Six key principles for effective behaviour substitution
De-implementing low-value care
Authors of De-implementing wisely: developing the evidence base to reduce low-value care propose six key principles for effective use of behaviour substitution in interventions to de-implement low-value care in commentary published in the latest issue of JBI Evidence Implementation.
Behaviour substitution has been identified as a commonly used technique for de-implementing low-value care. It provides an alternative approach that is potentially more acceptable to healthcare professionals.
Behaviour substitution aligns with the action-oriented nature of healthcare professionals, addressing their discomfort with the option of appearing to do nothing in patient consultations or in response to patient needs. It helps mitigate the negative consequences associated with inaction, reducing regret and blame. The technique draws on cognitive psychology research, which suggests that the negative consequences of doing nothing can lead to greater regret than the consequences associated with taking action.
Behaviour substitution does present challenges. One challenge is the lack of established methods for selecting appropriate substitute behaviours. Furthermore, behaviour substitution may not be suitable for all instances of low-value care. If there is no clear clinical behaviour to substitute, focusing on the nontechnical function of the unwanted behaviour, such as patient reassurance, may be more appropriate. In these cases, asking healthcare professionals to perform another behaviour may burden them unnecessarily.
To address the challenges, the authors propose six principles for selecting substitute behaviours, for de-implementing low-value care. These principles are derived from the Theoretical Domains Framework (TDF) of behaviour change, and serve as a foundation for the systematic and informed selection of substitute behaviours.
The commentary is open access, and is available in the June 2023 issue of JBI Evidence Implementation:
Patey, Andrea M; Grimshaw, Jeremy M; Francis, Jill J.
JBI Evidence Implementation 21(2):p 115-119, June 2023. | DOI: 10.1097/XEB.0000000000000351