Making psychological theory useful for implementing evidence based practice: a consensus approach
Open accessAbstract
BACKGROUND: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. METHODS: Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a "psychological theory" group (n = 18), a "health services research" group (n = 13), and a "health psychology" group (n = 30). RESULTS: Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. CONCLUSIONS: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.
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The framework of 12 theoretical domains has proved useful in assessing and intervening with implementation problems, but the domain of behaviour has remained under-theorised and underused.
“Whilst this framework of 12 theoretical domains has proved useful in assessing and intervening with implementation problems [9], the domain of behaviour has remained under-theorised and therefore underused in its application.”
From The behaviour change wheel: A new method for characterising and designing behaviour change interventions (2011) · cites this paper as [9]
The Discussion (page not available) identifies 12 domains for explaining implementation failures and designing interventions. Piloting interview questions (page not available) reports that field interviews identified relevant domains and suggested intervention strategies. This supports usefulness in assessment and intervention planning, but “proved useful in intervening” overstates the paper’s reported testing; the uncited second clause is not attributed to this source. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe original Theoretical Domains Framework group identified 33 theories and 128 key theoretical constructs related to behaviour change and synthesised them into a single framework.
“The group identified 33 theories and 128 key theoretical constructs related to behaviour change and synthesised them into a single framework”
From Validation of the theoretical domains framework for use in behaviour change and implementation research (2012) · cites this paper as [13]
The Results section reports 128 explanatory constructs drawn from 33 psychological theories, and the theory group describes organising them into an agreed framework of domains. However, the “Simplifying into theoretical domains” section says only 17 of the 128 constructs were prioritised as key for interdisciplinary research and 14 for changing healthcare professionals’ behaviour; it does not call all 128 key constructs. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredConsideration of patient acceptability using theories of behaviour change is key to effective evaluation, design and implementation of healthcare interventions.
“It has been increasingly acknowledged that consideration of patient acceptability using theories of behaviour change are key to effective evaluation, design and implementation of healthcare interventions [23–25] .”
From 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions (2020) · cites this paper as [24]
The Discussion says the paper develops a psychological-theory framework to explain failures to implement evidence-based practice and to design interventions for improved implementation. But the Abstract and piloting sections focus on changing healthcare professionals’ behaviour; they do not establish that considering patient acceptability is key to evaluating, designing, or implementing healthcare interventions. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe TDF is an integrated theoretical framework synthesised from 128 theoretical constructs from 33 theories judged most relevant to implementation questions.
“The TDF is an integrated theoretical framework synthesised from 128 theoretical constructs from 33 theories judged most relevant to implementation questions.”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [15]
The Results report identifying 128 constructs drawn from 33 psychological theories, and the paper describes developing an integrative framework for implementation research. But the Simplifying into theoretical domains section says only a subset of those constructs was prioritised as particularly relevant; it does not say that all 128 were judged most relevant to implementation questions. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe TDF is a synthesis of 33 theories of behaviour and behaviour change clustered into 14 (originally 12) domains.
“A synthesis of 33 theories of behaviour and behaviour change clustered into 14 (originally 12) domains [15,16];”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [15]
The Results identify 128 constructs drawn from 33 psychological theories, and the Discussion describes the paper’s framework as 12 domains. Our copy does not describe a later 14-domain framework, so that part of the jointly cited claim is not supported by this source. (LLM, conf=0.90)
Experimental — accuracy not yet measured
'Nature of the behaviour' was identified as one of 12 theoretical domains of influence on implementation-relevant behaviours.
“'Nature of the behaviour' was identified as one of 12 theoretical domains of influence on implementation-relevant behaviours [9].”
From The behaviour change wheel: A new method for characterising and designing behaviour change interventions (2011) · cites this paper as [9]
The original Theoretical Domains Framework was developed by 18 psychological theorists in collaboration with 16 health service researchers and 30 health psychologists.
“an integrative framework of theories of behaviour change was developed by 18 psychological theorists in collaboration with 16 health service researchers and 30 health psychologists [13].”
