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Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework

Simon D French12*, Sally E Green1, Denise A O’Connor1, Joanne E McKenzie1, Jill J Francis3, Susan Michie4, Rachelle Buchbinder159, Peter Schattner6, Neil Spike6 and Jeremy M Grimshaw78

Author Affiliations

1 School of Public Health and Preventive Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia

2 Primary Care Research Unit, University of Melbourne, 200 Berkeley St, Carlton, Victoria, 3010, Australia

3 Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen, AB25 2ZD , Scotland, UK

4 Centre for Outcomes Research and Effectiveness, Department of Clinical, Educational and Health Psychology, University College London, WC1E 7HB, London, UK

5 Monash Department of Clinical Epidemiology, Cabrini Hospital, Suite 41, Cabrini Medical Centre, 183 Wattletree Road, Malvern, VIC, 3144, Australia

6 Department of General Practice, School of Primary Health Care, Monash University, Bldg 1, 270 Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia

7 Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada

8 Department of Medicine, University of Ottawa, 1053 Carling Avenue Administration Building, Room 2-017, Ottawa, ON, Canada, K1Y 4E9

9 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, Australia, 3004

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Implementation Science 2012, 7:38  doi:10.1186/1748-5908-7-38

Published: 24 April 2012



There is little systematic operational guidance about how best to develop complex interventions to reduce the gap between practice and evidence. This article is one in a Series of articles documenting the development and use of the Theoretical Domains Framework (TDF) to advance the science of implementation research.


The intervention was developed considering three main components: theory, evidence, and practical issues. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components of an implementation intervention: Who needs to do what, differently? Using a theoretical framework, which barriers and enablers need to be addressed? Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? And how can behaviour change be measured and understood?


A complex implementation intervention was designed that aimed to improve acute low back pain management in primary care. We used the TDF to identify the barriers and enablers to the uptake of evidence into practice and to guide the choice of intervention components. These components were then combined into a cohesive intervention. The intervention was delivered via two facilitated interactive small group workshops. We also produced a DVD to distribute to all participants in the intervention group. We chose outcome measures in order to assess the mediating mechanisms of behaviour change.


We have illustrated a four-step systematic method for developing an intervention designed to change clinical practice based on a theoretical framework. The method of development provides a systematic framework that could be used by others developing complex implementation interventions. While this framework should be iteratively adjusted and refined to suit other contexts and settings, we believe that the four-step process should be maintained as the primary framework to guide researchers through a comprehensive intervention development process.