A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems

Abstract

BackgroundImplementing new practices requires changes in the behaviour of relevant actors, and this is facilitated by understanding of the determinants of current and desired behaviours. The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers who identified theories relevant to implementation and grouped constructs from these theories into domains. The collaboration aimed to provide a comprehensive, theory-informed approach to identify determinants of behaviour. The first version was published in 2005, and a subsequent version following a validation exercise was published in 2012. This guide offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. It presents a brief rationale for using a theoretical approach to investigate and address implementation problems, summarises the TDF and its development, and describes how to apply the TDF to achieve implementation objectives. Examples from the implementation research literature are presented to illustrate relevant methods and practical considerations.MethodsResearchers from Canada, the UK and Australia attended a 3-day meeting in December 2012 to build an international collaboration among researchers and decision-makers interested in the advancing use of the TDF. The participants were experienced in using the TDF to assess implementation problems, design interventions, and/or understand change processes. This guide is an output of the meeting and also draws on the authors’ collective experience. Examples from the implementation research literature judged by authors to be representative of specific applications of the TDF are included in this guide.ResultsWe explain and illustrate methods, with a focus on qualitative approaches, for selecting and specifying target behaviours key to implementation, selecting the study design, deciding the sampling strategy, developing study materials, collecting and analysing data, and reporting findings of TDF-based studies. Areas for development include methods for triangulating data, e.g. from interviews, questionnaires and observation and methods for designing interventions based on TDF-based problem analysis.ConclusionsWe offer this guide to the implementation community to assist in the application of the TDF to achieve implementation objectives. Benefits of using the TDF include the provision of a theoretical basis for implementation studies, good coverage of potential reasons for slow diffusion of evidence into practice and a method for progressing from theory-based investigation to intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0605-9) contains supplementary material, which is available to authorized users.

Increasing the uptake of stroke upper limb guideline recommendations with occupational therapists and physiotherapists. A qualitative study using the Theoretical Domains Framework

“…These same eligible therapists were then invited to participate in a focus group (60 minutes in duration, both disciplines in attendance) to further explore their motivators and barriers to implementing upper limb guideline recommendations that had been highlighted in survey results. The semi‐structured interview guide for the focus groups was developed based on the Theoretical Domains Framework (Cane, O’Connor, & Michie, ; Michie et al , ) using the recommendations published by Atkins et al () (Data S1). Survey results were used to inform focus group prompt and probing questions (see data analysis for more details) and included questions such as ‘ what do you think about the evidence base behind upper limb rehabilitation’ and ‘ what are some of the things that stop you applying upper limb clinical practice guideline recommendations’?.…”

‘If I die, I die, I don’t care about my health’: Perspectives on self‐care of people experiencing homelessness

“…These include environmental context and resources, knowledge, skills, intentions, goals and behavioural regulations (Table ). TDF has been used extensively in qualitative studies to identify target behaviours for future interventions and to characterise implementation problems (Atkins et al, ; Cane et al, ). The researchers have previously used TDF in qualitative studies in identifying barriers of: access to primary healthcare by persons experiencing homeless (Gunner et al, ) and effective transition of care of such persons across services (Smith, Paudyal, MacLure, et al, ).…”

Using Implementation Science to Promote the Use of the G8 Screening Tool in Geriatric Oncology

“…The Theoretical Domains Framework (TDF) identifies influences on individual health professional behaviors related to the implementation of evidence‐based recommendations. The TDF has been applied across a wide range of healthcare settings and clinical behaviors . It is a synthesis of behavior change theories.…”