Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

Background: The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose: This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods: Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results: Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion: The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF

Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

Cameron J Phillips,1,2 Andrea P Marshall,3,4 Nadia J Chaves,5 Stacey K Jankelowitz,6,7 Ivan B Lin,8 Clement T Loy,9,10 Gwyneth Rees,11 Leanne Sakzewski,12 Susie Thomas,13,14 The-Phung To,15 Shelley A Wilkinson,16,17 Susan Michie18 1Division of Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia; 2School of Medicine, Flinders University, Adelaide, SA, Australia; 3Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Southport, QLD, Australia; 4Gold Coast University Hospital, Southport, QLD, Australia; 5Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia; 6Central Clinical School, Sydney Medical School, University of Sydney, 7Institute of Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia; 8Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia; 9School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 10Huntington Diseases Centre, Westmead Hospital, Westmead, NSW, Australia; 11Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; 12Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, QLD, Australia; 13Physiotherapy Department, Flinders Medical Centre, Bedford Park, SA, Australia; 14International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, Adelaide, SA, Australia; 15Pharmacy Department, Austin Health, Heidelberg, VIC, Australia; 16Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia; 17Department of Nutrition and Dietetics, Mater Health Services, South Brisbane, QLD, Australia; 18University College London Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College, London, UK Background: The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose: This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods: Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results: Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion: The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF. Keywords: barriers and enablers, behavioral change, evidence-based practice, implementation, health care, Theoretical Domains Framewor

Electrical vestibular stimuli to enhance vestibulo-motor output and improve subject comfort

Electrical vestibular stimulation is often used to assess vestibulo-motor and postural responses in both clinical and research settings. Stochastic vestibular stimulation (SVS) is a recently established technique with many advantages over its square-wave counterpart; however, the evoked muscle responses remain relatively small. Although the vestibular-evoked responses can be enhanced by increasing the stimulus amplitude, subjects often perceive these higher intensity electrical stimuli as noxious or painful. Here, we developed multisine vestibular stimulation (MVS) signals that include precise frequency contributions to increase signal-to-noise ratios (SNR) of stimulus-evoked muscle and motor responses. Subjects were exposed to three different MVS stimuli to establish that: 1) MVS signals evoke equivalent vestibulo-motor responses compared to SVS while improving subject comfort and reducing experimentation time, 2) stimulus-evoked vestibulo-motor responses are reliably estimated as a linear system and 3) specific components of the cumulant density time domain vestibulo-motor responses can be targeted by controlling the frequency content of the input stimulus. Our results revealed that in comparison to SVS, MVS signals increased the SNR 3-6 times, reduced the minimum experimentation time by 85% and improved subjective measures of comfort by 20-80%. Vestibulo-motor responses measured using both EMG and force were not substantially affected by nonlinear distortions. In addition, by limiting the contribution of high frequencies within the MVS input stimulus, the magnitude of the medium latency time domain motor output response was increased by 58%. These results demonstrate that MVS stimuli can be designed to target and enhance vestibulo-motor output responses while simultaneously improving subject comfort, which should prove beneficial for both research and clinical applications.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin