Variance and DissentChanging the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings
Section snippets
Toward a theoretical framework
The assumption that clinical practice is a form of human behavior and can be described in terms of general theories relating to human behavior offers the basis for a generalizable model. Factors mediating the effectiveness of interventions could include the attitudes of the healthcare professional or their perceived ability to control generalizable concepts that can be used across different interventions, settings, and individuals.
A theory is “a coherent and non-contradictory set of statements,
Description or explanation?
There are many theories from a range of disciplines that describe behavior and behavior change [16], [17], [18], [19]. However, there are few that explain behavior change. Although descriptive theories can be helpful in anticipating situations and processes, such theories may not explain what determines change or may identify determinants that are not modifiable (e.g., age, intelligence). When one needs to reliably produce change, it is important to work with theories that explain change and
Current use of theory in implementation research
Within the most recent review of guideline implementation [10], the authors of included studies provided an explicit theoretical rationale for their intervention in less than 10% of studies [20]. Given this absence of a theoretical underpinning and interventions attempting to explicitly and prospectively modify theoretical constructs, it is difficult to interpret why interventions have had positive or negative effects. For example, social cognition theories [19] suggest that audit and feedback
Choosing theories
Ferlie and Shortell [22] have suggested four levels at which interventions to improve the quality of health care might operate: (1) the individual health professional, (2) health care groups or teams, (3) organizations providing health care (e.g., NHS trusts), and [4] the larger health care system or environment in which individual organizations are embedded. Different theories may be relevant to interventions at different levels; for example, theories of individual behavior are more relevant
Conclusions
We have suggested that the science of implementation research could be significantly improved by a more systematic approach to the use of theory. Although we have illustrated our arguments with examples from psychology, this is not an attempt to deny the importance of other disciplinary perspectives. These arguments form a useful structure for others to elaborate on or to argue against. It is possible that some or all of the steps we have suggested will turn out to be unhelpful or ineffective,
Acknowledgments
This work was supported by the UK Medical Research Council Health Services Research Collaboration. The Health Services Research Unit and the Dental Health Research Unit are funded by the Chief Scientist Office of the Scottish Executive. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. The views expressed in this paper are those of the authors and may not be shared by the funding bodies.
References (26)
- et al.
Are clinical practice guidelines valid for primary care?
J Clin Epidemiol
(2000) - et al.
Attributes of clinical recommendations that influence change in practice following audit and feedback
J Clin Epidemiol
(2002) - et al.
How good is the quality of health care in the United States?
Milbank Q
(1998) - et al.
Medicine, practice and guidelines: the uneasy juncture of science and art
J Clin Epidemiol
(1994) - et al.
Clinical guidelines: from conception to use
(2000) Successes and failures in the implementation of evidence-based guidelines for clinical practice
Med Care
(2001)- et al.
Why does primary care need more implementation research?
Fam Pract
(2001) - et al.
Closing the gap between research and practice: an overview of systematic reviews of interventions to promote implementation of research findings by health care professionals
BMJ
(1998) - et al.
No magic bullets: a systematic review of 102 trials of interventions to improve professional practice
Can Med Assoc J
(1995) - et al.
Changing provider behavior: an overview of systematic reviews of interventions
Med Care
(2001)
Effectiveness and efficiency of guideline dissemination and implementation strategies
Health Technol Assess
Evaluating the message: the relationship between compliance rate and the subject of practice guideline
Med Care
Attributes of clinical guidelines that influence use of guidelines in general practice: observational study
BMJ
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