Making psychological theory useful for implementing evidence based practice: a consensus approach
Making psychological theory useful for implementing evidence based practice: a consensus approach
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DOI：
10.1136/qshc.2004.011155
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发表时间：
2005-02-01
影响因子：
--
通讯作者：
Walker, A
中科院分区：
文献类型：
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作者：
Michie, S;Johnston, M;Walker, A
背景：循证指南往往得不到有效实施，结果是没有达到最佳的健康结果。这可能是由于缺乏对改变医疗保健专业人员行为所涉及的过程的理论理解。本文报告了就可用于实施研究的理论框架达成共识的进展情况。其目的是确定一套达成共识的关键理论结构，用于(1)研究循证实践的实施和(2)制定有效实施的策略，并将这些结构传达给跨学科的受众。方法：通过六个阶段的工作来达成共识：(1)确定理论结构；(2)简化为结构域；(3)评估结构域的重要性；(4)跨学科评估；(5)验证领域列表；(6)试点访谈问题。结果：确定了12个领域来解释行为变化：(1)知识，(2)技能，(3)社会/职业角色和身份，(4)关于能力的信念，(5)关于后果的信念，(6)动机和目标，(7)记忆、注意力和决策过程，(8)环境背景和资源，(9)社会影响，(10)情绪调节，(11)行为调节，(12)行为性质。结论：一套由专家达成共识的行为变化领域可用于实施研究。这一领域清单的应用将加强对实施循证做法所固有的行为变化过程的理解，并将检验这些拟议领域的有效性。
Background: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in ( 1) studying the implementation of evidence based practice and ( 2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience.Methods: Six phases of work were conducted to develop a consensus: ( 1) identifying theoretical constructs; ( 2) simplifying into construct domains; ( 3) evaluating the importance of the construct domains; ( 4) interdisciplinary evaluation; ( 5) validating the domain list; and ( 6) piloting interview questions. The contributors were a "psychological theory'' group ( n = 18), a "health services research'' group ( n = 13), and a "health psychology'' group ( n = 30).Results: Twelve domains were identified to explain behaviour change: ( 1) knowledge, ( 2) skills, ( 3) social/ professional role and identity, ( 4) beliefs about capabilities, ( 5) beliefs about consequences, ( 6) motivation and goals, ( 7) memory, attention and decision processes, ( 8) environmental context and resources, ( 9) social influences, ( 10) emotion regulation, ( 11) behavioural regulation, and ( 12) nature of the behaviour.Conclusions: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.