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Journal ArticleDOI

Health and social care professionals' attitudes to interprofessional working and interprofessional education: A literature review.

30 Jan 2016-Journal of Interprofessional Care (Taylor & Francis)-Vol. 30, Iss: 1, pp 42-49
TL;DR: In this article, a review of the literature on attitudes of health and social care staff to interprofessional working and interprofessional education (IPE) was carried out and the main factors found to influence attitudes and the strengths and limitations of these studies were identified.
Abstract: The healthcare setting is a rich learning environment for students to experience interprofessional working (IPW) and interprofessional education (IPE). However, opportunities for IPE are limited, and student experiences of effective IPW are varied. This raises the question of how IPW and IPE are valued by health or social care professionals. A search of the literature was carried out to identify studies of health and social care staff attitudes to IPW and IPE. This review provides a summary of the main factors found to influence attitudes and the strengths and limitations of these studies. Professional background and prior IPE experience were identified as the influencing factors for which there is most evidence. The main limitations of the studies accessed included a focus on the value of IPE for staff, as opposed to students, and a limited number of studies considering the relationship between attitudes to IPW and the value placed on IPE. It is important that health and social care professionals lead by example by working collaboratively and providing students with opportunities for IPE. Identifying the variables influencing attitudes to IPW and IPE may assist in improving IPW and experiences of IPE for students learning in the healthcare setting.

Summary (2 min read)

Introduction

  • The relationship between attitudes and behaviour is considered within the field of social psychology (Azjen & Fishbein,1977; Bem, 1970; Festinger, 1957).
  • It can be argued that investigating the attitudes of health and social care teams to IPW and IPE, may provide an understanding of the value that is placed on IPW and IPE for students learning in healthcare settings.
  • It is important that these issues are studied directly, within a relevant context, and from the perspective of staff working within these settings.

Methods

  • A systematic search was carried out using The Cochrane Database of Systematic Reviews, Education Resources Information Centre (ERIC), MEDLINE, and the Cumulative Index to Nursing and Allied Health Literature .
  • Relevant papers were also identified from a hand search of the Journal of Interprofessional Care and by interrogating references from relevant papers.
  • As the turn of century was a significant turning point for IPE and IPW (Barr, Helme & D’Avray, 2011), the search focused on literature published between 2000 and 2014 .
  • Table 1 provides a summary of the search strategy, including the inclusion and exclusion criteria.
  • The full texts of relevant studies were accessed and interrogated using Hawker, Payne, Kerr, Hardy, and Powell’s (2002) framework for appraising research and to reviewing IPE studies where mixed methodologies were used (Ireland, Gibb, & West, 2008).

Results

  • A total of 35 studies met the inclusion criteria for this review, and no studies were excluded on the basis of poor quality.
  • Fourteen of these studies included health and social care staff as research participants (Table 2).
  • This review was valuable in identifying two main common themes which included the effect of: professional background on attitudes to IPW and IPE previous experience of IPE on attitudes to IPW and IPE Table 2. 2012 Australia Healthcare IPE & IPW Braithwaite et al.
  • Health & social care IPW Herbert et al.

Effect of Professional Background on Attitudes to IPW and IPE

  • The effect of professional background on attitudes to IPW and IPE, and differences in attitudes among different professional groups was discussed by a number of studies.
  • These studies were carried out in a number of different countries (Table 2), and their findings highlight that although there may be cultural differences across global healthcare teams, professional background may be a common influence on attitudes.
  • The study by Wittenberg-Lyles, Oliver, Demiris, and Regehr (2010) compared health and social care professionals’ perceptions of collaboration from questionnaire responses with their observations of these professionals working together.
  • In two studies in particular, IPE interventions provided during undergraduate training were assessed as a positive influence on attitudes to IPW (Pollard & Miers, 2008; Pollard et al., 2012).

Assessment of the quality of the studies

  • Hawker et al., (2002) described the assessment of methodological rigor as the third and final stage of systematically reviewing research.
  • By using only quantitative methods the researchers’ ability to investigate participants’ responses to questionnaires was restricted.

