Evidence-Based Practice Implementation Within a Theory of Planned Behavior Framework

  • Alexandra M. BurgessEmail author
  • Jaime Chang
  • Brad J. Nakamura
  • Sonia Izmirian
  • Kelsie H. Okamura


Although significant progress has been made in the identification of youth evidence-based practices, the adoption of these interventions into community-based mental health care remains limited. Dissemination and implementation (DI) research has the potential to bridge this science-practice gap in clinical psychology. The theory of planned behavior (TPB) offers a useful conceptualization of individual behavior change including behavioral intention as defined by attitudes, subjective norms, and perceived behavioral control. To facilitate application of this model to DI efforts, the current study explores perspectives about using evidence-based practice from stakeholders in the field of youth mental health (including clinical supervisors, case managers, administrators at the departments of health and education, and direct service providers in clinic-based, school-based, and intensive in-home settings) within the TPB framework. A set of instrument items was created from this rich qualitative data using a rigorous mixed-method content validation approach. Instrument items are provided for future use in DI research.


Behavioral Intention Behavioral Control Control Belief Youth Mental Health Innovation Adoption 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards

Conflict of Interest

The authors are not aware of any existing or potential conflicts of interest.


  1. 1.
    American Psychological Association, Presidential Task Force on Evidence-Based Practice. Evidence-based practice in psychology. American Psychologist. 2006; 61(4): 271-285. doi: 10.1037/0003-066X.61.4.271 CrossRefGoogle Scholar
  2. 2.
    Chambless DL, & Hollon SD. Defining empirically supported therapies. Journal of Consulting and Clinical Psychology. 1989; 66(1): 7-18. doi: 10.1037/0022-006X.66.1.7 CrossRefGoogle Scholar
  3. 3.
    New Freedom Commission on Mental Health. Achieving the Promise: Transforming mental health care in America. Final Report. Pub. No. SMA-03-3832. Rockville, MD; 2003.Google Scholar
  4. 4.
    Silverman WK & Hinshaw SP. The second special issue on evidence-based psychosocial treatments for children and adolescents: A 10-year update. Journal of Clinical Child & Adolescent Psychology. 2008; 37(1): 1-7. doi: 10.1080/15374410701817725 CrossRefGoogle Scholar
  5. 5.
    Weisz JR, Jensen-Doss A, Hawley KM. Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist. 2006; 61(7): 671-689. doi: 10.1037/0003-066X.61.7.671 CrossRefPubMedGoogle Scholar
  6. 6.
    Hoagwood K, Olin S. The NIMH blueprint for change report: Research priorities in child and adolescent mental health. Journal of the American Academy of Child & Adolescent Psychiatry. 2002; 41(7): 760-767. doi: 10.1097/00004583-200207000-00006 CrossRefGoogle Scholar
  7. 7.
    Riemer M, Rosof-Williams J, Bickman L. Theories related to changing clinician practice. Child & Adolescent Psychiatric Clinics of North America. 2005; 14(2): 241-254.CrossRefGoogle Scholar
  8. 8.
    Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Administration and Policy in Mental Health and Mental Health Services Research. 2004; 6(2): 61-74. doi: 10.1023/B:MHSR.0000024351.12294.65 CrossRefGoogle Scholar
  9. 9.
    Walrath CM, Sheehan AK, Holden EW, et al. Evidence-based treatments in the field: A brief report on provider knowledge, implementation, and practice. Journal of Behavioral Health Services & Research. 2006; 33(2): 244-253. doi: 10.1007/s11414-005-9008-9 CrossRefGoogle Scholar
  10. 10.
    Fixsen DL, Naoom SF, Blasé KA, et al. Implementation research: A synthesis of the literature. FMHI Publication No. 231. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, National Implementation Research Network; 2005.Google Scholar
  11. 11.
    Tabak RG, Khoong EC, