Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

Abstract

Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors and structures of power, offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. The modified Delphi involved two rounds of online voting followed by a final majority vote. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. By considering the role of intersecting social factors when selecting, tailoring, and implementing KT interventions, they may become more effective.