Seite - 162 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Figure 2. Three-level hierarchy of interconnected feedback loops (from [1]). Especially amongst human behaviour theorists it is thought that hierarchies may have many levels of control [4], where behaviour outputs at the highest level are to live up to one’s self-image (e.g. to be a responsible and thoughtful person) and go all the way down to muscle movements at the lowest level. So, while the basic negative feedback loop from the thermostat example is relatively simple and has limited applicability in the real world, the hierarchical approach enables modelling of arbitrarily complex systems, both in the mechanical, biological, and behavioural world. 1.3. Alternative strategies of reducing discrepancies Feedback loops involving human behaviour are more complex than in relatively simple systems such as the thermostat. Whereas ideally potential discrepancies are resolved through behaviour, an alternative strategy is to change the reference value so that it better matches the input value. Both responses would effectively reduce perceived discrepancies, however with a different effect on the environment. For example, people being confronted by the fact that they are not achieving a lifestyle goal (e.g. walking 10,000 steps a day) sometimes respond by changing the goal rather than changing their behaviour. Other options are to reject the reference value, or to abandon the situation (physically or mentally) that signals the discrepancy, e.g. deeming the reference value unachievable or discounting the presented data or source. For instance, professionals may question the quality of underlying data when feedback on their performance indicates that it is below par. It is difficult to predict which strategy will be used in response to perceptions of discrepancies, but it is likely that alternative strategies are used when attempts by the output function to change the input seem to repeatedly fail or if the discrepancy is perceived to have a low likelihood of reduction through actions [5]. 1.4. Similarities and differences with related theories Several other theories use the concept of feedback as a central component. Key examples are goal-setting theory (Locke & Latham [6]), feedback intervention theory (Kluger & DeNisi [5]), and social cognitive theory (Bandura [7]). W.T.GudeandN.Peek /ControlTheory toDesignandEvaluateAudit andFeedback Interventions162