title: Practice change in chronic conditions care: an appraisal of theories.
abstract: Management of chronic conditions can be complex and burdensome for patients and complex and costly for health systems. Outcomes could be improved and costs reduced if proven clinical interventions were better implemented, but the complexity of chronic care services appears to make clinical change particularly challenging. Explicit use of theories may improve the success of clinical change in this area of care provision. Whilst theories to support implementation of practice change are apparent in the broad healthcare arena, the most applicable theories for the complexities of practice change in chronic care have not yet been identified.
  
  
  
  We developed criteria to review the usefulness of change implementation theories for informing chronic care management and applied them to an existing list of theories used more widely in healthcare.
  
  
  
  Criteria related to the following characteristics of chronic care: breadth of the field; multi-disciplinarity; micro, meso and macro program levels; need for field-specific research on implementation requirements; and need for measurement. Six theories met the criteria to the greatest extent: the Consolidate Framework for Implementation Research; Normalization Process Theory and its extension General Theory of Implementation; two versions of the Promoting Action on Research Implementation in Health Services framework and Sticky Knowledge. None fully met all criteria. Involvement of several care provision organizations and groups, involvement of patients and carers, and policy level change are not well covered by most theories. However, adaptation may be possible to include multiple groups including patients and carers, and separate theories may be needed on policy change. Ways of qualitatively assessing theory constructs are available but quantitative measures are currently partial and under development for all theories.
  
  
  
  Theoretical bases are available to structure clinical change research in chronic condition care. Theories will however need to be adapted and supplemented to account for the particular features of care in this field, particularly in relation to involvement of multiple organizations and groups, including patients, and in relation to policy influence. Quantitative measurement of theory constructs may present difficulties.
authors.affiliation: Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia. melanie.harris@flinders.edu.au.
authors.forename: Melanie
authors.initials: M
authors.lastname: Harris
authors.affiliation: Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Lawn
authors.affiliation: Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Morello
authors.affiliation: Flinders Human Behaviour & Health Research Unit, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: Malcolm W
authors.initials: MW
authors.lastname: Battersby
authors.affiliation: Health Economics Unit, Flinders Health Care and Workforce Innovations, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Ratcliffe
authors.affiliation: Flinders Southern Adelaide Clinical School, School of Medicine, Flinders University, Adelaide, SA, Australia.
authors.forename: R Doug
authors.initials: RD
authors.lastname: McEvoy
authors.affiliation: Palliative & Supportive Services, School of Health Sciences, Flinders University, Adelaide, SA, Australia.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Tieman
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans
keywords: Chronic conditions; Practice change; Theories