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      Enhancing the translation of health behaviour change research into practice: A selective conceptual review of the synergy between implementation science and health psychology

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          The theory of planned behavior

           Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            The behaviour change wheel: A new method for characterising and designing behaviour change interventions

            Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
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              Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

              Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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                Author and article information

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                Journal
                Health Psychology Review
                Health Psychology Review
                Informa UK Limited
                1743-7199
                1743-7202
                January 15 2021
                : 1-68
                Affiliations
                [1 ]Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada, K1H 8L6
                [2 ]School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada, K1G 5Z3
                [3 ]School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, Ontario, Canada, K1N 6N5
                [4 ]Division of Medical Education, University of Manchester, Manchester, M13 9PT, UK
                [5 ]Centre for Health Services Studies, University of Kent
                [6 ]Centre for Behaviour Change, University College London, London, UK
                [7 ]Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
                [8 ]School of Psychology, Aston University, Aston Triangle, Birmingham, UK, B47ET
                [9 ]Manchester Metropolitan University, Manchester, UK
                [10 ]Health Services and Performance Research, Univ Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France
                [11 ]Health Sciences, University of York, York, UK
                [12 ]School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL
                [13 ]University of Helsinki, Helsinki, Finland
                [14 ]Dept of Work & Social Psychology, Maastricht University, PO BOX 616, 6200MD, Maastricht, The Netherlands
                [15 ]Dept of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, 7000 Fannin, Houston, TX 77030. USA.
                [16 ]Centre for Aging and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
                [17 ]SWPS University of Social Sciences and Humanities, Wroclaw, Poland
                [18 ]Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
                [19 ]Municipal Health Service (GGD) Kennemerland, Zijlweg 200, 2015 CK Haarlem, the Netherlands
                [20 ]Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland.
                [21 ]Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, EC1V 0HB London, United Kingdom
                [22 ]School of Allied Health, University of Limerick, Limerick, Ireland
                Article
                10.1080/17437199.2020.1866638
                © 2021

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