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The big six: key principles for effective use of Behavior substitution in interventions to de-implement low-value care

Patey, A. M., Grimshaw, J. M. & Francis, J. J. ORCID: 0000-0001-5784-8895 (2023). The big six: key principles for effective use of Behavior substitution in interventions to de-implement low-value care. JBI Evidence Implementation, 21(2), pp. 115-119. doi: 10.1097/xeb.0000000000000351


Healthcare professionals provide care to help patients; however, sometimes that care is of low value – at best ineffective and at worst harmful. To address this, recent frameworks provide guidance for developing and investigating de-implementation interventions; yet little attention has been devoted to identifying what strategies are most effective for de-implementation. In this paper, we discuss Behavior substitution, a strategy whereby an unwanted behavior is replaced with a wanted behavior, thereby making it hypothetically easier to reduce or stop the unwanted behavior. We discuss why Behavior substitution may be a useful de-implementation strategy, and why it may not be suitable for all circumstances. On the basis of the body of knowledge in behavioral science, we propose a list of principles to consider when selecting a substitute behavior for a de-implementation intervention. Applying these principles should increase the likelihood that this technique will be effective in reducing low-value care.

Publication Type: Article
Additional Information: This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Publisher Keywords: Behavior substitution; de-implementation; health professional behavior change; intervention design; low-value care; technique
Subjects: R Medicine > R Medicine (General)
Departments: School of Health & Psychological Sciences
SWORD Depositor:
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