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      Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review

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          Abstract

          Background

          Systematic reviews consistently indicate that interventions to change healthcare professional (HCP) behaviour are haphazardly designed and poorly specified. Clarity about methods for designing and specifying interventions is needed. The objective of this review was to identify published methods for designing interventions to change HCP behaviour.

          Methods

          A search of MEDLINE, Embase, and PsycINFO was conducted from 1996 to April 2015. Using inclusion/exclusion criteria, a broad screen of abstracts by one rater was followed by a strict screen of full text for all potentially relevant papers by three raters. An inductive approach was first applied to the included studies to identify commonalities and differences between the descriptions of methods across the papers. Based on this process and knowledge of related literatures, we developed a data extraction framework that included, e.g. level of change (e.g. individual versus organization); context of development; a brief description of the method; tasks included in the method (e.g. barrier identification, component selection, use of theory).

          Results

          3966 titles and abstracts and 64 full-text papers were screened to yield 15 papers included in the review, each outlining one design method. All of the papers reported methods developed within a specific context. Thirteen papers included barrier identification and 13 included linking barriers to intervention components; although not the same 13 papers. Thirteen papers targeted individual HCPs with only one paper targeting change across individual, organization, and system levels. The use of theory and user engagement were included in 13/15 and 13/15 papers, respectively.

          Conclusions

          There is an agreement across methods of four tasks that need to be completed when designing individual-level interventions: identifying barriers, selecting intervention components, using theory, and engaging end-users. Methods also consist of further additional tasks. Examples of methods for designing the organisation and system-level interventions were limited. Further analysis of design tasks could facilitate the development of detailed guidelines for designing interventions.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13012-017-0560-5) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references19

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          Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group.

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            Getting research findings into practice: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings

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              A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations

              Background There is growing interest in the use of cognitive, behavioural, and organisational theories in implementation research. However, the extent of use of theory in implementation research is uncertain. Methods We conducted a systematic review of use of theory in 235 rigorous evaluations of guideline dissemination and implementation studies published between 1966 and 1998. Use of theory was classified according to type of use (explicitly theory based, some conceptual basis, and theoretical construct used) and stage of use (choice/design of intervention, process/mediators/moderators, and post hoc/explanation). Results Fifty-three of 235 studies (22.5%) were judged to have employed theories, including 14 studies that explicitly used theory. The majority of studies (n = 42) used only one theory; the maximum number of theories employed by any study was three. Twenty-five different theories were used. A small number of theories accounted for the majority of theory use including PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation), diffusion of innovations, information overload and social marketing (academic detailing). Conclusions There was poor justification of choice of intervention and use of theory in implementation research in the identified studies until at least 1998. Future research should explicitly identify the justification for the interventions. Greater use of explicit theory to understand barriers, design interventions, and explore mediating pathways and moderators is needed to advance the science of implementation research.
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                Author and article information

                Contributors
                heather.colquhoun@utoronto.ca
                jasquires@ohri.ca
                niina.kolehmainen@newcastle.ac.uk
                c.fraser@abdn.ac.uk
                jgrimshaw@ohri.ca
                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                1748-5908
                4 March 2017
                4 March 2017
                2017
                : 12
                : 30
                Affiliations
                [1 ]GRID grid.17063.33, Department of Occupational Science and Occupational Therapy, , University of Toronto, ; 160-500 University Ave, Toronto, Ontario M5G 1V7 Canada
                [2 ]ISNI 0000 0000 9606 5108, GRID grid.412687.e, Ottawa Hospital Research Institute, Clinical Epidemiology Program, , The Ottawa Hospital, ; General Campus, 501 Smyth Road, Centre for Practice Changing Research, Ottawa, Ontario K1H 8L6 Canada
                [3 ]ISNI 0000 0001 2182 2255, GRID grid.28046.38, , School of Nursing, University of Ottawa, ; 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
                [4 ]ISNI 0000 0001 0462 7212, GRID grid.1006.7, , Institute of Health and Society, Newcastle University, ; The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
                [5 ]ISNI 0000 0004 1936 7291, GRID grid.7107.1, Health Services Research Unit, , University of Aberdeen, ; Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD Scotland
                [6 ]ISNI 0000 0001 2182 2255, GRID grid.28046.38, Department of Medicine, , Epidemiology and Community Medicine, University of Ottawa, ; 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
                Article
                560
                10.1186/s13012-017-0560-5
                5336662
                28259168
                eddd785e-cbf8-4e0a-8cd9-91fda2decf5d
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 April 2016
                : 17 February 2017
                Categories
                Systematic Review
                Custom metadata
                © The Author(s) 2017

                Medicine
                knowledge translation,systematic review,intervention design,methodology
                Medicine
                knowledge translation, systematic review, intervention design, methodology

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