How can use of the Theoretical Domains Framework be optimized in qualitative research? A rapid systematic review

The Theoretical Domains Framework (TDF) is an integrative framework which can facilitate comprehensive assessment of behavioural determinants in qualitative studies. However, studies can become entirely deductive if they adhere rigidly to the provided guidance and may thus overlook important factors. This review identified the number of TDF-related qualitative publications employing health care professional (HCP) or patient/public samples (stage 1) and investigated the specific methods used and impact on findings in research involving patient/public populations, with consideration of how TDF use could be optimized in such studies (stage 2).

A rapid systematic review of TDF-based qualitative studies was conducted. Studies were included in stage 1 that had (1) used qualitative methods of both data collection and analysis and (2) used the TDF to inform data collection and/or analysis. Stage 2 included studies from stage 1 that employed patient/public populations and explored influences of behaviour. These studies were coded for instances of TDF use with respect to data collection, analysis, and reporting of findings.

In stage 1, 186 TDF-based qualitative studies were identified (HCP = 123; patient/public = 43; both = 20). Thirty-eight of these were eligible for inclusion in stage 2. Many of these studies used the TDF in a highly structured way within data collection, and the majority used a deductive approach to analysis. Most studies presented findings confined to TDF domains, with no non-TDF material presented.

Rigid operationalization of the TDF in qualitative studies may result in determinants being overlooked. We propose recommendations for flexible use of the TDF in order to optimize its use in exploratory qualitative research.