Background: Doctors' health is imperative for competent practice. Although evidence-based medicine advocates a biopsychosocial approach in patient-centred care, there is minimal attention to the biopsychosocial determinants of doctors' competence or health behaviour interventions targeted at augmenting competence. Dehydration can impair cognition; therefore, this research examined hydration as a buffer for competent practice. Aims: This thesis implemented a biopsychosocial approach to conceptualise doctor competence and established the potential of mechanisms of change in an examination of hydration as a dynamic biological buffer to augment competence. Methods: This thesis applied a structured, triphasic design of 'Conceptualisation', 'Examination', and 'Implementation' to investigate hydration as a modifiable factor influencing doctors' competent practice. It comprised four empirical studies: (1) an organisational case study, (2) an observational study, (3) a qualitative interview study, and (4) a mixed-method feasibility trial. These were underpinned by three non-empirical components: (1) a theoretical literature review, (2) a systematic review of competence measures, and (3) intervention development grounded in behavioural science. Furthermore, this thesis examined the contextual significance of this research during a pandemic. Results: Phase One found that multidimensional factors affect competence and proposed a multi-factor framework for conceptualisation and measurement. Phase Two identified that on shift dehydration was typical in doctors, with adverse effects on competence; the bidirectional mechanisms were qualitatively identified through adapted health psychology models as frameworks for behavioural examination. Phase Three specified health-protective mechanisms of change for targeted occupationally relevant interventions to promote fluid intake; these evidenced health-promotive effects. Conclusions: This research highlights the impact of systemic context and the responsibility of senior staff for imparting ethos and identity through their modelling of health behaviour. Transdisciplinary recommendations are proposed to address the interrelationships between competence and on-shift health-protective behaviour.
Kirsty Louise Hodgson (Thu,) studied this question.