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TDF (Theoretical Domain Framework): how inclusive are TDF domains and
constructs compared to other tools for assessing barriers to change?

Article in BMC Health Services Research · July 2014

DOI: 10.1186/1472-6963-14-S2-P81

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 Sarmast et al. BMC Health Services Research 2014, 14(Suppl 2):P81
http://www.biomedcentral.com/1472-6963/14/S2/P81
POSTER PRESENTATION
TDF (Theoretical Domain Framework): how inclusive
are TDF domains and constructs compared to other
tools for assessing barriers to change?
Hamideh Sarmast1,2, Mirkaber Mosavianpour2,3*, Jean-Paul Collet2,3, Niranjan Kissoon2,3
From Health Services Research: Evidence-based practice
London, UK. 1-3 July 2014
Background
Theoretical Domain Framework (TDF) provides an inte-
grative conceptual model for assessing barriers to change.
The TDF questionnaire has been applied by healthcare
researchers in several countries for assessing barriers to
performance improvement implying its possible usefulness
in behavior modification.
Aim
The purpose of this study is to review published literature
on barriers to change using specific tools created without
adhering to TDF theoretical framework and to investigate
whether these tools incorporate domains and constructs
of the TDF questionnaire.
Materials and methods
We conducted a systematic literature review. We searched
for papers in MEDLINE OVIDSP, PubMed, CINAHL,
PsycINFO (that includes full text from PsycARTICLES),
EBSCO Databases: Academic Search Complete and
Google Scholar from beginning until April 2014. Selection
criteria We included all papers that investigated barriers to
change in health-related behavior or changing practice in
health-related workplaces regardless of study design. Only
papers published in English were included. We included in
our review manuscripts that included the questionnaires
either as attachment or in the content of the article. Dupli-
cate studies were eliminated from the review by comparing
authors’ names, type and location of study.
Data abstraction Study review and data abstraction
were conducted by two reviewers working independently.
2
Child and Family Research Institute (CFRI), Vancouver, British Columbia,
Canada
Full list of author information is available at the end of the article
© 2014 Sarmast et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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Open Access
Disagreements were resolved by discussion and referring
unresolved issues to a third person.
Results
Of 552 papers initially identified, 50 papers were selected
for final review. The average number of items in the ques-
tionnaires assessing barriers was 19.2. In total the 50 ques-
tionnaires included 961 items, out of which 96.8% (930
out of 961) were covered by TDF. The “Environmental
Context and Resources”, “Beliefs about consequences” and
“Social Influence” were the domains of TDF that most
frequently studied in the selected papers: 30.2%, 12.4% and
10.3%, respectively.
Conclusions
This study confirms the validity of TDF framework to
assess barriers to change: only 2.2% of 961 items identified
were not covered by the TDF questionnaire. However,
unclear boundaries between domains and the difficulty in
identifying the appropriate construct were two issues iden-
tified that may be worth considering to improve the
framework.
Authors’ details
1
British Columbia Children’s Hospital (BCCH), Vancouver, British Columbia,
Canada. 2Child and Family Research Institute (CFRI), Vancouver, British
Columbia, Canada. 3Department of Pediatrics, University of British Columbia,
Vancouver, British Columbia, Canada.
Published: 7 July 2014
doi:10.1186/1472-6963-14-S2-P81
Cite this article as: Sarmast et al.: TDF (Theoretical Domain Framework):
how inclusive are TDF domains and constructs compared to other tools for
assessing barriers to change? BMC Health Services Research 2014 14(Suppl 2):
P81.