Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
Open accessAbstract
BACKGROUND: Evaluations of interventions to improve implementation of guidelines have failed to produce a clear pattern of results favouring a particular method. While implementation depends on clinicians and managers changing a variety of behaviours, psychological theories of behaviour and behaviour change are seldom used to try to understand difficulties in implementation or to develop interventions to overcome them. OBJECTIVES: This study applied psychological theory to examine explanations for difficulties in implementation. It used a theoretical framework derived from an interdisciplinary consensus exercise to code interviews across 11 theoretical domains. The focus of the study was a National Institute for Health and Clinical Excellence's Schizophrenia guideline recommendation that family intervention should be offered to the families of people with schizophrenia. METHODS: Participants were recruited from community mental health teams from three United Kingdom National Health Service (NHS) Trusts; 20 members (social workers, nurses, team managers, psychologists, and psychiatrists) participated. Semi-structured interviews were audio-taped and transcribed. Interview questions were based on the theoretical domains and addressed respondents' knowledge, attitudes and opinions regarding the guideline. Two researchers independently coded the transcript segments from each interview that were related to each theoretical domain. A score of 1 indicated that the transcript segments relating to the domain did not appear to contain description of difficulties in implementation of the family therapy guidelines; similarly a score of 0.5 indicated possible difficulties and a score of 0 indicated definite difficulties. RESULTS: Coding respondents' answers to questions related to the three domains 'beliefs about consequences,' 'social/professional role and identity,' and 'motivation' produced the three highest total scores indicating that factors relating to these domains were unlikely to constitute difficulties in implementation. 'Environmental context and resources' was the lowest scoring domain, with 'Emotion' scoring the second lowest, suggesting that these were likely to be areas for considering intervention. The two main resources identified as problems were time and training. The emotions that appeared to potentially influence the offer of family therapy were self-doubt and fear. CONCLUSION: This exploratory study demonstrates an approach to developing a theoretical understanding of implementation difficulties.
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The TDF has been the explicit basis of studies with a range of objectives and designs including identifying influences on behaviours, systematic intervention design, process evaluations, and guidance on identifying behaviour change techniques.
“It has been the explicit basis of studies with a range of objectives and designs including the following:”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [24]
The Methods and Discussion describe a study that used theoretical domains to identify factors affecting implementation of a schizophrenia guideline, so this paper supports that example. It does not itself report a process evaluation or provide guidance on identifying behaviour-change techniques; its Discussion treats intervention design and technique selection as related or future work. The indexed passages do not provide page numbers. (LLM, conf=0.84)
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- Authors
- Michie, S., Pilling, S., Garety, P., Whitty, P., Eccles, M. P., Johnston, M., & Simmons, J.
- Affiliations
- University College London (GB)
- Newcastle University (GB)
- University of Aberdeen (GB)
- Corresponding author
- Michie, Susan
- Venue
- Implementation Science
- Published
- 2007-03-26
- Volume
- 2
- Issue
- 1
- Pages
- 8-8
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC1864990
- OpenAlex
- W2086599889
- Cited by
- 161
- References
- 29
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 15 · 2023: 6 · 2022: 9 · 2021: 13 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 7 · 2016: 7 · 2015: 10 · 2014: 12 · 2013: 11 · 2012: 11
- FWCI
- 17.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- British Psychological Society
- National Institutes of Health
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- guideline implementation, implementation barriers, family therapy, schizophrenia, family intervention, behaviour change theory, Theoretical Domains Framework, clinician attitudes, community mental health teams, self-doubt, fear, NICE guidelines
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