Theory

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).

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).

Examples of theories specific to A&F are Control Theory, Goal Setting Theory, Feedback Intervention Theory and the newly developed Clinical Performance Feedback Intervention Theory (CP-FIT).

• 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.

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

TYPE	THEORY	AUTHOR	YEAR
Education	Adult Learning Theory	Knowles	1984, 1990
	Theory of Medical Education	Coles & Holm	1993
Diffusion	Diffusion of Innovations	Rogers	1983, 1995
	Technology Diffusion Theory	Penland	1997
Organization	Diffusion of Innovations in Service Organizations	Greenhalgh, Robert, Macfarlane, Bate & Kyriakidou	2004
	Lawler’s Organization Theory	Lawler	1976
	Organization Development Theory	Levitt	1965
	Kirkpatrick’s Hierarchy of Levels of Evaluation	Kirkpatrick	1967
Psychology	Social Cognitive Theory	Bandura	1969, 1986, 1997
	Transtheoretical Model	Prochaska & DiClemente	1982, 1986, 1992
	Theory of Reasoned Action	Fishbein, Fishbein & Ajzen	1979, 1968
	Theory of Planned Behaviour	Ajzen	1991
	Social Cognitive Models	Conner & Norman	1996
	Precede/Proceed Planning Model	Green & Kreeuter	1991
	Human Error Theory	Reason	2000
	Behavioural Psychology Theory	Ullman & Krasner	1975
	Social Learning Theory	Perry, Baranowski, & Parcel	1990
Audit & Feedback Specific	Control Theory	Carver & Scheier	1982
	Goal Setting Theory	Locke & Latham	2002
	Feedback Intervention Theory	Kluger & Denisi	1996