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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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In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
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In the citing paper
“'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]
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In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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 check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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 citing paper
“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]
In the citing paper
“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]
In the citing paper
“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.”
In the citing paper
“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.”
In the citing paper
“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)
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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.”
In the citing paper
“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].”
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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“Reference was made to the original article regarding the development of the TDF to ensure accurate interpretation of the domains [14].”
BackgroundFaithfull, S., Brophy, L., Pennell, K., & Simmons, M. B. (2019) · Journal of Mental Health · doi:10.1080/09638237.2018.1521926 · Cited by 86
Steinmo, S., Michie, S., Fuller, C., Stanley, S., Stapleton, C., & Stone, S. P. (2015) · Implementation Science · doi:10.1186/s13012-016-0376-8 · Cited by 98
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Self-citationChanging eating behaviour: W hat can we learn from behavioural science?
Atkins, L., & Michie, S. (2013) · Nutrition Bulletin · doi:10.1111/nbu.12004 · Cited by 92
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“These initial concepts were informed by the considerable experience of some authors of working with rural Kenyan hospitals and insights from a variety of perspectives in the literature on health systems, quality improvement, guideline implementation, and behavioural research [9,11-19].”
BackgroundNurse role and contribution to antimicrobial stewardship: An integrative review
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Barnes, K., Hladkowicz, E., Dorrance, K., Bryson, G. L., Forster, A. J., Gagné, S., Huang, A. R., Lalu, M. M., Lavallée, L. T., Saunders, C., et al. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-03990-3 · Cited by 93
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Efficacy of Interventions Promoting Blood Donation: A Systematic Review
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Why doorstepping can increase household waste recycling
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Lakerveld, J., Woods, C. B., Hebestreit, A., Brenner, H., Flechtner‐Mors, M., Harrington, J. M., Kamphuis, C. B. M., Laxy, M., Łuszczyńska, A., Mazzocchi, M., et al. (2020) · Food Policy · doi:10.1016/j.foodpol.2020.101873 · Cited by 83
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Self-citationThe demonstration of a theory-based approach to the design of localized patient safety interventions
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“We selected the theoretical domains framework (TDF) of behavior change [19] as the ‘impact’ theoretical approach for this work.”
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Glowacki, K., Weatherson, K. A., & Faulkner, G. (2018) · Mental health and physical activity · doi:10.1016/j.mhpa.2018.10.006 · Cited by 94
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Efficient clinical evaluation of guideline quality: development and testing of a new tool
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Understanding Practice: Factors That Influence Physician Hand Hygiene Compliance
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When knowledge is not enough: Changing behavior to change vaccination results
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Influences on individuals’ decisions to take up the offer of a health check: a qualitative study
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Human factors in the management of the critically ill patient
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Current challenges of behavior change talk for medical professionals and trainees
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Randomised controlled trials for policy interventions: a review of reviews and meta-regression.
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Metadata
- 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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