ORIGINAL ARTICLE Reflective and Automatic Processes in Health Care Professional Behaviour: a Dual Process Model Tested Across Multiple Behaviours Justin Presseau, Ph.D. & Marie Johnston, PhD & Tarja Heponiemi, PhD & Marko Elovainio, PhD & Jill J. Francis, PhD & Martin P. Eccles, MBBS, MD, FMedSci, FRCP & Nick Steen, PhD & Susan Hrisos, MPhil & Elaine Stamp, MMathStat & Jeremy M. Grimshaw, MBChB, PhD, FRCGP, FCAHS & Gillian Hawthorne, MBBCH, PhD, FRCP & Falko F. Sniehotta, PhD # The Society of Behavioral Medicine 2014 Abstract Background Clinicians’ behaviours require deliberate decision-making in complex contexts and may involve both impulsive (automatic) and reflective (motivational and voli- tional) processes. Purpose The purpose of this study was to test a dual process model applied to clinician behaviours in their management of type 2 diabetes. Methods The design used six nested prospective correlational studies. Questionnaires were sent to general practitioners and nurses in 99 UK primary care practices, measuring reflective (intention, action planning and coping planning) and impul- sive (automaticity) predictors for six guideline-recommended behaviours: blood pressure prescribing (N =335), prescribing for glycemic control (N =288), providing diabetes-related education (N =346), providing weight advice (N =417), pro- viding self-management advice (N =332) and examining the feet (N =218). Results Respondent retention was high. A dual process model was supported for prescribing behaviours, weight advice, and examining the feet. A sequential reflective process was sup- ported for blood pressure prescribing, self-management and weight advice, and diabetes-related education. Conclusions Reflective and impulsive processes predict be- haviour. Quality improvement interventions should consider both reflective and impulsive approaches to behaviour change. Keywords Clinician behaviour . Dual process . Diabetes . Motivation . Volition . Automaticity Electronic supplementary material The online version of this article (doi:10.1007/s12160-014-9609-8) contains supplementary material, which is available to authorized users. J. Presseau (*) : M. P. Eccles : N. Steen : S. Hrisos : E. Stamp : G. Hawthorne Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK e-mail: justin.presseau@ncl.ac.uk M. Johnston Institute of Applied Health Sciences, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK T. Heponiemi : M. Elovainio National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland M. Elovainio Institute of Behavioural Sciences, University of Helsinki, P.O Box 9, 00014 Helsinski, Finland J. J. Francis School of Health Sciences, City University London, Northampton Square London EC1V 0HB, UK J. M. Grimshaw Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, The Ottawa Hospital - General Campus, 501 Smyth Road, Box 711, Ottawa, ON K1H 8L6, Canada F. F. Sniehotta Fuse, The UK Clinical Research Collaboration Centre of Excellence in Translational Research in Public Health, Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK ann. behav. med. DOI 10.1007/s12160-014-9609-8