Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework
Tóm tắt
There is little systematic operational guidance about how best to develop complex interventions to reduce the gap between practice and evidence. This article is one in a Series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research. The intervention was developed considering three main components: theory, evidence, and practical issues. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components of an implementation intervention: Who needs to do what, differently? Using a theoretical framework, which barriers and enablers need to be addressed? Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? And how can behaviour change be measured and understood? A complex implementation intervention was designed that aimed to improve acute low back pain management in primary care. We used the TDF to identify the barriers and enablers to the uptake of evidence into practice and to guide the choice of intervention components. These components were then combined into a cohesive intervention. The intervention was delivered via two facilitated interactive small group workshops. We also produced a DVD to distribute to all participants in the intervention group. We chose outcome measures in order to assess the mediating mechanisms of behaviour change. We have illustrated a four-step systematic method for developing an intervention designed to change clinical practice based on a theoretical framework. The method of development provides a systematic framework that could be used by others developing complex implementation interventions. While this framework should be iteratively adjusted and refined to suit other contexts and settings, we believe that the four-step process should be maintained as the primary framework to guide researchers through a comprehensive intervention development process.
Tài liệu tham khảo
Grol R, Berwick DM, Wensing M: On the trail of quality and safety in health care. BMJ. 2008, 336 (7635): 74-76. 10.1136/bmj.39413.486944.AD.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8 (6): 1-84.
ICEBeRG: Designing theoretically-informed implementation interventions. Implement Sci. 2006, 1: 4-
van Bokhoven MA, Kok G, van der Weijden T: Designing a quality improvement intervention: a systematic approach. Qual Saf Health Care. 2003, 12 (3): 215-220. 10.1136/qhc.12.3.215.
Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci. 2010, 5: 14-10.1186/1748-5908-5-14.
Des Jarlais DC, Lyles C, Crepaz N: Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004, 94 (3): 361-366. 10.2105/AJPH.94.3.361.
Baker EA, Brennan Ramirez LK, Claus JM, Land G: Translating and disseminating research- and practice-based criteria to support evidence-based intervention planning. J Public Health Manag Pract. 2008, 14 (2): 124-130.
Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P: Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008, 148 (4): 295-309.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005, 58 (2): 107-112. 10.1016/j.jclinepi.2004.09.002.
Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. BMJ. 2000, 321 (7262): 694-696. 10.1136/bmj.321.7262.694.
Medical Research Council: A framework for development and evaluation of RCTs for complex interventions to improve health. 2000, MRC, London
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008, 337: a1655-10.1136/bmj.a1655.
Medical Research Council: Developing and evaluating complex interventions: new guidance. 2008, MRC, London
Ashford AJ: Behavioural change in professional practice: supporting the development of effective implementation strategies. 1998, Report No 88
Ferlie EB, Shortell SM: Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001, 79 (2): 281-315. 10.1111/1468-0009.00206.
Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M: Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007, 85 (1): 93-138. 10.1111/j.1468-0009.2007.00478.x.
Noar SM, Zimmerman RS: Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction?. Health Educ Res. 2005, 20 (3): 275-290. 10.1093/her/cyg113.
Lippke S, Ziegelmann JP: Theory-based health behavior change: developing, testing, and applying theories for evidence-based interventions. Appl Psychol. 2008, 57 (4): 698-716. 10.1111/j.1464-0597.2008.00339.x.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, on behalf of the "Psychological Theory" Group, on behalf of the "Psychological Theory" Group: Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality Safety in Health Care. 2005, 14 (1): 26-33. 10.1136/qshc.2004.011155.
Hrisos S, Eccles M, Johnston M, Francis J, Kaner EF, Steen N, Grimshaw J: Developing the content of two behavioural interventions: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1. BMC Health Serv Res. 2008, 8: 11-10.1186/1472-6963-8-11.
Foy R, Francis JJ, Johnston M, Eccles M, Lecouturier J, Bamford C, Grimshaw J: The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia. BMC Health Serv Res. 2007, 7: 207-10.1186/1472-6963-7-207.
McKenzie JE, French SD, O’Connor DA, Grimshaw JM, Mortimer D, Michie S, Francis J, Spike N, Schattner P, Kent PM: IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): Cluster randomised controlled trial study protocol. Implement Sci. 2008, 3: 11-10.1186/1748-5908-3-11.
