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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↵* Jill Burrough, Marion Campbell, Jan Clarkson, Martin Eccles, Rhona Flin, Robbie Foy, Ian Graham, Jeremy Grimshaw, Graeme MacLennan, Nigel Pitts, Liz Shirran, Nick Steen, Jacqueline Tetroe, Mags Watson, Michel Wensing, Paula Whitty.
↵* The 50% criterion was arbitrary but a more demanding definition of consensus than a simple majority. If there was little consensus about allocation of a construct to a particular domain, then the greatest number of group members supporting that allocation could be as low as two since the construct could have been assigned to different domains by all other group members.
This work was funded by the British Psychological Society with a grant awarded in its 2001 Seminars Research Competition “The scientific understanding of the psychological processes involved in the implementation of evidence based practice (EBP) in health services”. The joint meeting of the psychological theory and health services research groups was part funded by the MRC Health Services Research Collaboration.
Members of the “Psychological Theory” Group: Charles Abraham, Debbie Bonetti, Tanya Claridge, Mark Conner, Philippa Davies, Diane Dixon, Derek Johnston, Marie Johnston, Rebecca Lawton, Susan Michie, Dianne Parker, Gwyneth Rees, Noelle Robertson, Paschal Sheeran, Amanda Sowden, Anne Walker, John Weinman.
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