Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice
Abstract Background Disentangling the interplay between experience-based intuition and theory-informed implementation is crucial for identifying the direct contribution theory can make for generating behaviour changes needed for successful evidence translation. In the context of ‘clinicogenomics’, a...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-07-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-023-01284-1 |
| _version_ | 1797774042464256000 |
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| author | Natalie Taylor Skye McKay Janet C. Long Clara Gaff Kathryn North Jeffrey Braithwaite Jill J. Francis Stephanie Best |
| author_facet | Natalie Taylor Skye McKay Janet C. Long Clara Gaff Kathryn North Jeffrey Braithwaite Jill J. Francis Stephanie Best |
| author_sort | Natalie Taylor |
| collection | DOAJ |
| description | Abstract Background Disentangling the interplay between experience-based intuition and theory-informed implementation is crucial for identifying the direct contribution theory can make for generating behaviour changes needed for successful evidence translation. In the context of ‘clinicogenomics’, a complex and rapidly evolving field demanding swift practice change, we aimed to (a) describe a combined clinician intuition- and theory-driven method for identifying determinants of and strategies for implementing clinicogenomics, and (b) articulate a structured approach to standardise hypothesised behavioural pathways and make potential underlying theory explicit. Methods Interview data from 16 non-genetic medical specialists using genomics in practice identified three target behaviour areas across the testing process: (1) identifying patients, (2) test ordering and reporting, (3) communicating results. The Theoretical Domains Framework (TDF) was used to group barriers and facilitators to performing these actions. Barriers were grouped by distinct TDF domains, with ‘overarching’ TDF themes identified for overlapping barriers. Clinician intuitively-derived implementation strategies were matched with corresponding barriers, and retrospectively coded against behaviour change techniques (BCTs). Where no intuitive strategies were provided, theory-driven strategies were generated. An algorithm was developed and applied to articulate how implementation strategies address barriers to influence behaviour change. Results Across all target behaviour areas, 32 identified barriers were coded across seven distinct TDF domains and eight overarching TDF themes. Within the 29 intuitive strategies, 21 BCTs were represented and used on 49 occasions to address 23 barriers. On 10 (20%) of these occasions, existing empirical links were found between BCTs and corresponding distinct TDF-coded barriers. Twenty additional theory-driven implementation strategies (using 19 BCTs on 31 occasions) were developed to address nine remaining barriers. Conclusion Clinicians naturally generate their own solutions when implementing clinical interventions, and in this clinicogenomics example these intuitive strategies aligned with theoretical recommendations 20% of the time. We have matched intuitive strategies with theory-driven BCTs to make potential underlying theory explicit through proposed structured hypothesised causal pathways. Transparency and efficiency are enhanced, providing a novel method to identify determinants of implementation. Operationalising this approach to support the design of implementation strategies may optimise practice change in response to rapidly evolving scientific advances requiring swift translation into healthcare. |
| first_indexed | 2024-03-12T22:15:11Z |
| format | Article |
| id | doaj.art-aa23f5c0714d448d9105250755dad5be |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-03-12T22:15:11Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-aa23f5c0714d448d9105250755dad5be2023-07-23T11:21:27ZengBMCImplementation Science1748-59082023-07-0118111710.1186/s13012-023-01284-1Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practiceNatalie Taylor0Skye McKay1Janet C. Long2Clara Gaff3Kathryn North4Jeffrey Braithwaite5Jill J. Francis6Stephanie Best7School of Population Health, Faculty of Medicine and Health, UNSW SydneySchool of Population Health, Faculty of Medicine and Health, UNSW SydneyAustralian Institute of Health Innovation, Macquarie UniversityMelbourne Genomics Health Alliance, University of MelbourneAustralian Genomics, Murdoch Children’s Research Institute, Royal Children’s HospitalAustralian Institute of Health Innovation, Macquarie UniversitySchool of Health Sciences, University of MelbourneAustralian Institute of Health Innovation, Macquarie UniversityAbstract Background Disentangling the interplay between experience-based intuition and theory-informed implementation is crucial for identifying the direct contribution theory can make for generating behaviour changes needed for successful evidence translation. In the context of ‘clinicogenomics’, a complex and rapidly evolving field demanding swift practice change, we aimed to (a) describe a combined clinician intuition- and theory-driven method for identifying determinants of and strategies for implementing clinicogenomics, and (b) articulate a structured approach to standardise hypothesised behavioural pathways and make potential underlying theory explicit. Methods Interview data from 16 non-genetic medical specialists using genomics in practice identified three target behaviour areas across the testing process: (1) identifying patients, (2) test ordering and reporting, (3) communicating results. The Theoretical Domains Framework (TDF) was used to group barriers and facilitators to performing these actions. Barriers were grouped by distinct TDF domains, with ‘overarching’ TDF themes identified for overlapping barriers. Clinician intuitively-derived implementation strategies were matched with corresponding barriers, and retrospectively coded against behaviour change techniques (BCTs). Where no intuitive strategies were provided, theory-driven strategies were generated. An algorithm was developed and applied to articulate how implementation strategies address barriers to influence behaviour change. Results Across all target behaviour areas, 32 identified barriers were coded across seven distinct TDF domains and eight overarching TDF themes. Within the 29 intuitive strategies, 21 BCTs were represented and used on 49 occasions to address 23 barriers. On 10 (20%) of these occasions, existing empirical links were found between BCTs and corresponding distinct TDF-coded barriers. Twenty additional theory-driven implementation strategies (using 19 BCTs on 31 occasions) were developed to address nine remaining barriers. Conclusion Clinicians naturally generate their own solutions when implementing clinical interventions, and in this clinicogenomics example these intuitive strategies aligned with theoretical recommendations 20% of the time. We have matched intuitive strategies with theory-driven BCTs to make potential underlying theory explicit through proposed structured hypothesised causal pathways. Transparency and efficiency are enhanced, providing a novel method to identify determinants of implementation. Operationalising this approach to support the design of implementation strategies may optimise practice change in response to rapidly evolving scientific advances requiring swift translation into healthcare.https://doi.org/10.1186/s13012-023-01284-1Implementation scienceMechanism of actionClinical genomicsClinical practice changeAlgorithm |
| spellingShingle | Natalie Taylor Skye McKay Janet C. Long Clara Gaff Kathryn North Jeffrey Braithwaite Jill J. Francis Stephanie Best Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice Implementation Science Implementation science Mechanism of action Clinical genomics Clinical practice change Algorithm |
| title | Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice |
| title_full | Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice |
| title_fullStr | Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice |
| title_full_unstemmed | Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice |
| title_short | Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice |
| title_sort | aligning intuition and theory a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice |
| topic | Implementation science Mechanism of action Clinical genomics Clinical practice change Algorithm |
| url | https://doi.org/10.1186/s13012-023-01284-1 |
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