Abstract
Health-related behavior change refers to a body of behavior change strategies that aim to align people’s behavior with advances in evidence-based knowledge and decision-making. However, human behavior is complex, and changing it often requires a combination of strategies to be effective. The challenge is in choosing the combination of strategies that will work best. Implementation science, the study of behavior change, has rapidly expanded in recent years and has pioneered work in providing more transparent and theory-based methods for choosing and evaluating behavior change strategies. There are several models and frameworks that underlie the science of implementation, the most recent and comprehensive of which include the Implementation of Change Model, the COM-B (capability, motivation, and behavior) Model, and the Theoretical Domains Framework, as well as the behavior change techniques (BCTs) taxonomy. These models and frameworks can be applied to help support the development and evaluation of behavior change interventions. In this chapter, we will review the latest advances and lessons learned from implementation science as it applies to health-related behavior change.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Morris ZS, Wooding S, Grant J (2011) The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 104(12):510–520. https://doi.org/10.1258/jrsm.2011.110180
Kelly MP, Barker M (2016) Why is changing health-related behaviour so difficult? Public Health 136:109–116. https://doi.org/10.1016/j.puhe.2016.03.030
Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D (2010) Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet 376(9754):1775–1784. https://doi.org/10.1016/s0140-6736(10)61514-0
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L et al (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess (Winchester, England) 8(6):iii–iv, 1–72. https://doi.org/10.3310/hta8060
ICEBeRG (2006) The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG): designing theoretically-informed implementation interventions. Implement Sci 1:4. https://doi.org/10.1186/1748-5908-1-4
Davies P, Walker AE, Grimshaw JM (2010) A systematic review of the use of theory in the design of guideline dissemination and implemention strategies and interpretation of the results of rigorous evaluations. Implement Sci 5:14. https://doi.org/10.1186/1748-5908-5-14
van Bokhoven MA, Kok G, van der Weijden T (2003) Designing a quality improvement intervention: a systematic approach. Qual Safety Health Care 12(3):215–220. https://doi.org/10.1136/qhc.12.3.215
Peters DH, Adam T, Alonge O, Agyepong IA, Tran N (2013) Implementation research: what it is and how to do it. Br Med J 347:f6753
Davis R, Campbell R, Hildon Z, Hobbs L, Michie S (2015) Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psychol Rev 9(3):323–344. https://doi.org/10.1080/17437199.2014.941722
Glanz K, Bishop DB (2010) The role of Behavioural science theory in development and implementation of public health interventions. Annu Rev Public Health 31:399–418. https://doi.org/10.1146/annurev.publhealth.012809.103604
King AC (2015) Theory’s role in shaping Behavioural health research for population health. Int J Behav Nutr Phys Act 12:146. https://doi.org/10.1186/s12966-015-0307-0
Nilsen P (2015) Making sense of implementation theories, models and frameworks. Implement Sci 10:53. https://doi.org/10.1186/s13012-015-0242-0
Tabak RG, Khoong EC, Chambers DA, Brownson RC (2012) Bridging research and practice: models for dissemination and implementation research. Am Prev Med 43(3):337–350. https://doi.org/10.1016/j.amepre.2012.05.024
Grol R, Wensing M, Eccles M, Davis D (2004) The implementation of change in clinical practice, vol 1. Elsevier, London
NICE (2007) Behaviour change: general approaches. www.nice.org.uk/guidance/ph6
Craig P, Petticrew M (2013) Developing and evaluating complex interventions: reflections on the 2008 MRC guidance. Int J Nurs Stud 50(5):585–587. https://doi.org/10.1016/j.ijnurstu.2012.09.009
Canada H (2017) Knowledge translation planner toolkit. https://www.canada.ca/en/health-canada/corporate/about-health-canada/reports-publications/grants-contributions/knowledge-transfer-planner.html
Curran GM, Mukherjee S, Allee E, Owen RR (2008) A process for developing an implementation intervention: QUERI Series. Implement Sci 3:17. https://doi.org/10.1186/1748-5908-3-17
Michie S, Atkins L, West R (2014) The behaviour change wheel: a guide to designing interventions. Silverback Publishing, London
Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 7:37. https://doi.org/10.1186/1748-5908-7-37
Michie S, Wood CE, Johnston M, Abraham C, Francis JJ, Hardeman W (2015) Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess (Winchester, England) 19(99):1–188. https://doi.org/10.3310/hta19990
Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6:42. https://doi.org/10.1186/1748-5908-6-42
Michie SRK, Johnston M, Abraham C, Francis J, Hardeman W, Wood C (2013) The behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behaviour change interventions. Ann Behav Med 46(1):81–95. https://doi.org/10.1007/s12160-013-9486-6
Carey RN, Connell LE, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Michie S (2019) Behaviour change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med 53(8):693–707. https://doi.org/10.1093/abm/kay078
Connell LE, Carey RN, de Bruin M, Rothman AJ, Johnston M, Kelly MP, Michie S (2019) Links between behaviour change techniques and mechanisms of action: an expert consensus study. Ann Behav Med 53(8):708–720. https://doi.org/10.1093/abm/kay082
Michie S, Carey RN, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Connell LE (2018) From theory-inspired to theory-based interventions: a protocol for developing and testing a methodology for linking behaviour change techniques to theoretical mechanisms of action. Ann Behav Med 52(6):501–512. https://doi.org/10.1007/s12160-016-9816-6
Patey AM, Linklater S, Fedotova A, Brehaut E, McCleary N, Birken S, Francis JJ (2019) Identifying determinants of healthcare professional behaviour using the Theoretical Domains Framework: a systematic scoping review. In: Eur Health Psychol Soc 33rd annual conference, Dubrovnik, Croatia, 2019
Gould GS, Bar-Zeev Y, Bovill M, Atkins L, Gruppetta M, Clarke MJ, Bonevski B (2017) Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women. Implement Sci 12(1):114. https://doi.org/10.1186/s13012-017-0645-1
Chambers A, MacFarlane S, Zvonar R, Evans G, Moore JE, Langford BJ, Augustin A, Cooper S, Quirk J, McCreight L, Garber G (2019) A recipe for antimicrobial stewardship success: using intervention mapping to develop a program to reduce antibiotic overuse in long-term care. Infect Control Hosp Epidemiol 40(1):24–31. https://doi.org/10.1017/ice.2018.281
Atkins L (2016) Using the Behaviour Change Wheel in infection prevention and control practice. J Infect Prev 17(2):74–78. https://doi.org/10.1177/1757177415615952
McEvoy CT, Moore SE, Appleton KM, Cupples ME, Erwin C, Kee F, Prior L, Young IS, McKinley MC, Woodside JV (2018) Development of a peer support intervention to encourage dietary behaviour change towards a Mediterranean diet in adults at high cardiovascular risk. BMC Public Health 18(1):1194. https://doi.org/10.1186/s12889-018-6108-z
Ojo SO, Bailey DP, Brierley ML, Hewson DJ, Chater AM (2019) Breaking barriers: using the behaviour change wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time. BMC Public Health 19(1):1126. https://doi.org/10.1186/s12889-019-7468-8
Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, Foy R et al (2017) A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci 12(1):77. https://doi.org/10.1186/s13012-017-0605-9
Huijg JM, Gebhardt WA, Crone MR, Dusseldorp E, Presseau J (2014) Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research. Implement Sci 9:11. https://doi.org/10.1186/1748-5908-9-11
Cane J, Richardson M, Johnston M, Lahda R, Michie S (2015) From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol 20(1):130–150. https://doi.org/10.1111/bjhp.12102
Cochrane A (1979) Effectiveness and efficiency: random reflections on health services. Nuffield Provincial Hospitals Trust, London
Chakraborty H, Lyons G (2015) Cluster randomized trials: considerations for design and analysis. J Stat Theory Pract 9(3):685–698. https://doi.org/10.1080/15598608.2014.992081
Eccles M, Grimshaw J, Campbell M, Ramsay C (2003) Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Safety Health Care 12(1):47–52. https://doi.org/10.1136/qhc.12.1.47
Hemming K, Eldridge S, Forbes G, Weijer C, Taljaard M (2017) How to design efficient cluster randomised trials. Br Med J 358:j3064
Hemming K, Taljaard M, McKenzie JE, Hooper R, Copas A, Thompson JA et al (2018) Reporting of stepped wedge cluster randomised trials: extension of the CONSORT 2010 statement with explanation and elaboration. Br Med J 363:k1614
Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Br Med J 340:c332
Campbell MK, Piaggio G, Elbourne DR, Altman DG, For the CONSORT Group (2012) Consort 2010 statement: extension to cluster randomised trials. Br Med J 345:e5661
Goodacre S (2015) Uncontrolled before-after studies: discouraged by Cochrane and the EMJ. Emerg Med J 32(7):507–508. https://doi.org/10.1136/emermed-2015-204761
Hudson J, Fielding S, Ramsay CR (2019) Methodology and reporting characteristics of studies using interrupted time series design in healthcare. BMC Med Res Methodol 19(1):137. https://doi.org/10.1186/s12874-019-0777-x
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M (2011) Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Mental Health 38(2):65–76. https://doi.org/10.1007/s10488-010-0319-7