Discussion

  • Two main common themes where identified in relation to the factors effecting attitudes to IPE and IPW from the 35 eligible studies in this review: the effect of professional background on attitudes to IPW and IPE, and the effect of previous experience of IPE on attitudes to IPW and IPE.
  • Boundaries between professionals impacts on the provision of effective healthcare (Powell & Davies, 2010), and this review highlights the need for further research to investigate how professional boundaries influence attitudes to IPW and IPE.
  • This further reinforces the need for further high quality research to assess the impact of different types of IPE interventions on practice (Reeves et al., 2013).
  • A lack of clarity and understanding around the true concept of IPE and IPW remains in healthcare and education (Reeves, Goldman, Gilbert, Tepper, Silver, Suter and Zwarenstein, 2011) and as reported by Egan-Lee et al., (2006), experience of facilitating IPE can assist with providing this clarity.
  • Two main limitations are noted in relation to the search strategy employed in this review.

Concluding comments

  • There is limited evidence related to staff attitudes to IPW and the value placed on IPE for students learning in healthcare setting.
  • In relation to all of the studies reviewed, professional background and prior experience of IPE were identified as two of the main factors effecting attitudes to IPW or IPE.
  • Other possible influencing factors such as age, gender, professional experience and income were considered in some of the studies, although the strength of these correlations were varied and inconsistent.
  • Health and social care staff play a primary role in ensuring the provision of safe, quality care to patients and carers.
  • It is important that this research is carried out within a relevant context and that the chosen research design suits this context.

Declaration of interest

  • The authors report no declarations of interest.
  • The authors were responsible for the writing and content of this paper.

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Health and social care professionals attitudes to interprofessional working
and interprofessional education: A literature review
Abstract
The healthcare setting is a rich learning environment for students to experience
interprofessional working (IPW) and interprofessional education (IPE). However,
opportunities for IPE are limited, and student experiences of effective IPW are
varied. This raises the question of how IPW and IPE are valued by health or social
care professionals. A search of the literature was carried out to identify studies of
health and social care staff attitudes to IPW and IPE. This review provides a
summary of the main factors found to influence attitudes and the strengths and
limitations of these studies. Professional background and prior IPE experience were
identified as the influencing factors for which there is most evidence. The main
limitations of the studies accessed included a focus on the value of IPE for staff, as
opposed to students, and a limited number of studies considering the relationship
between attitudes to IPW and the value placed on IPE. It is important that health
and social care professionals lead by example by working collaboratively and
providing students with opportunities for IPE. Identifying the variables influencing
attitudes to IPW and IPE may assist in improving IPW and experiences of IPE for
students learning in the healthcare setting.

1
Introduction
The integration of health and social care in the United Kingdom (Health and
Social Care Act, 2012) is one of the most recent drivers for effective interprofessional
working (IPW) and for providing students with opportunities for interprofessional
education (IPE; Barr & Low, 2013; General Medical Council, 2009; Health and Social
Care Professions Council, 2009; Nursing and Midwifery Council, 2010; World Health
Organisation, 2010). This integration combines the services of health boards and
local councils to reduce the numbers of unecessary admissions to hospitals by
providing a more coordinated, cost effective approach to the provision of quality
health and social care. Integration has implications for the way that health and social
care teams collaborate and effective IPW is key to its success (Association of the
Directors of Social Work, 2013).
Although further high quality research is required to support the impact of IPE
and IPW on patient care (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013;
Zwarenstein, Goldman, & Reeves, 2009), previous inquiries have highlighted the
impact that ineffective IPW can have on patient safety (Kennedy, 2001; Laming,
2003). Twelve years after the Bristol Infirmary Heart Inquiry (Kennedy, 2001), the
Mid Staffordshire Report (Francis, 2013) highlighted that little progress had been
made in changing the damaging, target driven culture of the health service. Francis
(2013) recommended that this culture needed to change to put the patient first.
Time pressures, limited resources, lack of understanding of roles and
responsibilities, competing priorities, and access to other professionals prevent
effective IPW between professional groups (Bailey, Jones, & Way, 2006; Braithwaite
et al., 2012; Hughes & McCann, 2003; Kvarnström, 2008; Larkin & Callaghan, 2005;

