Making psychological theory useful for implementing evidence based practice: a consensus approach

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.