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Registered Massage Therapists’ Intention to Use Standardized Outcome Measures Hemsworth, Robert B.


Background: With the emergence of evidence-based practice (EBP) in healthcare, the use of standardized outcome measures (SOMs) has become important for providing credible and reliable treatment justification (Jette, 2009; Fawcett, 2007). However there are concerns that clinical decision-making by registered massage therapists (RMTs) may be based on education, prior experience, and peer opinion, rather than research and scientific evidence (Schroff, 2012; Fawcett, 2007). The theory of planned behavior (TPB) offered a theoretical basis to explain SOM behavior by RMTs and provide behavior change recommendations (Ajzen, 1988; 1991; 2005; 2006). Purpose: This study was framed by the TPB to measure and explain SOM behavior by RMTs. The primary research question was: What are RMTs’ intention to use SOMs? Sub questions were: Which theory-based factors most influence RMTs’ intention to use SOMs? And Which RMT beliefs contribute most to the factors of the TPB? Settings: The massage therapy (MT) profession of British Columbia, Canada. Participants: Members of the Registered Massage Therapists’ Association of British Columbia (RMTBC). Research Design: An anonymous cross-sectional online survey consisting of multiple-choice questions, Likert-type scale and short answers was used. Main Outcome Measures: Multiple regression analysis of nine TPB items reported construct measures of behavior-related attitudes (BA), normative expectations (SN), control perceptions (PBC), and intention (BI). Thematic analysis of text from two open-ended items enabled the reporting of themes within the data. Results: The combination of BA, SN, and PBC significantly explained 78% of the variance in RMTs’ intention to use SOMs [F(3,203)=239.08, p<.001, R²=0.78, R²Adjusted=0.78]. The combination of PBC and BI significantly explained 15% of the variance in SOM behavior [F(2,204)=18.89, P<.001, R²=0.16, R²Adjusted=0.15]. The BA (ß= 1.13, t=17.20, P<.001) and PBC (ß=0.20, t=2.57, P=.01) significantly influenced BI, whereas SN did not (ß=0.04, t=0.55; P=.58). Beliefs about SOM practice benefits and barriers were represented in three themes: behavioral, normative, and control beliefs. RMTs perceive numerous resource and ability-related practice barriers (time; knowledge; access; skills) that weaken control over SOM behavior. Conclusions: Few RMTs acknowledged using SOMs, even though most held positive intention towards doing so. RMTs’ intention to perform SOMs was significantly explained by behavior-related attitudes, norms, and perceptions of control. Attitudes and perceptions of control most influenced behavioral intention, indicating that RMTs with favorable attitudes are more likely to perform SOMs, and less likely to do so when a perceived lack of control exists. Despite holding favorable attitudes and positive intention, RMTs perceive numerous resource and ability-related practice barriers that weaken control over SOM behavior. Future interventions should address time, knowledge, access, and skills required to perform SOMs in MT. More research is needed to better understand SOM behavior by RMTs and further promote SOM uptake and sustained use in MT.

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