2
Snelgrove & Hughes, 2000). Healthcare teams are capable of improvising and
developing strategies to work around such barriers (Baxter & Brumfit, 2008; Lingard
et al., 2012). However, ineffective IPW continues to affect the quality of care
provided by health and social care teams (Laming, 2003).
As part of the practice placement agreements between health boards and
higher education institutes, health and social care students spend a proportion of
time learning within healthcare settings. Francis (2013) highlighted how vital it is that
students are exposed to positive experiences in these settings:
Good practical training should only be given where there is good clinical care.
Absence of care to that standard will mean that training is deficient. Therefore,
there is an inextricable link between the two that no organisation responsible
for the provision, supervision or regulation of education can properly ignore
(p.60).
Effective IPW is essential for maintaining quality care and improving
patient safety (Francis, 2013; Gordon, 2012; Laming, 2003; The Joint Commission,
2013). The healthcare setting can be an invaluable opportunity to learn with students
from other professions and to gain first-hand experience of how health and social
care teams work (OCarroll, Braid, Ker, & Jackson 2012; OCarroll, Smith, Collinson,
Jackson, & Ker, 2013). However, opportunities for IPE and students
experiences of IPW within the healthcare setting can be varied and limited (Pollard,
Miers, & Rickaby, 2012; Stew, 2005). The logistical difficulties of coordinating
student timetables, negative attitudes and uncertainty of the value of IPE have been
identified as reasons why support for IPE within the academic setting falters (Curran,
Sharpe & Forristall, 2007; Freeth, Hammick, Reeves, Koppel, & Barr, 2005; Rees &
Johnson, 2007). These are challenges that have been identified within the
academic setting, but it is possible that similar ambivalent attitudes exist with the
healthcare setting.

3
The relationship between attitudes and behaviour is considered within the
field of social psychology (Azjen & Fishbein,1977; Bem, 1970; Festinger, 1957).
Kraus (1995) argued that there is significant evidence that attitudes can predict
behaviour. It can be argued that investigating the attitudes of health and social care
teams to IPW and IPE, may provide an understanding of the value that is placed on
IPW and IPE for students learning in healthcare settings. It is important that these
issues are studied directly, within a relevant context, and from the perspective of
staff working within these settings. This literature review provides a summary and
critique of the existing literature related to two main constructs:
The attitudes of health and social care professionals, working in healthcare
settings, to IPW
The attitudes of health and social care professionals, working in healthcare
settings, to IPE for students
Methods
A systematic search was carried out using The Cochrane Database of
Systematic Reviews, Education Resources Information Centre (ERIC), MEDLINE,
and the Cumulative Index to Nursing and Allied Health Literature (CINAHL).
Relevant papers were also identified from a hand search of the Journal of
Interprofessional Care and by interrogating references from relevant papers. As the
turn of century was a significant turning point for IPE and IPW (Barr, Helme &
DAvray, 2011), the search focused on literature published between 2000 and 2014 .
Table 1 provides a summary of the search strategy, including the inclusion and
exclusion criteria. The terms interprofessional, multidisciplinary,’ and
interdisciplinary were used in combination with the following key words; learning,

4
education, working, collaboration, attitudes, staff and healthcare. Boolean operators
and truncations were used to allow for variability of terms adopted in the literature.
Table 1. Summary of search strategy
Figure 1 reports on the number of studies included and excluded at different
phases of the literature search. On initial identification and screening of titles and
abstracts, 59 papers met the inclusion criteria. Thirty five studies were selected after
excluding the following: studies within the context of an academic setting; student
attitudes to IPW and IPE; and the attitudes of only one professional group.
Inclusion criteria
Exclusion criteria
Studies measuring and comparing health and
social work staff attitudes within hospital and
community healthcare environment to IPE and
IPW
Studies using quantitative, qualitative or mixed
methods
Year 2000 to 2014
Published in peer reviewed journals
Studies written in the English language
Students’ attitudes (only) to IPE and
IPW
Academic staff attitudes (only) to IPE
and IPW
Studies exploring the attitudes of only
one professional group
Editorials
Descriptive articles
Opinion pieces
Search terms Key words
Interprofessional/multidisciplinary/interdisciplinary
learn* and attitude$1
Interprofessional/multidisciplinary/interdisciplinary
learn* and attitude$1 and staff
Interprofessional/multidisciplinary/interdisciplinary
education and attitude$1 and
staff
Interprofessional/multidisciplinary/interdisciplinary
work*and attitude$1
Interprofessional/multidisciplinary/interdisciplinary
work* and healthcare
Interprofessional/multidisciplinary/interdisciplinary
collaboration and healthcare

