Using the theoretical domains framework and the behavioural change wheel in an overarching synthesis of systematic reviews

OBJECTIVE: Synthesis that can filter the evidence from multiple sources to inform the choice of intervention components is highly desirable yet, at present, there are few examples of systematic reviews that explicitly define this type of synthesis using behaviour change frameworks. Here, we demonstrate how using the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel (BCW) made it possible to bring together the findings from a series of three interconnected systematic reviews on the self-care of minor ailments (MAs) to inform the choice of intervention components. METHOD: The TDF and the capability, opportunity, motivation model of behaviour at the hub of the BCW were used to synthesise the findings from the three reviews, including syntheses of service-user views in interviews (review 1, 20 studies) and surveys (review 2, 13 studies), and evaluations of a range of interventions and services (review 3, 21 studies). RESULTS: The TDF and BCW approach provided a systematic, structured and replicable methodology for retrospectively integrating different types of evidence within a series of systematic reviews. Several intervention strategies, grounded in theory and discussed with key stakeholders, were suggested, which can be implemented and tested. CONCLUSIONS: This novel application of the TDF/BCW approach illustrates how it can be used to bring together quantitative and qualitative evidence to better understand self-care behaviour for MAs within a systematic review context. The TDF/BCW approach facilitated exploration of the contradictions and gaps between the separate review syntheses, and supported the identification of possible intervention strategies, grounded in theory. The ongoing development and refinement of this method is supported. PROSPERO REGISTRATION NUMBER: CRD42017071515