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Changing behaviour, 'more or less': do implementation and de-implementation interventions include different behaviour

Andrea M Patey1,2, Jeremy M Grimshaw3,4, Jill J Francis5,3,6

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Summary
This summary is machine-generated.

Implementing and de-implementing healthcare practices may use different behavior change techniques (BCTs). This study found some distinct BCTs were more frequently used in implementation versus de-implementation interventions for clinician behavior change.

Keywords:
Behaviour changeDe-implementation versus implementationIntervention contentIntervention designTaxonomyTechniques

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Area of Science:

  • Healthcare practice change
  • Behavioral science in medicine
  • Clinical intervention research

Background:

  • De-implementation of ineffective or harmful healthcare practices may necessitate different strategies than implementing effective practices.
  • Existing psychological theories often lack differentiation between processes for decreasing versus increasing behavior.
  • It remains unclear if current implementation and de-implementation interventions employ distinct approaches.

Purpose of the Study:

  • To investigate whether implementation and de-implementation interventions for clinician behavior change utilize different behavior change techniques (BCTs).
  • To compare the frequency and types of BCTs used in interventions aimed at increasing versus decreasing specific clinical behaviors.

Main Methods:

  • A systematic review of 181 articles from the Cochrane Library was conducted.
  • Intervention descriptions were coded for implementation versus de-implementation and for specific BCTs using the BCT Taxonomy v1.
  • Frequencies of identified BCTs were compared between implementation and de-implementation interventions using statistical tests.

Main Results:

  • Twenty-nine BCTs were identified in implementation interventions and 25 in de-implementation interventions.
  • Feedback on behavior was more common in implementation interventions.
  • Behavior substitution, monitoring without feedback, and restructuring the social environment were more frequent in de-implementation interventions.

Conclusions:

  • Significant differences in BCTs used suggest researchers may implicitly theorize distinct techniques for implementation and de-implementation.
  • These findings highlight frequently used BCTs but do not confirm their effectiveness.
  • Replication across a wider range of clinical behaviors is needed to refine intervention design for both implementation and de-implementation.