Theoretical Domains Framework (TDF). ⢠What it is ... The original 12 TDF domains were used by Jane. Beenstock ... Dat
Theoretical Domains Framework: is this a useful tool for interrogating behaviour change in complex interventions? Susan Jones Dr. Sharon Hamilton Prof. Janet Shucksmith Dr. Vera Araujo-Soares
Aim of the presentation Theoretical Domains Framework (TDF) • What it is • How it was developed • How it has been used
What is the Theoretical Domains Framework? A method to bring together the models and theories of behavioural change What is the Theoretical Domains Framework used for? To identify …. which model and theory to use when designing an intervention How to … implement the intervention most effectively
Background to the TDF • Developed by Susan Michie and team at UCL • Originally had 12 domains • Each domain derived from the constructs of many behavioural change theories • Designed to be used in changing professional behaviour Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., Walker, A. (2005) Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality & Safety in Health Care, 14:26-33.
How was the TDF created? • Experts – theorists, researchers/implementers and health psychologists • 33 theories and 128 constructs generated • Grouped constructs into domains • Interdisciplinary validation process by the health psychologists
Further validation of the TDF Used in a number of settings with a variety of topics Sorting exercise to validate the domains explained in: Cane J., O’Connor D., Michie S. (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7, 37.
Number of domains increased to 14
TDF domains TDF 2005
TDF 2012
Knowledge
Knowledge
Skills
Skills
Social influences
Social influences
Memory, Attention and Decision processes
Memory, Attention and Decision processes
Action plans
Behavioural regulation
Professional/Social Role & Identity
Professional/Social Role & Identity
Beliefs about Capabilities
Beliefs about Capabilities
Beliefs about Consequences
Beliefs about Consequences Optimism
Motivation and goals
Intentions Goals
Emotion
Emotion
Environmental Context and Resources
Environmental Context and Resources Reinforcement
Nature of behaviour
Theoretical constructs TDF 2012 Knowledge Skills Social influences Memory, Attention and Decision processes Behavioural regulation
Professional/Social Role & Identity Beliefs about Capabilities Beliefs about Consequences Optimism Intentions Goals Emotion Environmental Context and Resources Reinforcement
Self-confidence Perceived competence Self-efficacy Perceived behavioural control Beliefs Self-esteem Empowerment Professional confidence
Using the TDF • Public health guidance 26, How to stop smoking in pregnancy and following childbirth. National Institute for Health and Clinical Excellence (2010) • Team at Newcastle University wanted to look at: • What helps and hinders midwives in engaging with pregnant women about stopping smoking? • The original 12 TDF domains were used by Jane Beenstock and colleagues to develop a questionnaire
Findings from Beenstock et al’s questionnaire Midwives were • in favour of providing stop smoking advice • had high levels of motivation • saw it as an integral part of their role BUT … Midwives were not sure about • the consequences of their actions (relating to SS) • the environmental context • the availability of resources
babyClear© as an example What is babyClear? Enhanced stop smoking service to support pregnant women to quit Project title: Process evaluation of a complex intervention to promote increased smoking cessation rates among pregnant women in maternity care Evaluation has two parts: quantitative (Newcastle University); qualitative (Teesside University). TDF (and NPT) used to inform the qualitative evaluation of the implementation of babyClear©.
Applying the TDF to babyClear© • Two sets of participants: HCPs and pregnant women who smoke • Method: qualitative (semi-structured interviews) • HCPs’ interview schedules: combined NPT and TDF • Pregnant women’s interview schedules: TDFbased, elements of NPT
Data analysis Data from staff Data analysis method: Framework Analysis Link into the key elements e.g. • about (un)successful change management • the thinking behind actions coded in NPT, especially reflexive monitoring.
Example of a domain TDF 2012 Knowledge Skills Social influences Memory, Attention and Decision processes Behavioural regulation Professional/Social Role & Identity Beliefs about Capabilities Beliefs about Consequences Optimism Intentions Goals Emotion Environmental Context and Resources Reinforcement
Environmental stressors resources / material resources organisational culture / climate salient events / critical incidents person x environment interaction barriers and facilitators
Coding to ‘resources’ Material resources: • Capacity for increased activity • Availability and maintenance of material resources • Capability of resources to meet the requirements • Funding/financing of resources; extra costs
Other related issues: • Suitability of resources • Use-ability of machinery • Reliability of resources • Prioritising of adequate resources • Appropriate staff available and financed
Identifying mechanisms of change • TDF – analysing influences on behaviour • Behaviour Change Wheel – analysing the nature of behaviour Michie S, van Stralen M, West R (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6:42.
