Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Implement Sci. 2019 Dec 5;14(1):102. doi: 10.1186/s13012-019-0951-x.
Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention's effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system.
We used French et al.'s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions.
Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions.
为了改变医疗保健提供者和卫生系统中其他专业人员的行为，需要详细说明目标行为，以确保干预措施的组成部分与测量结果保持一致。详细的行为规范可以帮助澄清证据与实践之间的差距，明确需要谁改变行为，确定可改变的障碍和促进因素，设计干预措施以解决这些问题，并最终提供一个衡量干预措施对行为改变效果的指标。现有的行为规范框架提出了四个领域（目标、行为、环境、时间；TACT），但没有足够明确地说明谁在执行行为（即执行者）。在由多个不同的人执行多种行为的医疗保健环境中，明确执行者尤其重要。我们提出并描述了对 TACT 的扩展和重新排序，以增强其对实施干预设计师、从业者和试验人员的实用性：行为、执行者、环境、目标、时间（AACTT）框架。我们旨在展示其在实施研究的关键步骤中的应用，并提供其在实践中的使用工具，以澄清医疗保健系统中多个层次的利益相关者的行为。
我们使用 French 等人的四步实施过程模型来描述 AACTT 框架在（a）明确需要谁改变行为，（b）识别障碍和促进因素，（c）选择适合目的的干预策略和组成部分，（d）评估实施干预措施方面的潜在应用。
使用 AACTT 框架描述和详细说明行为可能有助于增强对理论构建的测量，为主题指南和问卷的开发提供信息，增强实施干预措施的设计，并澄清评估实施干预措施的结果测量。
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