Evidence-based selection of theories for designing behaviour change interventions: Using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour
Evidence-based selection of theories for designing behaviour change interventions: Using methods based on theoretical construct domains to understand clinicians' blood transfusion behaviour
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DOI：
10.1348/135910708x397025
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发表时间：
2009-11-01
影响因子：
7.9
通讯作者：
Stanworth, Simon J.
中科院分区：
文献类型：
--
作者：
Francis, Jill J.;Stockton, Charlotte;Stanworth, Simon J.
背景许多行为理论可能与预测和干预研究相关，但大多数研究调查的理论范围很窄。米吉等人（2005年）从33种解释行为变化的理论中商定了12个“理论领域”。他们开发了一种“理论领域访谈”（TDI），用于确定特定临床行为的相关领域，但该框架尚未用于选择预测研究的理论。它被用来调查临床医生在重症监护病房（ICU）的输血行为。有证据表明，某些患者可以减少红细胞输注，而不会降低护理质量。(1)使用TDI识别ICU和新生儿重症监护室（NICU）输血实践相关领域。(2)使用所确定的域来选择适当的理论用于预测输血行为的研究。一个关于通过观察和等待而不是使用红细胞来管理边缘血红蛋白患者的适应性TDI被用于与英国18名重症监护顾问和儿科医生进行半结构化的一对一访谈。相关的理论领域是：知识，信念的能力，信念的后果，社会影响，行为监管。在构念层面的进一步分析中，选择了与此相关的七种理论方法：知识-态度-行为模型、计划行为理论、社会认知理论、操作学习理论、控制理论、工作团队效能规范模型和行动计划方法。这项研究说明，使用TDI来确定相关领域在一个复杂的住院治疗领域。这种方法对于选择与预测研究相关的理论具有潜在的价值，并且与采用单一理论模型相比，这种方法可以获得更广泛的潜在解释。
Background. Many theories of behaviour are potentially relevant to predictive and intervention studies but most studies investigate a narrow range of theories. Michie et al. (2005) agreed 12 'theoretical domains' from 33 theories that explain behaviour change. They developed a 'Theoretical Domains Interview' (TDI) for identifying relevant domains for specific clinical behaviours, but the framework has not been used for selecting theories for predictive studies. It was used here to investigate clinicians' transfusion behaviour in intensive care units (ICU). Evidence suggests that red blood cells transfusion could be reduced for some patients without reducing quality of care.Objectives. (1) To identify the domains relevant to transfusion practice in ICUs and neonatal intensive care units (NICUs), using the TDI. (2) To use the identified domains to select appropriate theories for a study predicting transfusion behaviour.Methods. An adapted TDI about managing a patient with borderline haemoglobin by watching and waiting instead of transfusing red blood cells was used to conduct semi-structured, one-to-one interviews with 18 intensive care consultants and neonatologists across the UK.Results. Relevant theoretical domains were: knowledge, beliefs about capabilities, beliefs about consequences, social influences, behavioural regulation. Further analysis at the construct level resulted in selection of seven theoretical approaches relevant to this context: Knowledge-Attitude-Behaviour Model, Theory of Planned Behaviour, Social Cognitive Theory, Operant Learning Theory, Control Theory, Normative Model of Work Team Effectiveness and Action Planning Approaches.Conclusions. This study illustrated, the use of the TDI to identify relevant domains in a complex area of inpatient care. This approach is potentially valuable for selecting theories relevant to predictive studies and resulted in greater breadth of potential explanations than would be achieved if a single theoretical model had been adopted.