Audit in general practice: factors influencing participation.

To identify the factors influencing participation in a single topic audit initiated by a medical audit advisory group. Interview and questionnaire survey of general practitioners who had been invited to take part in an audit of vitamin B-12. All 147 general practices in Leicestershire. Aspects of structure, attitude, and behaviour that influenced participation or non-participation. 75 practices completed the audit, 49 withdrew after initial agreement, and 23 refused to take part at the outset. Participants were more likely than those who refused to view the advisory group as useful or a threat and to have positive thoughts about audit but less likely to have previously undertaken audit entailing implementation of change. Participants were more likely than those who withdrew to have positive thoughts about audit and to have discussed whether to take part within the practice but were less likely to view the advisory group as useful. The most common reason given for withdrawal was lack of time. Participation was influenced by attitudes towards audit in general and the advisory group in particular and by aspects of behaviour such as communication within the practice. Practical support and resources may help some practices undertake audit, but advisory groups must also deal with attitudes and unsatisfactory communication in practice teams.