Davidson KW, Goldstein M, Kaplan RM, Kaufmann PG, Knatterud GL, Orleans CT, Spring B, Trudeau KJ, Whitlock EP: Evidence-based behavioral medicine: what is it and how do we achieve it? nn. Behav Med. 2003, 26 (3): 161-171. 10.1207/S15324796ABM2603_01.
Hakkennes S, Dodd K: Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care. 2008, 17 (4): 296-300. 10.1136/qshc.2007.023804.
Australian Acute Musculoskeletal Pain Guidelines Group (AAMPGG): Evidence-based management of acute musculoskeletal pain. 2003, Australian Academic Press, Brisbane
Green S, O’Connor D, French S, Grimshaw J, Spike N, Schattner P, King S, Michie S, Francis J, McKenzie J: Using a theoretical framework to identify barriers and enablers to the uptake of an evidence-based clinical practice guideline in general practice. 2008, Australia,http://www.phcris.org.au/conference/previous/index.php,
Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol. 2008, 57 (4): 660-680. 10.1111/j.1464-0597.2008.00341.x.
Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD: Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009, Issue 2:Art. No.: CD003030
Doumit G, Gattellari M, Grimshaw J, O'Brien MA: Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007, 1: CD000125-
Michie S, Lester K: Words matter: increasing the implementation of clinical guidelines. Qual Saf Health Care. 2005, 14 (5): 367-370. 10.1136/qshc.2005.014100.
Michie S, Johnston M: Changing clinical behaviour by making guidelines specific. BMJ. 2004, 328 (7435): 343-345. 10.1136/bmj.328.7435.343.
Henrotin YE, Cedraschi C, Duplan B, Bazin T, Duquesnoy B: Information and low back pain management: a systematic review. Spine. 2006, 31 (11): E326-E334. 10.1097/01.brs.0000217620.85893.32.
McAteer J, Stone C, Fuller R, Slade R, Michie S: Translating self-regulation theory into a hand-hygiene behaviour intervention for UK healthcare workers. Health Psychology Review. 2007, 1 (Supplement 1): 302-
Lane C, Rollnick S: The use of simulated patients and role-play in communication skills training: a review of the literature to August 2005. Patient Educ Couns. 2007, 67 (1–2): 13-20.
Beck RS, Daughtridge R, Sloane PD: Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002, 15 (1): 25-38.
Griffin SJ, Kinmonth AL, Veltman MW, Gillard S, Grant J, Stewart M: Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med. 2004, 2 (6): 595-608. 10.1370/afm.142.
Rothman AJ: “Is there nothing more practical than a good theory?”: Why innovations and advances in health behavior change will arise if interventions are used to test and refine theory. Int J Behav Nutr Phys Act. 2004, 1 (1): 11-10.1186/1479-5868-1-11.
Michie S, Fixsen D, Grimshaw JM, Eccles MP: Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009, 4: 40-10.1186/1748-5908-4-40.
Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998, 317 (7156): 465-468. 10.1136/bmj.317.7156.465.
Francis JJ, Stockton C, Eccles MP, Johnston M, Cuthbertson BH, Grimshaw JM, Hyde C, Tinmouth A, Stanworth SJ: Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians’ blood transfusion behaviour. Br J Health Psychol. 2009, 14 (Pt 4): 625-646.
McAteer J, Stone S, Fuller C, Slade R, Michie S: Translating self-regulation theory into a hand-hygiene behaviour intervention for UK healthcare workers. Psychology Review. 2007, 21 ((Supplement 1)): 302-
Francis JJ, Tinmouth A, Stanworth SJ, Grimshaw JM, Johnston M, Hyde C, Stockton C, Brehaut JC, Fergusson D, Eccles MP: Using theories of behaviour to understand transfusion prescribing in three clinical contexts in two countries: Development work for an implementation trial. Implement Sci. 2009, 4: 70-10.1186/1748-5908-4-70.
McEachan RR, Lawton RJ, Jackson C, Conner M, Lunt J: Evidence, theory and context: using intervention mapping to develop a worksite physical activity intervention. BMC Publ Health. 2008, 8: 326-10.1186/1471-2458-8-326.