Changing behaviour "more or less'do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis
Changing behaviour "more or less'do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis
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DOI：
10.1186/s13012-018-0826-6
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发表时间：
2018-10-29
影响因子：
7.2
通讯作者：
Francis, Jill J.
中科院分区：
文献类型：
--
作者：
Patey, Andrea M.;Hurt, Catherine S.;Francis, Jill J.
背景实施循证护理要求医疗从业人员少做一些事情（去实施），多做一些事情（实施）。行为改变干预措施的有效性的差异可能是由于没有考虑行为增加和减少频率的方法之间的区别。这种区别在设计干预措施的方法中没有得到很好的体现。这一审查旨在确定是否有一个理论的理由来支持这种distinction.MethodsUsing关键的解释性Synthesis，这一概念的审查包括文件从广泛的领域（生物学，心理学，教育，商业）可能报告的方法增加或减少的行为。使用与理论和行为改变相关的检索词从数据库中识别文章。纳入了报告行为频率变化和明确使用理论的文章。提取的数据是行为改变的方向，理论是如何操作的，以及基于理论的行为改变的建议。对提取的数据进行了迭代分析，涉及归纳编码和对思想的批判性探索以及对其他论文的有目的抽样，以更详细地探索理论概念。结果对66篇论文及其理论来源的批判性分析确定了三个关键发现：（1）在确定的15种行为理论中，有9种没有区分执行和不执行（5个理论仅适用于执行或取消执行，而不是两者）;（2）降低频率的常见策略是用一种行为替代另一种行为。没有这种策略的理论基础被阐明，也没有提出选择适当的替代行为的方法;（3）操作学习理论使技术之间的明确区别，增加和减少frequency.DiscussionBehavioural理论提供了一个小的洞察力之间的区别实现和去实现。操作学习理论确定了不同的战略实施和反实施，但这些战略可能是不可接受的卫生系统。此外，如果行为替代是取消执行的一种方法，进一步的调查可能会告知选择替代行为的方法或理由。
BackgroundImplementing evidence-based care requires healthcare practitioners to do less of some things (de-implementation) and more of others (implementation). Variations in effectiveness of behaviour change interventions may result from failure to consider a distinction between approaches by which behaviour increases and decreases in frequency. The distinction is not well represented in methods for designing interventions. This review aimed to identify whether there is a theoretical rationale to support this distinction.MethodsUsing Critical Interpretative Synthesis, this conceptual review included papers from a broad range of fields (biology, psychology, education, business) likely to report approaches for increasing or decreasing behaviour. Articles were identified from databases using search terms related to theory and behaviour change. Articles reporting changes in frequency of behaviour and explicit use of theory were included. Data extracted were direction of behaviour change, how theory was operationalised, and theory-based recommendations for behaviour change. Analyses of extracted data were conducted iteratively and involved inductive coding and critical exploration of ideas and purposive sampling of additional papers to explore theoretical concepts in greater detail.ResultsCritical analysis of 66 papers and their theoretical sources identified three key findings: (1) 9 of the 15 behavioural theories identified do not distinguish between implementation and de-implementation (5 theories were applied to only implementation or de-implementation, not both); (2) a common strategy for decreasing frequency was substituting one behaviour with another. No theoretical basis for this strategy was articulated, nor were methods proposed for selecting appropriate substitute behaviours; (3) Operant Learning Theory makes an explicit distinction between techniques for increasing and decreasing frequency.DiscussionBehavioural theories provide little insight into the distinction between implementation and de-implementation. Operant Learning Theory identified different strategies for implementation and de-implementation, but these strategies may not be acceptable in health systems. Additionally, if behaviour substitution is an approach for de-implementation, further investigation may inform methods or rationale for selecting the substitute behaviour.