Conceptualising Four Categories of Behaviours: Implications for Implementation Strategies to Achieve Behaviour Change

Abstract

Background: Effectiveness of implementation strategies is influenced by the extent to which they are based on appropriate theories concerning the behaviours that the strategies intend to impact. Effectiveness may be limited simply because the strategies are based on theories that are limited in scope or are derived from partially inaccurate assumptions about the behaviours in question. It may therefore be important to combine insights from various theories to cover the range of influences on the behaviours that will be changed.Aim: This article aims to explore concepts, theories and empirical findings from different disciplines to categorise four types of behaviours and discuss the implications for implementation strategies attempting to change these behaviours.Influences on behaviours: Multilevel influences on behaviours are dichotomized into individual-level and collective-level influences, and behaviours that are guided by conscious cognitive processes are distinguished from those that rely on non-conscious processing. Combining the two dimensions (levels and cognitive modes) creates a 2 x 2 conceptual map consisting of four categories of behaviours. Explicitly conceptualising the levels and cognitive modes is crucial because different implementation strategies are required depending on the characteristics of the behaviours involved in the practise that needs to be changed.Conclusion: The 2 x 2 conceptual map can be used to consider and reflect on the nature of the behaviours that need to be changed, thus providing guidance on the type of theory, model or framework that might be most relevant for understanding and facilitating behaviour change.

Increasing Access to Organization Theories for Implementation Science

“…For example, implementation climate, a construct from the Theory of Innovation Implementation, must be measured from the perspective of the organization rather than the individual (20). However, empirical studies in implementation science often collect data from individuals; the challenge of capturing collective-level influences may provide a further explanation as to why organizational theories are not used to the same extent as individual-level theories (21).…”

Co-designing, measuring, and optimizing innovations and solutions within complex adaptive health systems

“…The parallelism between PROLIFERATE and such measurement of fundamental care is based on the analysis of networking data about the personal experience of patients, clinicians, and care administrators, to eventually develop interventions through a thorough investigation of the intersections of 38 fundamental care elements, which are similar to the five person-centered constructs in the context of the individual sociodemographic characteristics as variables (Figure 4). The combination of constructs and variables in the described PROLIFERATE evaluation focus (presented in Figure 4) unites the ecological and social logics of Table 1 to capture and measure (via a mechanistic logic) different stakeholders' views/perceptions and their networking position and functions within the health system-they can be policymakers, implementers, community members, managers, providers, and other types of innovation users/roles (1,31,(38)(39)(40)(41).…”

“…Construct #5 can also be used (in combination with the sociodemographic variables) to assess the de-implementation of an innovation or a solution; to this end, the standardization of assessments that the score provides could help compare different evaluated matters across their sectors/users. Using the described network approach and benchmarking stakeholder feedback concerning the constructs and the person's sociodemographic variables can help to navigate across these levels of health systems by exploring their dynamics, i.e., cross-scale components (as presented in Figure 5) (1,31,(38)(39)(40)(41):…”

Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach

“…However, despite an overwhelming amount of literature on the topic, implementation strategies are often haphazardly designed and poorly specified, and theory is insufficiently applied [ 30 , 31 , 32 , 33 , 34 ]. Guidance regarding how best to select tailored strategies to address local contextual determinants (underlying factors, also referred to as barriers and facilitators that cause or influence behaviours and environmental conditions) for successful implementation is insufficient [ 25 , 34 , 35 , 36 ], thus limiting the possibility of replication.…”