Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis
Abstract Background Implementing evidence-based care requires healthcare practitioners to do less of some things (de-implementation) and more of others (implementation). Variations in effectiveness of behaviour change interventions may result from failure to consider a distinction between approaches...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-018-0826-6 |
| _version_ | 1819151884376604672 |
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| author | Andrea M. Patey Catherine S. Hurt Jeremy M. Grimshaw Jill J. Francis |
| author_facet | Andrea M. Patey Catherine S. Hurt Jeremy M. Grimshaw Jill J. Francis |
| author_sort | Andrea M. Patey |
| collection | DOAJ |
| description | Abstract Background Implementing evidence-based care requires healthcare practitioners to do less of some things (de-implementation) and more of others (implementation). Variations in effectiveness of behaviour change interventions may result from failure to consider a distinction between approaches by which behaviour increases and decreases in frequency. The distinction is not well represented in methods for designing interventions. This review aimed to identify whether there is a theoretical rationale to support this distinction. Methods Using Critical Interpretative Synthesis, this conceptual review included papers from a broad range of fields (biology, psychology, education, business) likely to report approaches for increasing or decreasing behaviour. Articles were identified from databases using search terms related to theory and behaviour change. Articles reporting changes in frequency of behaviour and explicit use of theory were included. Data extracted were direction of behaviour change, how theory was operationalised, and theory-based recommendations for behaviour change. Analyses of extracted data were conducted iteratively and involved inductive coding and critical exploration of ideas and purposive sampling of additional papers to explore theoretical concepts in greater detail. Results Critical analysis of 66 papers and their theoretical sources identified three key findings: (1) 9 of the 15 behavioural theories identified do not distinguish between implementation and de-implementation (5 theories were applied to only implementation or de-implementation, not both); (2) a common strategy for decreasing frequency was substituting one behaviour with another. No theoretical basis for this strategy was articulated, nor were methods proposed for selecting appropriate substitute behaviours; (3) Operant Learning Theory makes an explicit distinction between techniques for increasing and decreasing frequency. Discussion Behavioural theories provide little insight into the distinction between implementation and de-implementation. Operant Learning Theory identified different strategies for implementation and de-implementation, but these strategies may not be acceptable in health systems. Additionally, if behaviour substitution is an approach for de-implementation, further investigation may inform methods or rationale for selecting the substitute behaviour. |
| first_indexed | 2024-12-22T14:40:29Z |
| format | Article |
| id | doaj.art-3e0352f890574b9cbb081f6d2ea1fd7f |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-22T14:40:29Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-3e0352f890574b9cbb081f6d2ea1fd7f2022-12-21T18:22:33ZengBMCImplementation Science1748-59082018-10-0113111310.1186/s13012-018-0826-6Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesisAndrea M. Patey0Catherine S. Hurt1Jeremy M. Grimshaw2Jill J. Francis3School of Health Sciences, City, University of LondonSchool of Health Sciences, City, University of LondonCentre for Implementation Research, Ottawa Hospital Research Institute – General CampusSchool of Health Sciences, City, University of LondonAbstract Background Implementing evidence-based care requires healthcare practitioners to do less of some things (de-implementation) and more of others (implementation). Variations in effectiveness of behaviour change interventions may result from failure to consider a distinction between approaches by which behaviour increases and decreases in frequency. The distinction is not well represented in methods for designing interventions. This review aimed to identify whether there is a theoretical rationale to support this distinction. Methods Using Critical Interpretative Synthesis, this conceptual review included papers from a broad range of fields (biology, psychology, education, business) likely to report approaches for increasing or decreasing behaviour. Articles were identified from databases using search terms related to theory and behaviour change. Articles reporting changes in frequency of behaviour and explicit use of theory were included. Data extracted were direction of behaviour change, how theory was operationalised, and theory-based recommendations for behaviour change. Analyses of extracted data were conducted iteratively and involved inductive coding and critical exploration of ideas and purposive sampling of additional papers to explore theoretical concepts in greater detail. Results Critical analysis of 66 papers and their theoretical sources identified three key findings: (1) 9 of the 15 behavioural theories identified do not distinguish between implementation and de-implementation (5 theories were applied to only implementation or de-implementation, not both); (2) a common strategy for decreasing frequency was substituting one behaviour with another. No theoretical basis for this strategy was articulated, nor were methods proposed for selecting appropriate substitute behaviours; (3) Operant Learning Theory makes an explicit distinction between techniques for increasing and decreasing frequency. Discussion Behavioural theories provide little insight into the distinction between implementation and de-implementation. Operant Learning Theory identified different strategies for implementation and de-implementation, but these strategies may not be acceptable in health systems. Additionally, if behaviour substitution is an approach for de-implementation, further investigation may inform methods or rationale for selecting the substitute behaviour.http://link.springer.com/article/10.1186/s13012-018-0826-6ImplementationDe-implementationBehavioural theory and modelBehaviour changeHealth professionalIntervention |
| spellingShingle | Andrea M. Patey Catherine S. Hurt Jeremy M. Grimshaw Jill J. Francis Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis Implementation Science Implementation De-implementation Behavioural theory and model Behaviour change Health professional Intervention |
| title | Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis |
| title_full | Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis |
| title_fullStr | Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis |
| title_full_unstemmed | Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis |
| title_short | Changing behaviour ‘more or less’—do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis |
| title_sort | changing behaviour more or less do theories of behaviour inform strategies for implementation and de implementation a critical interpretive synthesis |
| topic | Implementation De-implementation Behavioural theory and model Behaviour change Health professional Intervention |
| url | http://link.springer.com/article/10.1186/s13012-018-0826-6 |
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