Cited by 3,440Health Policy Implementation ScienceBehavioral Health and InterventionsClinical practice guidelines implementation

Making psychological theory useful for implementing evidence based practice: a consensus approach

Open access
Michie, S·2005·Quality and Safety in Health Care

Abstract

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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Registry

Crossref · 10.1136/qshc.2004.011155

Cites

29 of 29 references verified0 citation errors · 0 not checkable

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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 measured
  • The 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 measured
  • Consideration 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 measured
  • The 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 measured
  • The 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

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Cites

Flagged first, then by citations

1 of the 30 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [4]4. Grimshaw J, Thomas R, Maclennan G, et al. Effectiveness and efficiency of guideline dissemination strategies. Health Technol Assess 2004;8:6:1-84.
  2. [8]8. Grol R. Beliefs and evidence in changing clinical practice. BMJ 1997;315:418-21.
  3. [12]12. Bandura A. Self-efficacy: towards a unifying theory of behavioural change. Psychol Rev 1977;84:191-215.

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Authors
Michie, S.
Affiliations
University College London (GB)
Corresponding author
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
OpenAlex
W2116567300
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
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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