Skip to main content

Table 3 Specification of the target behaviour according to the principle of behavioural specificity

From: A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems

Study title
 Evaluation of a TDF-informed implementation intervention for the management of acute low back pain in general medical practice
Rationale for changing behaviour
 Management of low back pain in general medical practice is common, but this management is not always concordant with recommended evidence-based guidelines. In particular, x-rays are overused which leads to unnecessary harm due to radiation exposure and possible detection of incidental irrelevant findings, and an intervention of known effectiveness, giving advice to stay active, is underused.
Study design and materials
 Three phase study:
1. Qualitative methods: focus groups with general practitioners (GPs) (n = 42) using TDF to identify barriers to and facilitators of two evidence-based target behaviours related to the management of acute low back pain: one related to diagnosis, that plain film x-rays are necessary only if fracture is suspected, and one related to treatment, that of providing advice to stay active, including the avoidance of advising more than two days of bed rest. Here is an example of specifying these behaviours using the criteria: Who is performing the behaviour? What do they need to do? When do they need to do it? Where do they need to do it? If applicable, the behaviour should also be specified in terms of how often and with whom it should be done.
Behaviour 1: Manage patients without referring for plain X-ray
Who–GPs
What–Manage patients with acute low back pain without referring for plain X-ray
When–On assessment or review of patients presenting with acute, uncomplicated low back pain of less than 3 months duration and without any serious underlying pathology suspected
Where–In clinic
How often–On assessment and review
With whom–Behaviour not depended on others
Behaviour 2: Provide advice to stay active
Who–GPs
What–Provide advice to stay active
When–When managing patients with acute, uncomplicated low back pain of less than 3 months duration and without any serious underlying pathology suspected
Where–In clinic
How often–On assessment and review
With whom–Behaviour not depended on others
2. Intervention development: mapping of barriers and facilitators within TDF domains to behaviour change techniques (detail provided in French et al. [36]). The TDF was used to guide the choice of behaviour change techniques and intervention components.
3. Cluster randomised trial: evaluation of a TDF-based intervention compared to simple dissemination of the guideline (results provided in French et al. [69]). Outcomes measured included behavioural predictors (e.g. knowledge, attitudes and intentions), fear avoidance beliefs, behavioural simulation (clinical decision about vignettes) and rates of X-ray and CT-scan (medical administrative data). Forty seven practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention.
Findings and conclusions
 The TDF allowed for the systematic identification of multiple barriers and facilitators in general medical practice and subsequent mapping to behaviour change techniques. The intervention consisted of interactive workshops designed to improve the knowledge, skills, intentions and clinical decision-making of the general practitioners. The intervention had some influence on GP adherence to an evidence-based guideline for the management of lower back pain at 12 months post-intervention. Overall, the intervention led to small changes in GP intention to practice in a manner consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour measured via administrative data.
Study outputs
 French et al. [36, 69]; Page et al. [70]; McKenzie et al. [71]