Page - 163 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Goal-setting theory [6] posits that people are motivated to achieve a goal rather than reduce discrepancies. In particular, it describes the mechanisms through which goals (comparable to CT’s reference value but set by people themselves) influence behaviour and the relationship between goal characteristics and subsequent performance i.e. goal attainment. The theory proposes that specific goals are more effective than general ones (e.g. ‘do your best’ goals); and that challenging yet achievable goals lead to better performance than both trivial goals and overambitious goals. Feedback intervention theory [5] considers feedback as the provision of information regarding some aspects of someone’s performance on a certain task. According to this theory, people’s behaviour is regulated by goals and standards which are organised, as also posited by CT, in a hierarchical fashion. Attention is limited and usually directed at an intermediate level within the hierarchy; only gaps that receive attention have the potential for change. Feedback works by providing people with new information which allows a shift of attention either toward the task or away from it. An attention shift towards the task tends to strengthen the feedback’s effect on task performance whereas a shift away from it weakens the effect. The theory proposes that feedback characteristics, the nature of the task performed, and situational and personality variables determine how effectively this shift occurs. Social cognitive theory [7] aims to guide the study of human behaviour, thought and motivation. It proposes that environment, behaviour, and personal and cognitive factors all interact as determinants of each other. The theory argues that self-efficacy, the beliefs regarding one’s capabilities of successfully completing tasks, determine what challenges people choose to undertake, how much effort to expend in the endeavour, how long to persevere in the face of obstacles and failures, and whether failures are motivating or demoralising [7]. The relationship between those beliefs and behaviour is described, similar to CT, as a reciprocal learning process in which people select, react to, and learn from experiences. 2. Usage of Control Theory in health informatics There are numerous examples of HI interventions that are based on the principle of a negative feedback loop, although few would explicitly reference CT. So, most references to CT in HI are implicit, and developers of interventions would often not consciously use the negative control loop when they design their tool or software – but the control loop would tacitly play a role in their intervention. The same holds for evaluation studies of interventions that build on CT: such evaluation studies would often assume a feedback loop around which the study is designed, without explicitly referencing CT. It is therefore challenging to assess how broadly CT is used in HI. However, we believe that there is a profound influence of CT on HI, and we will illustrate that by describing various broad areas that involve a feedback loop as a key component. The principal area that we will use to describe the usage of CT in HI is audit and feedback, but we also highlight several other areas. 2.1. Audit and feedback Audit and feedback (A&F) interventions [8] aim to improve the quality of care by comparing observed quality parameters (quality indicators) with predefined quality targets or benchmark values. Typically, feedback on quality indicators is delivered to W.T.GudeandN.Peek /ControlTheory toDesignandEvaluateAuditandFeedback Interventions 163