Changing behaviour, ‘more or less’: Investigating \nwhether there is a basis for designing different \ninterventions for implementation and deimplementation.
Bibliographic record
Abstract
Background: The process of decreasing ineffective or harmful healthcare (deimplementation) may require different approaches than those used to promote uptake of new procedures (implementation) but research into different approaches is currently lacking. It has not been determined if there is a theoretical and evidence-based rationale for designing different interventions for implementation and de-implementation. \n \nObjectives: The objectives of this thesis were to: 1) Investigate whether there is a theoretical basis for identifying different mechanisms of change by which behaviour might increase versus decrease; 2) Assess whether predictors of health professional behaviour differ depending on whether behaviour was one clinicians should implement or behaviours clinicians should de-implement; and 3) Identify the Behaviour Change Techniques of published implementation and de-implementation interventions to determine if there is a difference between the techniques reported in these interventions. \n \nMethods: Study 1 used Critical Interpretive Synthesis to investigate whether a theoretical rationale exists for identifying different mechanisms of change by which interventions may work for implementation and de-implementation. Study 2 investigated whether the theoretical constructs commonly used to predict health professional behaviour differ based on whether the behaviours should be implemented or de-implemented. It was an exploratory study involving secondary analysis on 13 existing questionnaire datasets from a variety of healthcare professional groups in primary care settings in the United Kingdom and Canada. Study 3 involved the classification and frequency of Behaviour Change Techniques in implementation and de-implementation interventions from selected Cochrane Effective Practice and Organisation of Care systematic reviews. Findings from these three studies were interpreted using the concurrent triangulation approach to report on the key findings. \n \nResults: Operant Learning Theory (OLT) proposes different approaches to increasing and decreasing behaviour changes and therefore implementation and de-implementation interventions (Studies 1 & 3), despite a number of commonly used theories being poor predictors of behaviours for implementation and de-implementation (Study 2). Additionally, whilst the range of techniques was limited, the technique Behaviour substitution was frequently used to decrease health professionals’ behaviours (Study 3) and also identified as a strategy commonly used to decrease behaviour in general (Study 1). \n \nConclusion: Whilst the findings suggest that OLT may be promising in developing different interventions for implementation and de-implementation, how best to use these OLT principles is unclear. In instances whereby Behaviour substitution is part of a de-implementation intervention, it is not clear how best to identify the substitute behaviour. Additional investigation is required to better inform the design of implementation and de-implementation interventions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.006 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".