Theoretical domains framework to assess barriers to change for planning health care quality interventions: a systematic literature review

Abstract

Background

Theoretical domains framework (TDF) provides an integrative model for assessing barriers to behavioral changes in order to suggest interventions for improvement in behavior and ultimately outcomes. However, there are other tools that are used to assess barriers.

Objective

The objective of this study is to determine the degree of concordance between domains and constructs identified in two versions of the TDF including original (2005) and refined version (2012) and independent studies of other tools.

Methods

We searched six databases for articles that studied barriers to health-related behavior changes of health care professionals or the general public. We reviewed quantitative papers published in English which included their questionnaires in the article. A table including the TDF domains of both original and refined versions and related constructs was developed to serve as a reference to describe the barriers assessed in the independent studies; descriptive statistics were used to express the results.

Results

Out of 552 papers retrieved, 50 were eligible to review. The barrier domains explored in these articles belonged to two to eleven domains of the refined TDF. Eighteen articles (36%) used constructs outside of the refined version. The spectrum of barrier constructs of the original TDF was broader and could meet the domains studied in 48 studies (96%). Barriers in domains of “environmental context and resources”, “beliefs about consequences”, and “social influences” were the most frequently explored in 42 (84%), 37 (74%), and 33 (66%) of the 50 articles, respectively.

Conclusion

Both refined and original TDFs cataloged barriers measured by the other studies that did not use TDF as their framework. However, the original version of TDF explored a broader spectrum of barriers than the refined version. From this perspective, the original version of the TDF seems to be a more comprehensive tool for assessing barriers in practice.

Keywords:

• theoretical domains framework
• TDF
• practice change
• health care quality improvement
• barriers

Disclosure

The authors report no conflicts of interest in this work.

Author contributions

MM contributed to the conception and design of the study, and the acquisition, analysis, and interpretation of data. HHS contributed to acquisition, analysis, and interpretation of data. NK and JPC contributed to conception and design of the study. All authors contributed toward drafting and critically revising the paper, read and approved the final manuscript, and agree to be accountable for all aspects of the work. This project was not supported by any funding.