McHugh RK, Otto MW, Barlow DH, Gorman JM, Shear MK, Woods SW (2007) Cost-efficacy of individual and combined treatments for panic disorder. J Clin Psychiatry 68(7):1038–1044. https://doi.org/10.4088/jcp.v68n0710
Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J (2015) Process evaluation of complex interventions: Medical Research Council guidance. Br Med J 350:h1258. https://doi.org/10.1136/bmj.h1258
Hall ARH, Thompson J, Albury C, Matthews J, Hayden J, Etchegary H (2018) What behaviour change techniques are used in interventions to change physican ordering of imaging for low back pain and how have they been evaluated? In: Paper presented at the Choosing Wisely Canada: implementing change, Toronto
Lewin S, Glenton C, Oxman AD (2009) Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. Br Med J 339:b3496. https://doi.org/10.1136/bmj.b3496
Scott SD, Rotter T, Flynn R, Brooks HM, Plesuk T, Bannar-Martin KH, Chambers T, Hartling L (2019) Systematic review of the use of process evaluations in knowledge translation research. Syst Rev 8(1):266. https://doi.org/10.1186/s13643-019-1161-y
Toomey E, Currie-Murphy L, Matthews J, Hurley DA (2015) Implementation fidelity of physiotherapist-delivered group education and exercise interventions to promote self-management in people with osteoarthritis and chronic low back pain: a rapid review part II. Manual Ther 20(2):287–294. https://doi.org/10.1016/j.math.2014.10.012
Nilsen P, Bernhardsson S (2019) Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv Res 19(1):189. https://doi.org/10.1186/s12913-019-4015-3
Dusenbury L, Brannigan R, Falco M, Hansen WB (2003) A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res 18(2):237–256. https://doi.org/10.1093/her/18.2.237
Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S (2007) A conceptual framework for implementation fidelity. Implement Sci 2:40. https://doi.org/10.1186/1748-5908-2-40
Borrelli B (2011) The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials. J Public Health Dent 71(s1):S52–S63. https://doi.org/10.1111/j.1752-7325.2011.00233.x
Haynes A, Brennan S, Redman S, Williamson A, Gallego G, Butow P, CIPHER Team (2016) Figuring out fidelity: a worked example of the methods used to identify, critique and revise the essential elements of a contextualised intervention in health policy agencies. Implement Sci 11(1):23. https://doi.org/10.1186/s13012-016-0378-6
VanderWeele TJ (2016) Mediation analysis: a practitioner’s guide. Annu Rev Public Health 37:17–32. https://doi.org/10.1146/annurev-publhealth-032315-021402
Lee H, McAuley J, Cashin AG, Herbert R, Kamper S, Henschke N, Williams C (2017) Developing a guideline for reporting mediation analyses (AGReMA) in randomized trials and observational studies: protocol. Open Science Framework. doi: https://doi.org/10.31222/osf.io/867k3
Vo TT, Superchi C, Boutron I, Vansteelandt S (2019) The conduct and reporting of mediation analysis in recently published randomized controlled trials: results from a methodological systematic review. J Clin Epidemiol 117:78–88. https://doi.org/10.1016/j.jclinepi.2019.10.001
QoCNL (2019) Reduction in potentially unnecessary biochemical testing by general practitioners in eastern health. https://qualityofcarenl.ca/wp-content/uploads/2019/04/Practice_Points_Volume4_2018.pdf
Hall AM, Scurrey SR, Pike AE, Albury C, Richmond HL, Matthews J, Toomey E, Hayden JA, Etchegary H (2019) Physician-reported barriers to using evidence-based recommendations for low back pain in clinical practice: a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework. Implement Sci 14(1):49. https://doi.org/10.1186/s13012-019-0884-4
Pike A, Mahoney K, Patey AM, Inwood S, Mortazhejri S, Lawrence R, Hall A; De-implementing Wisely Research Group. Protocol for assessing the determinants of preoperative test-ordering behaviour for low-risk surgical procedures using a theoretically driven, qualitative design. BMJ Open. 2020 May 11;10(5):e036511. doi: 10.1136/bmjopen-2019-036511. PMID: 32398338; PMCID: PMC7223279.
Grimshaw JM, Patey AM, Kirkham KR, Hall A, Dowling SK, Rodondi N, Ellen M, Kool T, van Dulmen S, Kerr E, Linklater S, Levinson W, Bhatia RS (2020) De-implementing wisely: developing the evidence base to reduce low-value care. Br Med J Qual Safety 29:409–417. https://doi.org/10.1136/bmjqs-2019-010060
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Science+Business Media, LLC, part of Springer Nature
About this protocol
Cite this protocol
Hall, A., Richmond, H., Mahoney, K., Matthews, J. (2021). Changing Health-Related Behaviors 3: Lessons from Implementation Science. In: Parfrey, P.S., Barrett, B.J. (eds) Clinical Epidemiology. Methods in Molecular Biology, vol 2249. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-1138-8_31
Download citation
DOI: https://doi.org/10.1007/978-1-0716-1138-8_31
Published:
Publisher Name: Humana, New York, NY
Print ISBN: 978-1-0716-1137-1
Online ISBN: 978-1-0716-1138-8
eBook Packages: Springer Protocols