Our meeting at the end of August started with the ice-breaker question “If you could choose any device to help you in your everyday life, what would you like to have?” Whilst I’m sure we would all have a lovely long wish list, some of the favourites included a device to translate thoughts into brilliantly written papers ready for publication; a magic wand to get jobs done quickly; and a babel fish to translate any language.
The focus of our meeting was to explore the Theoretical Domains Framework (TDF) and its use in research. Ruth Backman, a research fellow from the Institute of Applied Health Research, kindly shared her experience of using the TDF in an intervention development study1. Her paper detailing this example of TDF in practice can be found by following the link:
The development and implementation of behavioural change interventions forms a key part of applied health research. The TDF aims to assist in this process by offering an integrative framework to help researchers apply psychological theories to behavioural change interventions. 2
The TDF was developed by Professor Susan Michie and her team at UCL. They synthesised existing psychological theories and integrated these into a simplified and useable framework. In this process, 33 theories were identified, from which 128 theoretical constructs were generated. These were then grouped into 12 domains which could be categorised into three broad groups: motivational, action and organisational theories. This original framework was refined in 2012 and now comprises of 14 domains to encompass 83 theoretical constructs as illustrated in Table 1. 3
|1. Knowledge||Knowledge (including knowledge of condition / scientific rationale), Procedural knowledge, Knowledge of task environment|
|2. Skills||Skills, Skill development, Competence, Ability, Interpersonal skills, Practice, Skill assessment|
|3. Professional role and Identity||Professional identity, Professional role, Social identity, Identity, Professional boundaries, Professional confidence, Group identity, Leadership, Organisational commitment|
|4. Beliefs about capabilities||Self-confidence, Perceived competence, Self-efficacy, Perceived behavioural control, Beliefs, Self-esteem, Empowerment, Professional confidence|
|5. Optimism||Optimism, Pessimism, Unrealistic optimism, Identity|
|6. Beliefs about consequence||Beliefs, Outcome expectancies, Characteristics of outcome expectancies, Anticipated regret, Consequents|
|7. Reinforcement||Rewards (proximal / distal, valued / not-valued, probable / improbable), Incentives, Punishment, Consequents, Reinforcement, Contingencies, Sanctions|
|8. Intentions||Stability of intentions, Stages of change model, Transtheoretical model and stages of change|
|9. Goals||Goals (distal / proximal), Goal priority, Goal/ target setting, Goals (autonomous / controlled), Action planning, Implementation intention|
|10. Memory, Attention and Decision Processes||Memory, Attention, Attention control, Decision making, Cognitive overload / tiredness|
|11. Environmental context and resources||Environmental stressors, Resources / material resources, Organisational culture / climate, Salient events / critical incidents, Person x environment interaction, Barriers and Facilitators|
|12. Social influences||Social pressure, Social norms, Group conformity, Social comparisons, Group norms, Social support, Power, Intergroup conflict, Alienation, Group identity, Modelling|
|13. Emotions||Fear, Anxiety, Affect, Stress, Depression, Positive/ negative affect, Burn-out|
|14. Behavioural regulation||Self-monitoring, Breaking habit, Action planning|
Table 1 (Refined framework taken from Michie, 2012 3)
The TDF can be used to theoretically inform research either prospectively by directing the development of data collection tools, or retrospectively as part of the process evaluation process. 2
Using the TDF reportedly increases researchers’ confidence in their approach to data collection as the framework offers a “systematic approach” with a “broad perspective” 2. Furthermore, by encompassing a large number of constructs, the TDF may be applied to range of intervention types and can thus provide a commonality among different interventions that may be developed in the future.
However, the TDF is still fairly new and as identified in our discussion, collaboration is required to assist the successful application of TDF in the future. It also became apparent through the discussion of Ruth’s example that there is a need for a framework which will complement the TDF but will explore the modes of delivery of interventions.
- TDF is not difficult to use if the questions are framed sensitively and appropriately to the topic of research
- It is a useful tool to help develop an understanding of behavioural change systematically
- The practicality of applying behavioural change theories is the main issue as real world settings can be complex
- Alternative factors effecting behaviour change can include internal and external factors e.g. social networks
Many of our members think ECRAG would benefit from having a regular behavioural change meeting. Therefore, we will try and facilitate a group as regularly as possible. For further information please contact firstname.lastname@example.org to be added to the mailing list for future events.
- Backman R, Foy R, Michael B, Defres S, Kneen R, Solomon T. The development of an intervention to promote adherence to national guidelines for suspected viral encephalitis. Implementation Science. 2015;10(1).
- Wilkinson S, Thomas S, Phillips C, Marshall A, Chaves N, Jankelowitz S et al. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study. Journal of Multidisciplinary Healthcare. 2015;:139.
- Michie S. Development and validation of the Theoretical Domains Framework. Presentation presented at Knowledge Translation Canada; 2012; Ottowa, Canada.