From Validation of the theoretical domains framework for use in behaviour change and implementation research (2012) · cites this paper as [13]
The original Theoretical Domains Framework comprised 12 theoretical domains and exemplar questions for each.
“This resulted in 12 theoretical domains and exemplar questions for each to use in interviews or focus groups”
From Validation of the theoretical domains framework for use in behaviour change and implementation research (2012) · cites this paper as [13]
Themes and constituent codes were mapped to the Theoretical Domains Framework by KR, EH and KA, and mapping was validated by JG.
“Following thematic analysis, themes and constituent codes were mapped to the TDF [24] by KR, EH and KA. Mapping was undertaken by determining the ‘fit’ of themes and codes with domains using domain descriptions as working definitions [25].Once mapping was complete, data were checked a final time by KR and then validated by JG to confirm fit with the framework; any discrepancies during the mapping”
From 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions (2020) · cites this paper as [24]
Interviews followed a semi-structured schedule taking into consideration elements of the Theoretical Domains Framework and the Theoretical Framework of Acceptability, and the schedules were reviewed by the EQUITy Lived Experience Advisory Panel.
“Interviews followed a semi-structured schedule, taking into consideration elements of the TDF [24], and TFA [23]. Once drafted, interview schedules were reviewed by the EQUITy Lived Experience Advisory Panel (LEAP).”
From 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions (2020) · cites this paper as [24]
The TDF facilitated mapping study findings into coherent areas to target for change, providing a theoretically robust premise for later-stage implementation studies.
“The TDF facilitated in mapping the study findings into coherent areas to target for change providing a theoretically robust premise for later-stage implementation studies [24, 25].”
From 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions (2020) · cites this paper as [24]
A team of behavioural scientists developed the TDF in collaboration with implementation researchers in an effort to make theories more accessible to those working in implementation.
“In an effort to make theories more accessible to those working in implementation, a team of behavioural scientists developed the TDF in collaboration with implementation researchers [15].”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [15]
The TDF was initially developed for implementation research to identify influences on health professional behaviour related to implementation of evidence-based recommendations.
“The Theoretical Domains Framework (TDF) was initially developed for implementation research to identify influences on health professional behaviour related to implementation of evidence-based recommendations and has been cited in over 800 peer-review publications (Web of Knowledge accessed April 2017).”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [15]
The majority of TDF domains relate to individual motivation and capability factors, while the domains cover the physical and social environment.
“Whilst the domains cover the physical and social environment, the majority relate to individual motivation and capability factors.”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [15]
The TDF is a theoretical framework rather than a theory.
“the TDF is a theoretical framework rather than a theory; it does not propose testable relationships between elements but provides a theoretical lens through which to view the cognitive, affective, social and environmental influences on behaviour.”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [15]
The TDF does not propose testable relationships between elements but provides a theoretical lens through which to view the cognitive, affective, social and environmental influences on behaviour.
“the TDF is a theoretical framework rather than a theory; it does not propose testable relationships between elements but provides a theoretical lens through which to view the cognitive, affective, social and environmental influences on behaviour.”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [15]
UK Medical Research Council guidance for developing and evaluating complex interventions advocates drawing on theory but does not specify how to select and apply theory.
“Useful guidance from the UK Medical Research Council for developing and evaluating complex interventions advocates drawing on theory in intervention design but does not specify how to select and apply theory [9].”
From The behaviour change wheel: A new method for characterising and designing behaviour change interventions (2011) · cites this paper as [9]
The introductory section (page not available) says that the many competing psychological theories leave no good basis for selecting among them. But our copy does not discuss UK Medical Research Council guidance for complex interventions or say whether that guidance advocates theory while leaving its selection and application unspecified. Searches for the MRC guidance and complex interventions found only an MRC-funded research collaboration. (LLM, conf=0.73)
Experimental — accuracy not yet measuredPoor theoretical underpinning makes it difficult to understand and explain how and why implementation succeeds or fails, thus restraining opportunities to identify factors that predict the likelihood of implementation success and develop better strategies to achieve more successful implementation.
“Poor theoretical underpinning makes it difficult to understand and explain how and why implementation succeeds or fails, thus restraining opportunities to identify factors that predict the likelihood of implementation success and develop better strategies to achieve more successful implementation.”
From Making sense of implementation theories, models and frameworks (2015) · cites this paper as [3]
The discipline-specific approach in targeted innovations, settings, and end-users has resulted in multiple and potentially disparate frameworks being developed and used.
“This discipline-specific approach in the targeted innovations, settings, and end-users, has resulted in multiple and potentially disparate frameworks being developed and used [4,6-12].”
From A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework (2015) · cites this paper as [10]
Implementation and knowledge translation frameworks have predominantly developed within disciplines.
“Implementation and knowledge translation frameworks have predominantly developed within disciplines.”
From A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework (2015) · cites this paper as [10]
In the ensuing 9 years, the field has expanded considerably and further taxonomies, checklists, conceptual frameworks, theories, and models of implementation have been developed.
“In the ensuing 9 years, the field has expanded considerably and further taxonomies, checklists, conceptual frameworks, theories, and models of implementation have been developed [10,13,14,17,18].”
From A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework (2015) · cites this paper as [10]
The concept of the individual might incorporate capability, capacity, motivation (including recognising a need for change), resilience, acceptability, feelings, knowledge and beliefs (including self efficacy) about the intervention/evidence, position and fit within the organization/social system, and approach to decision-making.
“we propose that the concept of the individual might incorporate: capability, capacity, motivation (including recognising a need for change), resilience, acceptability, feelings, knowledge and beliefs (including self efficacy) about the intervention/evidence, position and fit within the organization/social system, and approach to decision-making (e.g., experimentation, use of information).”
From The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework (2013) · cites this paper as [42]
Intervention development frameworks offer guidance as to which BCTs to select for targeting mechanisms of action.
“Further, there are intervention development frameworks (e.g. the Behaviour Change Wheel Guide [72], Intervention Mapping [60] and the Theoretical Domains Framework [64, 65]), which offer guidance as to which BCTs to select for targeting mechanisms of action.”
The Theoretical Domains Framework (TDF) specifies 14 theoretical domains, each of which includes several theoretical constructs that are similar in definition but derive from different theories.
“The TDF specifies 14 theoretical domains, each of which includes several theoretical constructs that are similar in definition, but derive from different theories, and which may be relevant to understanding and changing behaviour.”
Michie et al.'s (2005) 12-domain original version of the TDF might be more applicable in developing a TDF-based questionnaire.
“and suggest that Michie et al.’s (2005) 12-domain original version might be more applicable in developing a TDF-based questionnaire.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as Michie et al.’s (2005)
The Theoretical Domains Framework (TDF) was developed as an integrative framework of theories of behavior change to overcome these challenges.
“The Theoretical Domains Framework (TDF) [31] was developed as an integrative framework of theories of behavior change to overcome these challenges.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [31]
The TDF includes 12 theoretical domains of potential behavioral determinants.
“The framework includes 12 theoretical domains of potential behavioral determinants and provides exemplar questions for the theoretical assessment of implementation problems.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [31]
The consensus study that produced the TDF has been validated, leading to Cane et al.'s refined TDF.
“Since its original development, the consensus study that produced the TDF [31] has been validated, leading to Cane et al.’s [37] refined TDF.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [31]
The refinement of the domain Motivation and goals of the original TDF into the domains Goals and Intentions in the recent version of the TDF and the classification of multiple goal-related constructs to the domains Goals, Intentions, and Behavioral regulation imply overlap between these domains.
“the refinement of the domain Motivation and goals of the original TDF [31] into the domains Goals and Intentions in the recent version of the TDF and the classification of multiple goal-related constructs to the domains Goals, Intentions, and Behavioral regulation imply overlap between these domains”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [31]
The domain Reinforcement is a refinement of the Beliefs about consequences domain and was originally included within the latter domain in the original TDF.
