Influence mechanism of social norms on prescribing behavior for chronic hepatitis B and its variation between different prescriber subgroups

Despite evidence-based guidelines outlining rational prescription behaviors for chronic hepatitis B(CHB), irrational prescriptions persist. Since interventions grounded in social norms have been widely acknowledged for their pivotal role, the specific mechanisms through which these norms influence prescribing behavior warrant deeper investigation. Therefore, this study aims to investigate the influence mechanism of social norms on CHB prescribing behavior, and examines whether it varies among different prescriber subgroups. A cross-sectional study was conducted using multi-stage sampling method to include physicians with CHB prescribing authority. A structured questionnaire was designed based on the integrated Theory of Planned Behavior and Theory of Normative Social Behavior to survey the participants. The influence mechanism of social norms on CHB prescribing behavior were analyzed using partial least squares structural equation modeling (SEM), and multi-group SEM was conducted to examine the moderating effect of hospital level, professional title, and years in practice on paths for CHB prescribing behavior. Totally 234 physicians were included in the study. The results indicated that injunctive norms (β = 0.289, P < 0.01), attitude (β = 0.359, P < 0.01), perceived behavioral control (β=-0.080, P < 0.01), and group identity (β = 0.319, P < 0.001) had significant direct effects on prescribers’ behavioral intention, while behavioral intention positively affect prescribing behavior (β = 0.535, P < 0.001). Descriptive norms (β = 0.391, P < 0.001) and injunctive norms (β = 0.261, P < 0.001) had significant indirect effects on CHB prescribing behavior. Furthermore, multi-group SEM indicated that the effect of group identity on behavioral intention was stronger among physicians in tertiary hospitals; the effect of attitude on behavioral intention was stronger, whereas the effect of injunctive norms on behavioral intention was weaker, among those with a senior professional title; and the effects of descriptive norms on injunctive norms and of behavioral intention on prescribing behavior were weaker among physicians with longer years in practice. Descriptive and injunctive norms have significant direct or indirect effects on CHB prescribing behavior, and the mechanisms varied across different prescriber subgroups. We propose recommendations for regulating CHB prescribing behavior, such as enhancing audit and feedback systems and leveraging the demonstration effect of core personnel. Furthermore, targeted social norm intervention strategies are required for different subgroups to optimize prescribing practices.