Citations
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Journal ArticleDOI

260 citations

Journal ArticleDOI
TL;DR: A positive association emerged between professional identification and shared leadership in that participants who expressed the strongest level of profession identification also reported the greatest agreement with shared leadership.
Abstract: Despite the proposed benefits of applying shared and distributed leadership models in healthcare, few studies have explored the leadership beliefs of clinicians and ascertained whether differences exist between professions. The current article aims to address these gaps and, additionally, examine whether clinicians' leadership beliefs are associated with the strength of their professional and team identifications. An online survey was responded to by 229 healthcare workers from community interprofessional teams in mental health settings across the East of England. No differences emerged between professional groups in their leadership beliefs; all professions reported a high level of agreement with shared leadership. A positive association emerged between professional identification and shared leadership in that participants who expressed the strongest level of profession identification also reported the greatest agreement with shared leadership. The same association was demonstrated for team identification and shared leadership. The findings highlight the important link between group identification and leadership beliefs, suggesting that strategies that promote strong professional and team identifications in interprofessional teams are likely to be conducive to clinicians supporting principles of shared leadership. Future research is needed to strengthen this link and examine the leadership practices of healthcare workers.

24 citations

DissertationDOI
16 Jun 2019
TL;DR: In this paper, a case study of a module in interprofessional education (IPE) taught at a Higher Education Institution has been conducted to examine the potential within the module to identify new ideas for health and social care educators to consider in this challenging area of curricula as IPE remains a core element of the curricula of contemporary health education programs in Higher Education Institutions.
Abstract: The focus of this thesis is a module in interprofessional education (IPE) taught at a Higher Education Institution. The objective is to examine the potential within the module to identify new ideas for health and social care educators to consider in this challenging area of curricula as IPE remains a core element of the curricula of contemporary health and social care programmes in Higher Education Institutions. The rationale for the study is that the concept of attitudes in IPE has not previously been fully explored; it has often been suggested that IPE focuses on developing students’ knowledge, beliefs and attitudes but it could be thought that ‘attitudes’ have been recurrently used in very general terms, perhaps without conscious attention. The concepts of ‘attitudes’ and ‘collaboration’ are dual foci that have been used as lenses with which to examine the data. The study evolved from an ontological stance that any reality is based on a range of perceptions, and that with specific regard to IPE, consideration of the range of perceptions across the breadth of those involved is fundamental. As a practitioner, experienced in both healthcare and education, taking only my perceptions of IPE into account was insufficient to allow me to conduct credible research, an aim of which was to gain a greater understanding. The operational demands of being an IPE module leader are significant and inform the study throughout. Although the size of the student cohort is very large, the primary challenge is in the diversity of the group, as students from twelve different health and social care professions enrol on the module. Timetabling constraints also impact on the way the module is taught. Two unresolved challenges were identified. The first was the requirement to make the module as effective as possible for both staff and students. The second was the polarised feedback received from the student cohort against the background of the National Student Survey (NSS) as an influential driver in higher education. The research methodology employed has focused on a case study approach in the belief that such an organisational strategy is in concordance with inquiry into an acknowledged complex area of health and social care curricula. This is consistent with my epistemological and ontological stance that peoples’ day to day reality is based on a range of perceptions. The approach has enabled the use of my own knowledge and perceptions as carefully acknowledged influences. Although the research could have been conducted with a single cohort, the demands of leading this module had the consequence that it was not possible to collect all the data within a single semester. Another relevant rationale was the desire to develop the research iteratively, using previous findings to inform the future direction. Therefore, the case study encompassed successive cohorts over the study period. The initial tranche of data was collected using two questionnaires that enabled a greater understanding of the students’ perceptions of the module. The quantitative data collected was a useful initial foundation on which to build the case study. Analysis of the questionnaire data using descriptive statistics suggested that there was