Using theory to synthesise evidence from behaviour change interventions: The example of audit and feedback
Section snippets
Using theory to synthesise evidence from behaviour change interventions
Behaviour change theories represent integrated summaries of hypothesized causal processes, and so offer a standardized and systematic framework for categorising and evaluating intervention content. Applying theory to evidence synthesis allows scientific knowledge about behaviour change to be used in specifying intervention techniques and likely mechanisms by which any effects are achieved. Theory-based explanations offer explicit causal pathways and so avoid use of implicit assumptions
The example of ‘audit and feedback’ as a change technique
Audit and feedback (A&F) is defined as ‘any summary of clinical performance of health care over a specified period of time’ aimed at changing health professional behaviour, as indexed by ‘objectively measured professional practice in a healthcare setting or healthcare outcomes’ (Jamtvedt, Young, Kristoffersen, O'Brien, & Oxman, 2006, p. 3). A systematic review of interventions reported in 118 study datasets found effects to vary from a 16% decrease in adherence to recommended practice to a 70%
The present study
The present study proposes a robust method for selection and application of theory to evidence synthesis around behaviour change interventions, drawing on recent developments in behaviour change techniques (Abraham & Michie, 2008) and statistical methodology (Sutton & Higgins, 2008). This paper adds a methodological innovation to evidence synthesis, by using theory to systematically categorize intervention components, and multivariate meta-regression to isolate the unique contribution of these
Overview of a theory-based method for evidence synthesis
Our method involves several sequential stages. First, the focal behaviour change intervention is deconstructed into component techniques, which are then mapped onto the most relevant behaviour change theory or theories, as identified via an examination of the extant theory literature. Second, hypotheses are subsequently generated, in accordance with theory, concerning the effectiveness of (configurations of) intervention techniques. Third, literature searches are conducted to identify eligible
Results
Eighty-five comparisons reported in 61 studies were included in the analysis (see Table 1). Fifty-nine interventions (69%) were assessed as part of a cluster randomized controlled trial, and 26 interventions (31%) used a patient randomized controlled trial design.
Discussion
Health care policy and practice are increasingly based on summaries of research evidence, but such reviews rarely use theory to understand intervention content. We have outlined a systematic theory-based approach to synthesising evidence of the effectiveness of behaviour change interventions. This approach involves: deconstructing interventions into component techniques, selecting a theory of behaviour change which offers predictions about how these techniques bring about change; coding
Acknowledgements
We thank Theresa Moore, Tony Ades, Gro Jamtvedt and Doris Kristoffersen for input into the early stages of this work. This study was supported by the MRC Health Services Research Collaboration.
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References included in the meta-regression but not cited in the text are listed in the Supplementary References (see online references). References included in the meta-regression and cited in the main text are marked with an asterisk.