How is the Theoretical Domains Framework Applied in Designing Interventions to Support Healthcare Practitioner Behaviour Change? A Systematic Review.

Abstract

BACKGROUND\nThe use of theory is recommended to support interventions to promote implementation of evidence-based practices. However, there are multiple models of behaviour change which can be complex and lack comprehensiveness and are therefore difficult to understand and operationalise. The Theoretical Domains Framework sought to address these problems by synthesising 33 models of behaviour or behaviour change. Given that it is 15 years since the first publication of the TDF it is timely to reflect on how the framework has been applied in practice. The aim of this review is to identify and narratively synthesise papers in which the TDF, including frameworks that incorporate the TDF have been used in relation to practice behaviours, which go as far as to report on intervention development and/or testing.\n\n\nMETHODS\nWe searched MEDLINE, PsychINFO, CINAHL and the Cochrane databases using the terms: theoretical domains framework* or TDF or COM-B or behav* change wheel or BCW AND implement* or improv* or quality or guideline* or intervention* or practice* or EBP or evidence based practice and conducted citation and key author searches. Included papers were those that used any version of the TDF published from 2005 onwards. Included papers were subject to narrative synthesis.\n\n\nRESULTS\nA total of 3,540 papers were identified and 60 were included. Thirty-two papers reported intervention design only and 28 reported intervention design and testing. Despite over three thousand citations there has been limited application to the point of designing interventions to support best practice. In particular use of the framework has not been tried or tested in non-western countries and barely used in non-primary or acute care settings. Authors have applied the framework to assess barriers and facilitators successfully but reporting of the process of selection of behaviour change techniques and intervention design thereafter was variable.\n\n\nCONCLUSION\nDespite over three thousand citations of the framework there has been limited application to the point of designing interventions to support best practice. The framework is barely used in non-western countries or beyond primary or acute care settings. A stated purpose of the framework was to make psychological theory accessible to researchers and practitioners alike, if this is to be fully achieved further guidance is needed on the application of the framework beyond the point of assessment of barriers and facilitators.