Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.
It is true that some theories seem to survive longer than they should (Glanz et al., for example, select theories based on their popularity in the past).
This permitted several barriers to be identified and rectified both at the level of theory selection (eg, by selecting theory that explained and guided behaviour change rather than theory that simply explained behaviour but did not guide change) and optimisation in practice (eg, the use of prompt cards to identify important symptoms and activities).
The disadvantage is that conflicting theories could exist to choose from which makes it unclear whether a selected theory would hold in the application domain.
And even if they did seek to apply a particular theory, change agents may find that their selected theory is insufficiently broad to account for all of the factors that motivate or thwart behavior change.
The results of the theoretical review relating to the broad area of work motivation (including its close relationship with retention and performance) are presented first before CHW motivation specifically and the selected theory— the Social Identity Approach.
A summary of the selected theories is shown in table 1 below.
In addition to guiding the design of implementation interventions, the selected theories also provide a means to experimentally evaluate and refine implementation interventions.
We selected theory-based methods that relate to the change objectives in step 2. These methods were required to change the behavioural and environmental determinants of ineffective hospital discharge.
The protocol consists of six steps: (1) assessing needs, (2) formulating programme objectives, (3) selecting theory-based methods and practical strategies, (4) designing the programme plan, (5) designing the adoption and implementation plan, and (6) designing the evaluation plan.
The first two columns in Table 2 illustrate how we elaborated the empirically identified themes with constructs from the selected theories that led to the development of learning objectives.