Strengths and Limitations Strengths • Provides a clear structure • Multidisciplinary application Limitations • Still on trial • Confusion around if it is a theory of itself or only a framework of theories • Large number of constructs
Key points • Developed over the last decade • Re-validated in 2012 • Applied widely to investigating the application of guidance in healthcare • Uncovered some of the issues within the research-implementation gap • Still under development, especially as regards how it can be used in designing interventions, with various staff and patient groups, in combination with theories
References Beenstock J, Sniehotta FF, White M, Bell R, Milne EM, Araujo-Soares V (2012) What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England. Implementation Science, 7:36. Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7, 37. Michie S, van Stralen M, West R (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6:42. Michie, S, Pilling, S, Garety, P, Whitty, P, Eccles, M P, Johnston, M, Simmons, J (2007) Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory. Implementation Science, 2:8. Michie, S, Johnston, M, Abraham, C, Lawton, R, Parker, D, Walker, A (2005) Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality & Safety in Health Care, 14:26-33. National Institute for Health and Clinical Excellence (2010) Public health guidance 26, How to stop smoking in pregnancy and following childbirth. NICE: London.
Contact details Susan Jones Teesside University
[email protected]
MOTIVATION THEORIES • Theory of planned behaviour (+ theory of reasoned action, • protection motivation theory, health belief model) • Social cognitive theory • Locus of control theories • Social learning theory • Social comparison theory • Cognitive adaptation theory • Social identity theory • Elaboration likelihood model • Goal theories • Intrinsic motivation theories • Self‐determination theory • Attribution theory • Decision making theories (e.g. social judgment theory, ‘‘fast and frugal’’ model, systematic versus heuristic decision making) • Fear arousal theory
ACTION THEORIES • Learning theory • Operant theory • Modelling • Self‐regulation theory • Implementation theory/automotive model • Goal theory • Volitional control theory • Social cognitive theory • Cognitive behaviour therapy • Transtheoretical model • Social identity theory
ORGANISATION THEORIES • Effort‐reward imbalance • Demand‐control model • Diffusion theory • Group theory (e.g. group minority theory) • Decision making theory • Goal theory • Social influence • Person situation contingency models
KT interventions using this approach Michie et al. >150 citations (Web of Knowledge) Australia • Improving implementation of guidelines for acute low back pain in primary care. – McKenzie et al. • Diagnosis and post‐diagnosis management of people with dementia – Green et al. • Implementing preconception care guidelines in the general practice Setting. – Mazza et al.
Canada • Chiropractors compliance with diagnostic imaging guideline recommendations for spine disorders – Bussieres et al.
Finland • Guidelines on tobacco and nicotine dependency treatment. – Kinnunan et al. Ireland • Primary care practitioners' HPV related Behaviours. – McSherry et al. Netherlands • Blood transfusion management in elective hip and knee arthroplasties. – Voorn et al. UK • Physicians’ transfusion practice. – Eccles et al. • Hospital staff hand hygiene. – Sheldon et al. • A suite of dental guidelines across Scotland. – Clarkson et al.
MRC guidance 2008 • Developing and evaluating complex interventions: new guidance (2008) Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, Medical Research Council Guidance: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008, 337:a1655.
Examples by Michie of how the TDF has been used
• NICE recommendation for families of people with schizophrenia Michie, S., Pilling, S., Garety, P., Whitty, P., Eccles, M. P., Johnston, M., Simmons, J. (2007) Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory. Implementation Science, 2:8.
• Finnish guideline for dental staff to offer a brief stop smoking intervention Amemori, M., Korhonen, T., Kinnunen, T., Michie, S., Murtomaa, H. (2011) Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial. Implementation Science 2011, 6:13.
Another example … • Primary care practitioners’ HPV-related behaviours McSherry et al. (2012) ‘It’s a can of worms’: understanding primary care practitioners’ behaviours in relation to HPV using the theoretical domains framework. Implementation Science, 7:73.
Data analysis • Data from pregnant women • Snug fit with the themes that are emerging from the data
• Gap between NICE recommendations and the mechanism by which they are expected to work • Will the TDF provide some answers?
