Theoretical bases of interventions to improve use of medicines and tests

Abstract

Programs to improve prescribing or use of diagnostic tests must be well designed if they are to be effective. This requires an understanding of what the behaviour is, why it occurs, the context of the consultation, factors influencing the main protagonists (doctor and patient) and the wider environment. A large number of behaviour change theories have been put forward to explain prescribing behaviour and a whole series of decision-making biases are known to be important. How then can an implementation practitioner navigate this extensive literature, based strongly on psychology and design program interventions that are both achievable and likely to work? This chapter summarises important theoretical constructs and frameworks and points to three tools for use in primary care interventions: mindlines as a means of assimilation of information among general practitioners; a 360-degree assessment of the complexity of change; and a practical framework that brings together critical theoretical components into an operational tool.