Page - 166 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

been only recently that the use of extant theory has been recognised as an essential component of both the design and evaluation of A&F interventions [21]. In response there have been various studies making explicit use of CT to enhance understanding the A&F’s underlying mechanisms in improving healthcare and quality interventions. We have selected four recent studies that jointly illustrated the breadth of activities that can be supported with CT. These activities include interpreting published literature; designing new interventions; secondary analysis of clinical trial data; and the design of new scientific experiments. 3.1. Synthesising evidence from A&F interventions In an illustration of how theory can be used to synthesise published evidence from behaviour change interventions, Gardner et al. [22] used CT to organise, understand and synthesise evidence relating to behaviour change techniques within A&F. Using CT as conceptual framework, the authors hypothesise that A&F may be enhanced through the use of specific performance targets to permit comparison between current and target performance, and action plans to inform behavioural adjustment to reduce discrepancy [22]. The authors conducted a re-analysis of the 2006 Cochrane review [23], recoding each study included in the review, to test target-setting and action plans as effect- modifiers of A&F. The results however were inconclusive because very few studies explicitly described their use of targets or action plans. When Ivers et al. updated the Cochrane review in 2012 [8], and repeated Gardner’s analysis, explicit targets and action plans were found to be significant effect modifiers of A&F. 3.2. Improving the design of A&F to increase uptake of evidence-based blood transfusion practice The second illustration is a study by Gould et al. [24] that used CT to enhance the content of a feedback intervention for improving blood transfusion practice. The authors describe the feedback loop as a dynamic, iterative process of control in which “individuals manage their behaviour by knowing what they want to do or achieve (i.e. setting a goal or standard), trying to do it (i.e. action), monitoring the behaviour (i.e. audit), assessing whether they are making progress towards the goal (i.e. feedback, which informs the nature and extent of any discrepancy between behaviour and goals), and adapting what they do in light of the feedback (i.e. action planning)” [24, page 2]. They also used the taxonomy of behavioural change techniques [25] for identifying and describing intervention components that are consistent with CT and that may enhance practice. A number of the techniques included in the taxonomy encompass strategies proposed in CT, such as ‘goal setting’; ‘feedback on behaviour’; ‘discrepancy between behaviour and goal’; and ‘action planning’. The authors then aimed to enhance content in feedback documents by incorporating behavioural change techniques consistent with CT that were previously absent. For example, to incorporate goal setting as a change technique, the authors added an introductory statement in documents that proposes an evidence-based goal, e.g. “XX% of patients with [XX clinical attributes] are likely to require transfusion and so we suggest that, within your clinical team, you make this your explicit goal”. The authors propose that such enhanced feedback has the potential to facilitate the enactment of CT’s feedback processes and lead to larger improvements. W.T.GudeandN.Peek /ControlTheory toDesignandEvaluateAuditandFeedback Interventions166