Evidence‐based selection of theories for designing behaviour change interventions: Using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour
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Background Many theories of behaviour are potentially relevant to predictive and intervention studies but most studies investigate a narrow range of theories. Michie et al. (2005) agreed 12 ‘theoretical domains’ from 33 theories that explain behaviour change. They developed a ‘Theoretical Domains Interview’ (TDI) for identifying relevant domains for specific clinical behaviours, but the framework has not been used for selecting theories for predictive studies. It was used here to investigate clinicians' transfusion behaviour in intensive care units (ICU). Evidence suggests that red blood cells transfusion could be reduced for some patients without reducing quality of care. Objectives (1) To identify the domains relevant to transfusion practice in ICUs and neonatal intensive care units (NICUs), using the TDI. (2) To use the identified domains to select appropriate theories for a study predicting transfusion behaviour. Methods An adapted TDI about managing a patient with borderline haemoglobin by watching and waiting instead of transfusing red blood cells was used to conduct semi‐structured, one‐to‐one interviews with 18 intensive care consultants and neonatologists across the UK. Results Relevant theoretical domains were: knowledge , beliefs about capabilities , beliefs about consequences , social influences, behavioural regulation . Further analysis at the construct level resulted in selection of seven theoretical approaches relevant to this context: Knowledge‐Attitude‐Behaviour Model, Theory of Planned Behaviour, Social Cognitive Theory, Operant Learning Theory, Control Theory, Normative Model of Work Team Effectiveness and Action Planning Approaches. Conclusions This study illustrated, the use of the TDI to identify relevant domains in a complex area of inpatient care. This approach is potentially valuable for selecting theories relevant to predictive studies and resulted in greater breadth of potential explanations than would be achieved if a single theoretical model had been adopted.
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The number and heterogeneity of potential theories that might be used to guide implementation research poses a challenge to researchers wanting to assess and identify theory-based factors underlying healthcare professional behavior.
“The number and heterogeneity of potential theories that might be used to guide implementation research poses a challenge to researchers wanting to assess and identify theory-based factors underlying healthcare professional behavior [22,28-30].”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [30]
The TDF domains are potential behavioral determinants, instead of factors proven to influence implementation behavior.
“the TDF domains are potential behavioral determinants, instead of factors proven to influence implementation behavior”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [30]
The TDF framework does not specify relationships between domains.
“the framework does not specify relationships between domains [30]”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [30]
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- Authors
- Francis, J. J., Stockton, C., Eccles, M. P., Johnston, M., Cuthbertson, B. H., Grimshaw, J. M., Hyde, C., Tinmouth, A., & Stanworth, S. J.
- Affiliations
- University of Aberdeen (GB)
- Newcastle University (GB)
- University of Ottawa (CA)
- Corresponding author
- Francis, Jill J.
- ORCID
- Venue
- British Journal of Health Psychology
- Publisher
- Wiley
- Published
- 2009-11
- Volume
- 14
- Issue
- 4
- Pages
- 625-646
- ISSN
- 1359-107X (ISSN-L)
- 2044-8287
- OpenAlex
- W2063492576
- Cited by
- 230
- References
- 33
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 10 · 2023: 14 · 2022: 19 · 2021: 15 · 2020: 21 · 2019: 19 · 2018: 15 · 2017: 16 · 2016: 10 · 2015: 16 · 2014: 16 · 2013: 14 · 2012: 12
- FWCI
- 10.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- Aberdeen University Research Archive (Aberdeen University) (acceptedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Scottish Government
- Chief Scientist Office, Scottish Government Health and Social Care Directorate
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- clinicians, intensive care unit, neonatal intensive care unit, Theoretical Domains Framework, behaviour change interventions, red blood cell transfusion, theory of planned behavior, social cognitive theory, control theory, action planning, theory choice
- MeSH terms
- Adult, Behavior Therapy, Blood Transfusion, Female, United Kingdom, Humans, Intensive Care Units, Neonatal, Interviews as Topic, Male, Middle Aged, Models, Theoretical, Practice Patterns, Physicians', Quality of Health Care, Evidence-Based Medicine
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