Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework.

Area of Science:

• Healthcare quality improvement
• Behavioral science in medicine
• Osteoporosis management

Background:

• Behavioral theory can explain intervention effectiveness in healthcare, but is often implicitly used.
• A quality gap exists in post-fracture osteoporosis investigation (BMD scanning) and management (bisphosphonate prescription).

Purpose of the Study:

• To retrospectively identify theoretical factors targeted by interventions aimed at improving post-fracture care using the Theoretical Domains Framework (TDF).
• To explore the relationship between targeted theoretical domains and intervention effectiveness for bone mineral density (BMD) scanning and bisphosphonate prescription.

Main Methods:

• A systematic review of nine randomized controlled trials (RCTs) involving 10 interventions was conducted.
• A behavioral scientist and clinician independently coded intervention and control groups using TDF domains.
• Quantitative analyses examined the link between intervention effect size and the number of TDF domains targeted.

Main Results:

• Interventions frequently targeted "memory, attention and decision processes," "knowledge," "environmental context and resources," "social influences," and "beliefs about consequences."
• An inverse relationship was observed between the number of TDF domains targeted and the effect size for BMD scanning.
• No significant relationship was found between the number of targeted domains and the effect size for bisphosphonate prescription.

Conclusions:

• The TDF can retrospectively identify targeted behavioral determinants in implementation interventions, even when theory use is not explicit.
• Several likely determinants of healthcare professional behavior in osteoporosis management may not have been adequately addressed by current interventions.
• This retrospective TDF application can inform future implementation strategies in various healthcare contexts.