Variance and Dissent
Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings

https://doi.org/10.1016/j.jclinepi.2004.09.002Get rights and content

Abstract

Objective

The uptake of research findings into routine health care is a haphazard and unpredictable process. The usefulness of the results of implementation studies is limited, due in part to the lack of an underlying framework of the important dimensions of research studies in this area and the healthcare settings within which they are conducted and may subsequently be used.

Study design and setting

We explore the role for a theory-based framework and suggest some of the methods that would be needed to operationalize the framework in the context of designing and conducting interventions aimed at improving the use of research findings by individual healthcare professionals or teams.

Conclusions

This research offers a framework for those who would seek to use the results of such studies in routine healthcare settings.

Section snippets

Toward a theoretical framework

The assumption that clinical practice is a form of human behavior and can be described in terms of general theories relating to human behavior offers the basis for a generalizable model. Factors mediating the effectiveness of interventions could include the attitudes of the healthcare professional or their perceived ability to control generalizable concepts that can be used across different interventions, settings, and individuals.

A theory is “a coherent and non-contradictory set of statements,

Description or explanation?

There are many theories from a range of disciplines that describe behavior and behavior change [16], [17], [18], [19]. However, there are few that explain behavior change. Although descriptive theories can be helpful in anticipating situations and processes, such theories may not explain what determines change or may identify determinants that are not modifiable (e.g., age, intelligence). When one needs to reliably produce change, it is important to work with theories that explain change and

Current use of theory in implementation research

Within the most recent review of guideline implementation [10], the authors of included studies provided an explicit theoretical rationale for their intervention in less than 10% of studies [20]. Given this absence of a theoretical underpinning and interventions attempting to explicitly and prospectively modify theoretical constructs, it is difficult to interpret why interventions have had positive or negative effects. For example, social cognition theories [19] suggest that audit and feedback

Choosing theories

Ferlie and Shortell [22] have suggested four levels at which interventions to improve the quality of health care might operate: (1) the individual health professional, (2) health care groups or teams, (3) organizations providing health care (e.g., NHS trusts), and [4] the larger health care system or environment in which individual organizations are embedded. Different theories may be relevant to interventions at different levels; for example, theories of individual behavior are more relevant

Conclusions

We have suggested that the science of implementation research could be significantly improved by a more systematic approach to the use of theory. Although we have illustrated our arguments with examples from psychology, this is not an attempt to deny the importance of other disciplinary perspectives. These arguments form a useful structure for others to elaborate on or to argue against. It is possible that some or all of the steps we have suggested will turn out to be unhelpful or ineffective,

Acknowledgments

This work was supported by the UK Medical Research Council Health Services Research Collaboration. The Health Services Research Unit and the Dental Health Research Unit are funded by the Chief Scientist Office of the Scottish Executive. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. The views expressed in this paper are those of the authors and may not be shared by the funding bodies.

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