice: a consensus approach

Background: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. Methods: Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a “psychological theory” group (n = 18), a “health services research” group (n = 13), and a “health psychology” group (n = 30). Results: Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. Conclusions: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.

Driving errors, driving violations and accident involvement

A survey of over 1600 drivers is reported, the results of which are consistent with those reported in an earlier study (Reason et al. 1990), which identified a three-fold typology of aberrant driving behaviours. The first type, lapses, are absent-minded behaviours with consequences mainly for the perpetrator, posing no threat to other road users. The second type, errors, are typically misjudgements and failures of observation that may be hazardous to others. The third type, violations, involve deliberate contraventions of safe driving practice. In the present study the survey instrument used, the Driver Behaviour Questionnaire, was also shown to be reliable over time. Each type of behaviour was found to have different demographic correlates. Most importantly, accident liability was predicted by self-reported tendency to commit violations, but not by tendency to make errors or to have lapses. The implications for road safety are discussed.

The Manchester Driver Behaviour Questionnaire: a cross-cultural study

The aim of the present study was to investigate if the original factorial structure of the Manchester Driver Behaviour Questionnaire (DBQ) was replicated in Finland and The Netherlands. A postal questionnaire survey of drivers was carried out in Britain, Finland and The Netherlands. Exploratory factor analysis together with target (Procrustes) rotation and factorial agreement indexes were calculated to investigate the applicability of Finnish and Dutch versions of DBQ. Results of the factor comparisons showed that the DBQ four-factor structures found in Finland and The Netherlands were congruent but not perfect with the target structure found in Britain. Reliabilities of the scales were around the same level as in the British data. In addition to the four first-order factors, two second-order factors (deliberate violations and unintentional errors) were found in all three countries which supports the original structure by Reason et al. Issues related to cross-cultural use of traffic behaviour questionnaires are discussed.

Are aggressive people aggressive drivers? A study of the relationship between self-reported general aggressiveness, driver anger and aggressive driving.

In this study the relationships among self-reported general aggressiveness, impulsiveness, driver anger, and aggressive responses to anger-provoking situations on the road were studied. The British version of a driver anger scale (UK DAS), aggression questionnaire (AQ), and an impulsiveness questionnaire (I7) together with background questions (gender, age, annual mileage) were administered to a sample of 270 British drivers. Variation in strength of correlations between anger and aggressive reactions in the 21 UK DAS items showed that the relationship between driver anger and aggression depends in part on the characteristics of the situation. In addition, three path models for describing the relationships among the measures were constructed separately for women and men. The models suggested that the effects of verbal aggressiveness on self-reported driver aggression were mediated by driver anger whereas physical aggressiveness was directly related to aggressive behaviour. Age was negatively related to both driver anger and aggression among men whereas annual mileage was negatively related to aggression among women. The models constructed indicate that aggressive driver behaviour is a complex phenomenon with a range of psychological causes.

Attitudinal predictors of interpersonally aggressive violations on the road

Abstract Aggressive driving behaviour was studied using a self-report questionnaire. Respondents were asked about their own behaviour on the road using a version of the Driver Behaviour Questionnaire which contained an extended set of driving violation items. Three violation factors were distinguished, providing support for the findings of Lawton, R., Parker, D., Manstead, A.S.R., and Stradling, S.G. (1997). The role of affect in predicting social behaviours: the case of road traffic violations. Journal of Applied Social Psychology , 27 , 1258–1276). Respondents’ beliefs and attitudes towards two aggressive driving scenarios were measured, using Ajzen’s (1988) theory of planned behaviour model (Ajzen, I. (1988). Attitudes, personality and behavior . Milton Keynes, UK: Open University Press) supplemented by a measure of affective beliefs. In one scenario the driver was described as initiating an aggressive driving episode, and in the other as retaliating to the aggressive driving of another. Beliefs and attitudes in relation to the scenarios were found to be significantly predictive of own self-reported aggressive driving behaviour. It was shown that aggressive driving behaviour was particularly associated with relatively positive (or less negative) beliefs and attitudes in relation to the initiation of an aggressive driving episode.

DIMENSIONS OF DRIVER ANGER, AGGRESSIVE AND HIGHWAY CODE VIOLATIONS AND THEIR MEDIATION BY SAFETY ORIENTATION IN UK DRIVERS

Abstract Aggressive behaviour on the roads is reported to be on the increase. This study administered Driving Anger Scale ( Deffenbacher et al. (1994) . Development of a driving anger scale. Psychological Reports, 74 , 83–91.), the Driver Behaviour Questionnaire, and the Driving Skill Inventory to a sample of 270 British drivers. Factor analysis of the Driving Anger Scale items yielded three factors measuring anger generated by the reckless driving, direct hostility and impeded progress by others—contrary to the six subscales found with the original US sample. Younger drivers and low mileage drivers were more likely to exhibit all three types of driving anger, but no differences between male and female drivers were found. In addition, a driver’s safety orientation predicted (negatively) anger evoked by impeded progress and direct hostility whereas self-assessed perceptual-motor skills were positively related to anger generated by impeded progress. Both Highway Code and aggressive violations were significantly related to the anger factors, and, using the procedure by Baron and Kenny ( Baron & Kenny (1986) . The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51 , 1173–1182.), the prediction of violating behaviour (Driver Behaviour Questionnaire) by reported anger was shown to be mediated by the self-assessed safety skill scale but not the perceptual-motor skill scale (Driver Skill Inventory), and moderated by neither. Implications for driver education countermeasures are noted.