“the domain Reinforcement is a refinement of the Beliefs about consequences domain and was originally included within the latter domain in the original TDF [31]”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [31]
A valid TDF-based questionnaire will increase the use of theory in the assessment of barriers and facilitators for implementation problems, which can inform the selection of possible techniques that can be used to change healthcare professionals' behaviors.
“a valid TDF-based questionnaire will increase the use of theory in the assessment of barriers and facilitators for implementation problems [31,69,70], which can inform the selection of possible techniques that can be used to change healthcare professionals’ behaviors [15,23,26]”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [31]
The results partly support Cane et al.'s validation of the TDF and suggest that the 12-domain version might be more applicable in developing a TDF-based questionnaire.
“The results partly support Cane et al.’s validation of the TDF [37] and suggest that the 12-domain version [31] might be more applicable in developing a TDF-based questionnaire.”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [31]
Michie et al. applied a systematic consensus approach to develop a framework grounded in psychological theory that simplifies theories relevant to behaviour change; the consensus identified 12 theoretical domains from 33 theories and 128 constructs that may explain health-related behaviour change.
“Michie et al. [20] applied a systematic consensus approach to develop a framework grounded in psychological theory that simplifies theories relevant to behaviour change. The consensus identified 12 theoretical domains from 33 theories and 128 constructs that may explain health-related behaviour change.”
The Theoretical Domains Framework can be used to inform the choice of potential behaviour change techniques to develop interventions as well as to investigate determinants of behaviour.
“The Theoretical Domains Framework (TDF) can be used to inform the choice of potential behaviour change techniques to develop interventions as well as to investigate determinants of behaviour [20].”
These reviews reflect calls for the use of theories to generate testable hypotheses linking tailored strategies with factors that promote or inhibit implementation, and attempts to identify theories or constructs best suited for successful implementation.
“They reflect calls for the use of theories to generate testable hypotheses linking tailored strategies with factors that promote or inhibit implementation, and various attempts to identify theories or constructs within theories best suited for successful implementation [15].”
From Development of a theory of implementation and integration: Normalization Process Theory (2009) · cites this paper as [15]
All of these factors play a central role in behavior change associated with effective mental health treatments.
“All of these factors play a central role in behavior change associated with effective mental health treatments [87,88,89]”
From eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes (2018) · cites this paper as [88]
Practice change theories and reviews of clinical practice change interventions suggest that interventions that address multiple barriers to care provision may be more likely to be effective.
“Practice change theories [19–22] and reviews of clinical practice change interventions suggest that interventions that address multiple barriers to care provision may be more likely to be effective [23, 24].”
From Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial (2017) · cites this paper as [21]
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“developed using an expert consensus process [93].”
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- Authors
- Michie, S.
- Affiliations
- University College London (GB)
- Corresponding author
- Michie, S
- ORCID
- Michie, S
- Venue
- Quality and Safety in Health Care
- Publisher
- BMJ
- Published
- 2005-02-01
- Volume
- 14
- Issue
- 1
- Pages
- 26-33
- ISSN
- 1475-3898 (ISSN-L)
- 1475-3901
- PMC
- PMC1743963
- OpenAlex
- W2116567300
- Semantic Scholar
- bdf39eabaf7691033bd0ad16d7d7fa59c92141a9
- Cited by
- 3,440
- References
- 30
- Citations by year
- 2026: 186 · 2025: 221 · 2024: 317 · 2023: 310 · 2022: 372 · 2021: 327 · 2020: 349 · 2019: 209 · 2018: 202 · 2017: 152 · 2016: 159 · 2015: 149 · 2014: 118 · 2013: 103 · 2012: 72
- FWCI
- 39.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- British Psychological Society
- Medical Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- evidence-based practice implementation, behavior change, theoretical constructs, consensus development, implementation research, healthcare professional behaviour, health psychology, social influence, emotion regulation, professional role and identity, knowledge and skills
- MeSH terms
- United Kingdom, Health Personnel, Humans, Models, Psychological, Evidence-Based Medicine
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