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Action, actor, context, target, time (AACTT): a framework for specifying behaviour.

ABSTRACT: BACKGROUND:Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention's effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system. METHODS AND RESULTS:We used French et al.'s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions. CONCLUSIONS:Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions.

SUBMITTER: Presseau J

PROVIDER: S-EPMC6896730 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Action, actor, context, target, time (AACTT): a framework for specifying behaviour.

Presseau Justin J McCleary Nicola N Lorencatto Fabiana F Patey Andrea M AM Grimshaw Jeremy M JM Francis Jill J JJ

Implementation science : IS 20191205 1

<h4>Background</h4>Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these an ...[more]

PMID: 31806037

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Project description:IntroductionThe value approximation bias is known to lead to suboptimal policies or catastrophic overestimation bias accumulation that prevent the agent from making the right decisions between exploration and exploitation. Algorithms have been proposed to mitigate the above contradiction. However, we still lack an understanding of how the value bias impact performance and a method for efficient exploration while keeping stable updates. This study aims to clarify the effect of the value bias and improve the reinforcement learning algorithms to enhance sample efficiency.MethodsThis study designs a simple episodic tabular MDP to research value underestimation and overestimation in actor-critic methods. This study proposes a unified framework called Realistic Actor-Critic (RAC), which employs Universal Value Function Approximators (UVFA) to simultaneously learn policies with different value confidence-bound with the same neural network, each with a different under overestimation trade-off.ResultsThis study highlights that agents could over-explore low-value states due to inflexible under-overestimation trade-off in the fixed hyperparameters setting, which is a particular form of the exploration-exploitation dilemma. And RAC performs directed exploration without over-exploration using the upper bounds while still avoiding overestimation using the lower bounds. Through carefully designed experiments, this study empirically verifies that RAC achieves 10x sample efficiency and 25% performance improvement compared to Soft Actor-Critic in the most challenging Humanoid environment. All the source codes are available at https://github.com/ihuhuhu/RAC.DiscussionThis research not only provides valuable insights for research on the exploration-exploitation trade-off by studying the frequency of policies access to low-value states under different value confidence-bounds guidance, but also proposes a new unified framework that can be combined with current actor-critic methods to improve sample efficiency in the continuous control domain.

Project description:Background: Contextual factors such as an intervention's setting are key to understanding how interventions to change behaviour have their effects and patterns of generalisation across contexts. The intervention's setting is not consistently reported in published reports of evaluations. Using ontologies to specify and classify intervention setting characteristics enables clear and reproducible reporting, thus aiding replication, implementation and evidence synthesis. This paper reports the development of a Setting Ontology for behaviour change interventions as part of a Behaviour Change Intervention Ontology, currently being developed in the Wellcome Trust funded Human Behaviour-Change Project. Methods: The Intervention Setting Ontology was developed following methods for ontology development used in the Human Behaviour-Change Project: 1) Defining the ontology's scope, 2) Identifying key entities by reviewing existing classification systems (top-down) and 100 published behaviour change intervention reports (bottom-up), 3) Refining the preliminary ontology by literature annotation of 100 reports, 4) Stakeholder reviewing by 23 behavioural science and public health experts to refine the ontology, 5) Assessing inter-rater reliability of using the ontology by two annotators familiar with the ontology and two annotators unfamiliar with it, 6) Specifying ontological relationships between setting entities and 7) Making the Intervention Setting Ontology machine-readable using Web Ontology Language (OWL) and publishing online. Re sults: The Intervention Setting Ontology consists of 72 entities structured hierarchically with two upper-level classes: Physical setting including Geographic location, Attribute of location (including Area social and economic condition, Population and resource density sub-levels) and Intervention site (including Facility, Transportation and Outdoor environment sub-levels), as well as Social setting. Inter-rater reliability was found to be 0.73 (good) for those familiar with the ontology and 0.61 (acceptable) for those unfamiliar with it. Conclusion: The Intervention Setting Ontology can be used to code information from diverse sources, annotate the setting characteristics of existing intervention evaluation reports and guide future reporting.

Project description:BackgroundThere is growing evidence that context mediates the effects of implementation interventions intended to increase healthcare professionals' use of research evidence in clinical practice. However, conceptual clarity about what comprises context is elusive. The purpose of this study was to advance conceptual clarity on context by developing the Implementation in Context Framework, a meta-framework of the context domains, attributes and features that can facilitate or hinder healthcare professionals' use of research evidence and the effectiveness of implementation interventions in clinical practice.MethodsWe conducted a meta-synthesis of data from three interrelated studies: (1) a concept analysis of published literature on context (n = 70 studies), (2) a secondary analysis of healthcare professional interviews (n = 145) examining context across 11 unique studies and (3) a descriptive qualitative study comprised of interviews with heath system stakeholders (n = 39) in four countries to elicit their tacit knowledge on the attributes and features of context. A rigorous protocol was followed for the meta-synthesis, resulting in development of the Implementation in Context Framework. Following this meta-synthesis, the framework was further refined through feedback from experts in context and implementation science.ResultsIn the Implementation in Context Framework, context is conceptualized in three levels: micro (individual), meso (organizational), and macro (external). The three levels are composed of six contextual domains: (1) actors (micro), (2) organizational climate and structures (meso), (3) organizational social behaviour (meso), (4) organizational response to change (meso), (5) organizational processes (meso) and (6) external influences (macro). These six domains contain 22 core attributes of context and 108 features that illustrate these attributes.ConclusionsThe Implementation in Context Framework is the only meta-framework of context available to guide implementation efforts of healthcare professionals. It provides a comprehensive and critically needed understanding of the context domains, attributes and features relevant to healthcare professionals' use of research evidence in clinical practice. The Implementation in Context Framework can inform implementation intervention design and delivery to better interpret the effects of implementation interventions, and pragmatically guide implementation efforts that enhance evidence uptake and sustainability by healthcare professionals.

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Action, actor, context, target, time (AACTT): a framework for specifying behaviour.

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Action, actor, context, target, time (AACTT): a framework for specifying behaviour.

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