Using psychological theory to better implement evidence in healthcare: literature review and proposed theoretical framework

Abstract

Background: Clinical practice often fails to draw on best available evidence to meet the needs of patients. The reasons for this are not well understood, but involve factors at the individual, organisational and system level. Psychology can shed light on this health professional behaviour, but is currently under-used in implementation research. This paper aims to assess the use of psychology to support implementation research, and proposes a novel, multi-level theoretical framework for using psychological theory to better understand implementation. Methods: A systematic review of literature on the use of psychological theory to support implementation of evidence-based practice in healthcare, drawing on a protocol-driven search strategy supplemented with emergent strategies including snowball searching, theoretically-driven searches drawing on the diffusion of innovations framework and professional networks. Results: The literature review identified four strands of psychological research that are used to support implementation of best evidence in healthcare: • use of individual psychological theories, principally the theory of planned behaviour; • use of multiple psychological theories adapted to the individual professional; • use of compendiums of psychological constructs, principally the Theoretical Domains Framework; • and integration of psychological constructs into wider implementation models. Discussion: Psychology remains largely detached from implementation research; its use is limited and mostly not theory-based. One reason is the difficulty of incorporating complex psychological theories into already-complex multi-level implementation models. Integrating psychological theories into the diffusion of innovations framework (widely used in implementation research in healthcare settings) offers a practical means of bridging this gap.