Effect of multiple social norms on physicians' use of clinical practice guidelines on antimicrobials: A structural...

With the improper use of antimicrobials becoming a major public health concern, poor compliance of clinical practice guidelines (CPGs) on antimicrobials is still prominent globally, especially in the less developed regions. Although social norms have received increasing attention as the determinants of physicians' CPG use, most studies set forth only a single level of social norms.

This study aims to investigate the impact of multifaceted social norms on physician' use of CPGs on antimicrobials, and further reveal the temporal effects of social norms.

Based on integration of Theory of Planned Behavior and Theory of Normative Social Behavior, a questionnaire survey was conducted covering social norms at individual level (subjective norms), organizational level (organization criterion) and social level (social identity). Data were collected by multi-stage random sampling from 502 physicians in secondary and tertiary general hospitals in central-western China. Structural equation model (SEM) and was multi-group SEM used to link the three-level factors with physician's behavior.

This study found that subjective norms, organization criterion and social identity were linked to higher behavioral intentions (β = 0.212, p < 0.001; β = 0.254, P < 0.001; β = 0.212, P < 0.001). The indirect effects of subjective norms, organizational criterion and social identity on behavioral intentions were 0.162, 0.033 and 0.075, and the direct effect of behavioral intentions on physicians' practice was 0.822. And the effects of organization criterion and social identity on behavior were moderated by the professional title, and regarding effects would be weakened with the rise of professional title.

These findings will not only help tailor pertinent social intervention strategies to expand the use of CPGs on antimicrobials, especially for the less developed regions, but also provide clues for future research about the impact mechanism of multiple social norms on physicians' adoption behavior of certain health services or products.