Theory

To increase the consistency and magnitude by which A&F interventions achieve change we need to design interventions informed by extant theory and empirical evidence. Using theory can help to define and clarify potential mechanisms of action helping to create more effective interventions (Colquhoun et al. 2013).

There are many different theories from different disciplines that can be applied to healthcare; some theories are exclusively about feedback whereas some include feedback as a component. Different theories discuss feedback in different context. However, only few studies explicitly used theory to design their A&F intervention and none of them used theory specific to A&F (see Table below).

  • Control Theory suggests that people will develop action plans to achieve behaviour change when observing a discrepancy between current practice and target behaviour.
  • According to Goal Setting Theory people are motivated to achieve a goal rather than eliminate the discrepancy.
  • Feedback Intervention Theory builds upon these two theories and suggests that feedback that directs attention towards acceptable and familiar tasks (as opposed to those that generate emotional responses or cause deep self-reflection) seem most likely to lead to improvement.
  • Clinical Performance Feedback Intervention Theory (CP-FIT) builds upon 30 pre-existing theories and states that effective feedback works in a cycle of sequential processes. Feedback’s success is influenced by several factors: the feedback method used, health professional receiving feedback, and context in which feedback takes place.
Clinical Performance Feedback Intervention Theory’s variables and explanatory mechanisms, and their influence on the feedback cycle. Solid arrows are necessary pathways for successful feedback. Dotted arrows represent potential pathways.

Various recent A&F studies now use these theories in their design such as Gude et al. and Hartley et al.

The theories are also used to evaluate A&F such as Hysong et al. and Gardner et al.

The Table below provides a list of all of the theories identified from the 2012 Cochrane update on audit and feedback interventions. This table has been adapted from Table 1 in Colquhoun et al. 2013

TYPETHEORYAUTHORYEAR
EducationAdult Learning TheoryKnowles1984, 1990
Theory of Medical EducationColes & Holm1993
DiffusionDiffusion of InnovationsRogers1983, 1995
Technology Diffusion TheoryPenland1997
OrganizationDiffusion of Innovations in Service OrganizationsGreenhalgh, Robert, Macfarlane, Bate & Kyriakidou2004
Lawler’s Organization TheoryLawler1976
Organization Development TheoryLevitt1965
Kirkpatrick’s Hierarchy of Levels of EvaluationKirkpatrick1967
PsychologySocial Cognitive TheoryBandura1969, 1986, 1997
Transtheoretical ModelProchaska & DiClemente1982, 1986, 1992
Theory of Reasoned ActionFishbein, Fishbein & Ajzen1979, 1968
Theory of Planned BehaviourAjzen1991
Social Cognitive ModelsConner & Norman1996
Precede/Proceed Planning ModelGreen & Kreeuter1991
Human Error TheoryReason2000
Behavioural Psychology TheoryUllman & Krasner1975
Social Learning TheoryPerry, Baranowski, & Parcel1990
Audit & Feedback SpecificControl TheoryCarver & Scheier1982
Goal Setting TheoryLocke & Latham2002
Feedback Intervention TheoryKluger & Denisi1996