Use of theory in process evaluations of healthcare professional behaviour change interventions: a systematic review

Abstract

Background: Understanding how, why, and under what conditions interventions are effective remain critical issues for advancing health psychology and improving health care delivery. Process evaluations (PEs) explore such issues. The Medical Research Council guidance for designing and conducting PEs of complex interventions recommends explicitly using theory. However, whether and how theory has been applied in PEs of healthcare professional (HCP) behaviour change interventions is unclear. This review aims to investigate (a) to what extent, and (b) how theory has been used in PEs of HCP behaviour change interventions. Methods: Electronic databases will be searched using terms related to: process evaluation, healthcare professionals, behaviour/practice change, and intervention. Eligible studies will report a PE of a HCP behaviour change intervention. Data extraction will include study characteristics and the extent to which theory is used. Extracted data from PEs employing theory will include: types of theories used, theoretical constructs measured, and description of cause-and-effect associations between theoretical constructs. Expected results: This review will provide an overview of current theory use in PEs, and describe the state-of-the-science in PE literature. Current stage of work: Search strategy, eligibility criteria, and data extraction sheets have been drafted. Based on scoping searches for ‘gold-standard’ articles, precision of the search strategy is acceptable (11%). Discussion: Establishing current theory use in PEs is essential for optimising the application of theory in PEs. Review findings will inform a theory-based PE of an audit-and-feedback intervention aiming to improve blood transfusion practice and may similarly inform the design of other theory-based PEs.