Predicting Clinical Practice Guideline Utilization Among Chemical Dependency Professionals

Thomas Davis
University of Washington, Seattle
5730 38th Ave NE
Seattle WA 98105
206-729-5233
tomdavis@u.washington.edu
Purpose:  Recent strides in substance abuse treatment have led to the development of clinical practice guidelines (CPGs) for the treatment of individuals with substance abuse disorders. One such CPG recommendation is that chemical dependency professionals (CDPs) use a non-confrontational counseling approach to address client denial.  Because CPG utilization research has been atheoretical in nature, the objective of this study was to determine if Ajzen and Fishbein’s Theory of Reasoned Action (TRA) could be used to link CDP antecedent attitudes and normative pressures to probabilities that CDPs will intend to adhere to the CPG recommendation.  Because CDPs who were also social workers were included in this study, there emerges an opportunity to understand how attitudes and beliefs influence decisions among social workers to adhere to a CPG.
 
Methods:  Following TRA protocol, this research will first report findings from 19 CDP interviews designed to capture CDP beliefs and normative pressures in response to the CPG.  Second, this research will report findings from a cross-sectional survey of a 126 CDPs in 10 treatment facilities in Washington State using a theoretically-driven survey instrument designed to predict CDP intention to adhere to the CPG.
 
Results: Correlation analysis revealed that “researchers” (.31**) and “continuing education courses” (.31**) account for nearly 20% of the normative pressures on CDPs to adopt the CPG.  Multiple regression analysis revealed that CDP beliefs (.41**) and normative pressures (.22*) account for nearly one third of the variance in CDP intention to adhere to the CPG.  Independent sample t-tests revealed that CDPs who engage in professional development activities hold more favorable beliefs toward the CPG.
 
Implications for clinical practice:  TRA can be used to predict CPG utilization.  Findings augment RSWPs’ special volume (May 1999) devoted to practice guidelines and clinical social work.