Family Practice Advance Access originally published online on February 27, 2008
Family Practice 2008 25(2):98-104; doi:10.1093/fampra/cmn008
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Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model—a randomized controlled study
a Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
b Educational Development Centre
c Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
d Department of Psychiatry, University of Toronto, Toronto, Canada
e Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
f Department of Psychiatry, Army University, Tehran, Iran
g Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
h Department of Applied Sciences of Education, University of Helsinki, Helsinki, Finland
i Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden
Correspondence to Mandana Shirazi, Division of International Health (IHCAR), Karolinska Institutet, Nobels vag 9, SE-171 77 Stockholm, Sweden; Email: mandana.shirazi{at}ki.se
Received 3 September 2007; Revised 30 December 2007; Accepted 18 January 2008.
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Abstract |
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Background. The Prochaska model of readiness to change has been proposed to be used in educational interventions to improve medical care.
Objective. To evaluate the impact on readiness to change of an educational intervention on management of depressive disorders based on a modified version of the Prochaska model in comparison with a standard programme of continuing medical education (CME).
Methods: This is a randomized controlled trial within primary care practices in southern Tehran, Iran. The participants included 192 general physicians working in primary care (GPs) were recruited after random selection and randomized to intervention (96) and control (96). Intervention consisted of interactive, learner-centred educational methods in large and small group settings depending on the GPs' stages of readiness to change. Change in stage of readiness to change measured by the modified version of the Prochaska questionnaire was the main outcome measure.
Results. The final number of participants was 78 (81%) in the intervention arm and 81 (84%) in the control arm. Significantly (P < 0.01), more GPs (57/96 = 59% versus 12/96 = 12%) in the intervention group changed to higher stages of readiness to change. The intervention effect was 46% points (P < 0.001) and 50% points (P < 0.001) in the large and small group setting, respectively.
Conclusions. Educational formats that suit different stages of learning can support primary care doctors to reach higher stages of behavioural change in the topic of depressive disorders. Our findings have practical implications for conducting CME programmes in Iran and are possibly also applicable in other parts of the world.
Keywords. Depressive disorders, educational intervention, primary care, randomized controlled trial.
Shirazi M, Zeinaloo AA, Parikh SV, Sadeghi M, Taghva A, Arbabi M, Sabouri Kashani A, Alaeddini F, Lonka K and Wahlström R. Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model—a randomized controlled study. Family Practice 2008; 25: 97–104.