evidence of a need to influence students’ attitudes towards both other professions and collaboration The second element of data collection was based on a drawing activity on the topic of stereotypes and was designed to give some insight into students’ implicit attitudes towards other professions, and therefore to collaboration across professional boundaries. A content analysis approach was adopted whereby categorisation and creation of numerical data reduced the complexity of the images. It was evident that students were categorising professions, some with values-based assumptions. The objective of the third element of data collection was to investigate whether patient narratives had an influence on the students’ attitudes towards collaboration. The method of analysis encompassed features of discourse analysis with a detailed examination of the language used. Results demonstrated that the service user should be an integral part and equal partner in teaching and therefore scrutiny of the impact is both timely and an imperative. To this point the data collection methods had not yet afforded the opportunity for dialogue with either students or members of the teaching team and so, using purposive sampling, focus groups were conducted with staff and students. A model of thematic analysis was used and differing contexts and understandings of key concepts, such as collaboration became evident. Staff and student anxieties, with respect to both IPE and collaborative working, were identified as probable influences on the IPE module. The final aspect of data collection was individual interviews with students and the adoption of a purposive sampling method created opportunities for greater dialogue and depth of discussion. Using a content analysis strategy, tensions between students maintaining their own self-esteem and being able to equally value the attributes of other professions became apparent. A further challenge for students was that of finding common ground in mixed professional groups, unless conscious attention was paid to the composition of the groups. In conclusion it seems that the IPE module does influence students’ attitudes towards collaboration. Whilst some students experienced IPE as a positive learning experience the findings also showed that for some students and staff the IPE module proved to be a highly problematic and anxiety laden experience. The study suggests that tailoring aspects and activities of the IPE curriculum to the cognitive, affective and behavioural domains of attitude may ameliorate the variety of student experiences of IPE and therefore improve the potential for increased collaborative behaviours in student health and social care professionals. Acknowledgements and dedication My supervisors, Dr Michele Lloyd, Dr Diane Duncan and Dr Jon Berry have been supportive, encouraging and reliable sources of advice and reassurance throughout. I owe a debt of gratitude to my family, Richard, Adam, Jack and Alice. Throughout, they have been a wonderful presence, having faith in me, spurring me on, supporting me through the challenging times and never giving up. As an expert, my father Dr John Palfrey, has been a constant and constructive source of advice and support. I am grateful to the students and members of the teaching team for their willing contributions and co-operation as without them this work would not have been achievable. Colleagues within my own profession and across the School have been supportive. Professor Hugh Barr was generous in his time and support, with an enjoyable lunch at the Royal Society of Medicine. His endorsement of my work at the ‘All Together Better Health VIII’ conference at Oxford University in September 2016 was very much appreciated. I am dedicating this work to my lovely mum, Dr Ann Palfrey. As a doctor, she understood the challenges in successful collaboration between professions and the impact on patients. She was so proud of this undertaking, and it is so sad that she didn’t live quite long enough to see it completed.

22 citations


Cites background or methods from "Health and social care professional..."

  • ...More recently, a literature review on the topic of attitudes towards IPE similarly briefly explained the link between attitude and behaviour (O’Carroll et al., 2016)....

    [...]

  • ...18 recognised that such studies generally restricted the discussion to the impact of IPE on students’ attitudes, rather than extending the inquiry into potential mechanisms of how any recorded attitude change occurred, although more recently there has been some exploration of the cognitive, emotional and behavioural elements of attitudes (Gould et al., 2017; O’Carroll et al., 2016; Domac et al., 2015)....

    [...]

  • ...…rather than extending the inquiry into potential mechanisms of how any recorded attitude change occurred, although more recently there has been some exploration of the cognitive, emotional and behavioural elements of attitudes (Gould et al., 2017; O’Carroll et al., 2016; Domac et al., 2015)....

    [...]

  • ...During the process of constructing the questionnaire for this study, and considering the implications of the results, a broad selection of articles using, or reviewing, such instruments had been studied (O’Carroll et al., 2016; Kururi et al., 2014; Hayashi et al., 2012; Ateah et al., 2011; Hojat et al, 2015; Hammick et al., 2007; Mc Fayden et al., 2007; Lindqvist et al., 2005; Mc Fayden et al., 2005; Tunstall-Pedoe et al., 2003; Bronstein, 2002)....

