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A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice

Signe A Flottorp12*, Andrew D Oxman1, Jane Krause3, Nyokabi R Musila4, Michel Wensing5, Maciek Godycki-Cwirko6, Richard Baker3 and Martin P Eccles7

Author Affiliations

1 Norwegian Knowledge Centre for the Health Services, Oslo, Norway

2 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

3 Department of Health Sciences, University of Leicester, Leicester, UK

4 African Institute for Development Policy (AFIDEP), Nairobi, Kenya

5 Scientific Institute for Quality of Healthcare, Nijmegen, Radboud University Nijmegen Medical Centre, Geert Grooteplein, Nijmegen, the Netherlands

6 Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland

7 Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK

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Implementation Science 2013, 8:35  doi:10.1186/1748-5908-8-35

Published: 23 March 2013



Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive, integrated checklist of determinants of practice (the TICD checklist).


We performed a systematic review of frameworks of determinants of practice followed by a consensus process. We searched electronic databases and screened the reference lists of key background documents. Two authors independently assessed titles and abstracts, and potentially relevant full text articles. We compiled a list of attributes that a checklist should have: comprehensiveness, relevance, applicability, simplicity, logic, clarity, usability, suitability, and usefulness. We assessed included articles using these criteria and collected information about the theory, model, or logic underlying how the factors (determinants) were selected, described, and grouped, the strengths and weaknesses of the checklist, and the determinants and the domains in each checklist. We drafted a preliminary checklist based on an aggregated list of determinants from the included checklists, and finalized the checklist by a consensus process among implementation researchers.


We screened 5,778 titles and abstracts and retrieved 87 potentially relevant papers in full text. Several of these papers had references to papers that we also retrieved in full text. We also checked potentially relevant papers we had on file that were not retrieved by the searches. We included 12 checklists. None of these were completely comprehensive when compared to the aggregated list of determinants and domains. We developed a checklist with 57 potential determinants of practice grouped in seven domains: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organisational change, and social, political, and legal factors. We also developed five worksheets to facilitate the use of the checklist.


Based on a systematic review and a consensus process we developed a checklist that aims to be comprehensive and to build on the strengths of each of the 12 included checklists. The checklist is accompanied with five worksheets to facilitate its use in implementation research and quality improvement projects.