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Table 6 Using the TDF to understand effect size; the example of post-fracture management of patients at risk of osteoporosis

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

Study title
 Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework
Rationale for changing behaviour
 There is evidence that two behaviours related to post-fracture management of patients at risk of osteoporosis are sub-optimally performed: 1) primary and secondary healthcare professionals scanning bone mineral density and 2) prescribing anti-resorptive therapy (bisphosphonate medication). This study used the TDF to identify which theoretical factors were targeted in a systematic review of interventions to improve quality of care in post-fracture investigation and their relation to observed effect sizes.
Study design and materials
 A behavioural scientist and a clinician independently coded TDF domains in intervention and control groups in 10 interventions identified in a systematic review. For example, part of an intervention describing an ‘algorithm for diagnosis and treatment of osteoporosis’ was coded in the domain memory, attention and decision processes. Pearson’s correlations were used to explore the relationship between intervention effect size and total number of domains identified in reviews.
Findings and conclusions
 The five domains coded most frequently (in order of frequency highest to lowest) were:
1. Memory, attention and decision processes
2. Knowledge
3. Environmental context and resources
4. Social influences
5. Beliefs about consequences
 Correlational analysis identified a statistically significant inverse relationship between both the domain count and frequency with the observed effect size in interventions for scanning bone mineral density, i.e. interventions with a small number of domains coded infrequently tended to have larger effect sizes than interventions with a greater number of domains coded more frequently. This relationship was not observed for interventions to improve bisphosphonate prescribing.
Study outputs
 Little et al. [74]