    [...]

  • ...I identified that although a questionnaire would not facilitate a detailed level of understanding, it might provide some initial quantitative data (O’Carroll et al., 2016)....

    [...]

Journal ArticleDOI
TL;DR: A review of 22 published evaluations which examined domestic abuse interventions across the UK was conducted in November 2016 as discussed by the authors, with the main aim of the review was to identify emerging good practise in multi-agency early intervention; thus, to be eligible for inclusion in the review, projects were multi-agent in nature and aimed to intervene early.

17 citations

Journal ArticleDOI
TL;DR: Results of a baseline survey on attitudes and preferences for IPE among first-year students in medicine and nursing, as well as among chief physicians, nurse directors, and administrative directors at the associated university hospital are presented.
Abstract: In order to enhance patient outcome and patient safety in healthcare, interprofessional education (IPE) has over the years become a specific area of interest focusing on teaching concepts, research methods, and implementation strategies. To achieve commitment and positive attitudes as part of the institutional readiness towards IPE, the adoption of change management aspects can support its early implementation. This short report presents results of a baseline survey on attitudes and preferences for IPE among first-year students in medicine and nursing, as well as among chief physicians, nurse directors, and administrative directors at the associated university hospital. For the survey, the UWE-IP (University of the West of England Interprofessional Questionnaire) was used along with ten customised questions. Overall, a high degree of approval for IPE was observed in all participants. Furthermore, participants showed positive attitudes in three of the four UWE-IP subscales. However, neutral to nega...

17 citations


Cites result from "Health and social care professional..."

  • ...These findings are similar to results observed in previous studies, showing that physicians have more negative attitudes towards IPE than other health professionals (O’Carroll et al., 2016)....

    [...]

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TL;DR: The QUOROM Statement (QUality Of Reporting Of Meta-analyses) as mentioned in this paper was developed to address the suboptimal reporting of systematic reviews and meta-analysis of randomized controlled trials.
Abstract: Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field,1,2 and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research,3 and some health care journals are moving in this direction.4 As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in 4 leading medical journals in 1985 and 1986 and found that none met all 8 explicit scientific criteria, such as a quality assessment of included studies.5 In 1987, Sacks and colleagues6 evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in 6 domains. Reporting was generally poor; between 1 and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement.7 In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials.8 In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1 Conceptual issues in the evolution from QUOROM to PRISMA

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TL;DR: In this article, an intensive study of case study research methods is presented, focusing on the Unique Case Research Questions and the Nature of Qualitative Research Data Gathering Analysis and Interpretation Case Researcher Roles Triangulation.
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  • ...(2011) adds to the body of research and builds on the findings from other studies within the field (Stake, 2005; Yin, 2003), investigating a number of different departments and using quantitative and qualitative methods of data collection is essential if the working environment is to be investigated as a variable....

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Frequently Asked Questions (8)
Q1. What were the main factors that were considered as influences on attitudes?

Questionnaires provided data for statistical analysis, which was valuable in measuring influences on attitudes, such as professional background. 

This integration combines the services of health boards and local councils to reduce the numbers of unecessary admissions to hospitals by providing a more coordinated, cost effective approach to the provision of quality health and social care. 

These studies highlighted that prior uncertainties, doubt and ambiguity related to the value of IPE for students, decreased once staff experienced IPE as a facilitator. 

These findings suggest that a greater sense of professional identity and professional culture as well as a lack of understanding of roles and responsibilties may influences attitudes to IPW and IPE. 

As qualified healthcare professionals, staff with experience of IPE in their pre-qualifying training felt more prepared for IPW and had increased self-awareness of positioning in a team, compared to those without prior IPE experience (Pollard & Miers, 2008). 

The effects of othervariables such as professional experience, income, job satisfaction, gender on attitudes were considered briefly by some researchers. 

The differences in attitudes between regions and locality of hospitals was also considered as a possible influence on attitudes, although researchers acknowledged that this relationship would need to be further explored (Jové et al., 2014). 

Other possible influencing factors such as age, gender, professionalexperience and income were considered in some of the studies, although the strength of these correlations were varied and inconsistent.