Elderly drivers and their accidents : the Aging Driver Questionnaire

The Manchester Driver Behavior Questionnaire (DBQ) was included as part of a questionnaire survey of 1989 drivers aged 50 or over. Previous research has differentiated three main types of aberrant driver behavior: errors, lapses and violations. Each of these has different psychological origins, and different implications for road safety interventions [Reason et al., 1990. Ergonomics 33, 1315-1312]. It has also been shown that, using a full age-range sample of drivers, reported violations were statistically associated with accident involvement, whereas errors and lapses were not [Parker et al., 1995a. Ergonomics 38, 1036-1048; Parker et al., 1995b. Accident Analysis and Prevention 27, 571-581]. Although factor analysis of the DBQ responses of this sample produced five factors, the original three-way distinction was preserved. However the pattern of relationships between factor scores and accident involvement was different. Relatively high scores on the error factor and the lapse factor were predictive of involvement in an active accident, while passive accident involvement was associated with high scores on the lapse factor.

A social psychological approach to driving violations in two Chinese cities

Abstract A questionnaire study conducted in two Chinese cities investigated the determinants of the respondents’ aberrant driving behaviours. The Chinese Driving Questionnaire (CDQ) was developed and a version of the Manchester Driver Behaviour Questionnaire (DBQ) containing an extended set of driving violations particularly relevant in China was also included. Factor analysis of the DBQ revealed four factors with Alpha values over .60, two of them violations and the other two lapses and errors. Factor analysis of the CDQ items also revealed four factors with Alpha values over .60, namely the sense of social hierarchy, potential road safety countermeasure, belief in interpersonal network, and challenging legitimate authority. The result of a correlation analysis of the DBQ and CDQ scales showed that while the two violation scales were significantly and positively correlated with the social hierarchy and interpersonal network scale, the two lapse and error scales basically were not. When the DBQ scales were regressed on demographic variables and CDQ scales, the results of the hierarchical regressions showed that the prediction of self-reported driving violations had been significantly improved by the addition of culture relevant factors measured in the CDQ, while there was no major change in the prediction of lapses and errors. Logistic regression analysis showed that aggressive violations made a significant contribution to traffic accident involvement, independent of the demographic variables. The present study also identified some potential road safety countermeasures, and suggested young female drivers, and drivers at their early thirties should be especially targeted in road safety campaign.

Patient safety culture in primary care: developing a theoretical framework for practical use

Objective: Great importance has been attached to a culture of safe practice in healthcare organisations, but it has proved difficult to engage frontline staff with this complex concept. The present study aimed to develop and test a framework for making the concept of safety culture meaningful and accessible to managers and frontline staff, and facilitating discussion of ways to improve team/organisational safety culture. Setting: Eight primary care trusts and a sample of their associated general practices in north west England. Methods: In phase 1 a comprehensive review of the literature and a postal survey of experts helped identify the key dimensions of safety culture in primary care. Semistructured interviews with 30 clinicians and managers explored the application of these dimensions to an established theory of organisational maturity. In phase 2 the face validity and utility of the framework was assessed in 33 interviews and 14 focus groups. Results: Nine dimensions were identified through which safety culture is expressed in primary care organisations. Organisational descriptions were developed for how these dimensions might be characterised at five levels of organisational maturity. The resulting framework conceptualises patient safety culture as multidimensional and dynamic, and seems to have a high level of face validity and utility within primary care. It aids clinicians’ and managers’ understanding of the concept of safety culture and promotes discussion within teams about their safety culture maturity. Conclusions: The framework moves the agenda on from rhetoric about the importance of safety culture to a way of understanding why and how the shared values of staff working within a healthcare organisation may be operationalised to create a safe environment for patient care.

Application of the theory of planned behaviour to the prediction of objectively assessed breaking of posted speed limits

In two studies the Theory of Planned Behaviour (TPB) including moral norms, anticipated regret and past behaviour was applied to predicting intention to exceed the posted speed limit across different roads and objectively assessed speeding behaviour. All measures except behaviour were taken by self-report questionnaires referring to different driving scenarios. The behaviour measures were based on performance in a simulator (Study 1) or unobtrusive on-road speed camera assessment taken without driver awareness (Study 2) across roads with varying posted speed limits. Results are reported averaged across road types in both studies. In Study 1 (N=83), 82% of the variance in intentions to speed was explained, with attitudes, subjective norms, perceived behavioural control (PBC), moral norms, anticipated regret and past behaviour being significant predictors. A total of 35% of the variance in speed as assessed on a driving simulator was accounted for with intentions, PBC, moral norms and previous accidents being significant predictors. In Study 2 (N=303), 76% of the variance in intentions to speed was explained with attitudes, moral norms, anticipated regret and past behaviour being significant predictors. A total of 17% of the variance in speed as assessed on-road was accounted for with intentions and moral norms being significant. Practical implications of the findings for road safety are discussed.