Assessing predictors of intention to prescribe sick leave among primary care physicians using the theory of planned behaviour

Yogarabindranath Swarna Nantha, Lei Hum Wee, Caryn Mei-Hsien Chan

Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians. A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions. The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p < 0.05). Attitudes and subjective norms were identified as important predictors in physician intention to provide sick leave to patients. An integrated behavioural model utilizing the TPB could help fully explain the complex act of providing sickness leave to patients. Findings from this study could assist relevant agencies to facilitate the creation of policies that may help regulate the provision of sickness leave and alleviate the work burden of sickness leave tasks faced by physicians in Malaysia.