Theoretical domains framework to assess barriers to change for planning health care quality interventions: a systematic literature review

Abstract

BackgroundTheoretical domains framework (TDF) provides an integrative model for assessing barriers to behavioral changes in order to suggest interventions for improvement in behavior and ultimately outcomes. However, there are other tools that are used to assess barriers.ObjectiveThe objective of this study is to determine the degree of concordance between domains and constructs identified in two versions of the TDF including original (2005) and refined version (2012) and independent studies of other tools.MethodsWe searched six databases for articles that studied barriers to health-related behavior changes of health care professionals or the general public. We reviewed quantitative papers published in English which included their questionnaires in the article. A table including the TDF domains of both original and refined versions and related constructs was developed to serve as a reference to describe the barriers assessed in the independent studies; descriptive statistics were used to express the results.ResultsOut of 552 papers retrieved, 50 were eligible to review. The barrier domains explored in these articles belonged to two to eleven domains of the refined TDF. Eighteen articles (36%) used constructs outside of the refined version. The spectrum of barrier constructs of the original TDF was broader and could meet the domains studied in 48 studies (96%). Barriers in domains of “environmental context and resources”, “beliefs about consequences”, and “social influences” were the most frequently explored in 42 (84%), 37 (74%), and 33 (66%) of the 50 articles, respectively.ConclusionBoth refined and original TDFs cataloged barriers measured by the other studies that did not use TDF as their framework. However, the original version of TDF explored a broader spectrum of barriers than the refined version. From this perspective, the original version of the TDF seems to be a more comprehensive tool for assessing barriers in practice.

Implementation, context and complexity

“…As reviews by Lau et al [ 7 , 8 ] have shown, changes in policy direction, organisational turbulence and the exigencies of everyday work in complex healthcare settings, all affect implementation processes. Such problems are also consistently shown to be centrally important in studies informed by psychological theories [ 9 ].…”

Applying the Theoretical Domains Framework to understand knowledge broker decisions in selecting evidence for knowledge translation in low- and middle-income countries

“…Most findings of influences on evidence use surfaced by the TDF agree with ones mentioned in the literature, whilst a few disagreed. The high relevance of Belief About Consequences coincides with findings showing that healthcare professionals tend to act on knowledge if they believe it will have positive consequences for the care of patients (or not act upon it in the case of anticipated negative outcomes) [11, 38–40]. The strong influence on KBs of the anticipated health outcomes resulting from evidence use may link to the fact that many KBs in the study had hybrid professional roles, including responsibility for applying knowledge (such as through healthcare service delivery) as well as knowledge brokering.…”

Nutritionists and the comprehensive care of overweight individuals in primary care

“…The Theoretical Domains Framework has proven to be a useful tool for a systematic approach to identify barriers in work processes, contributing to the planning of more effective interventions by recognizing that barriers have different natures and therefore require different interventions. In this research, the model was used to identify which barriers impact the possibility of performing comprehensive care for overweight individuals in primary care [18,19].…”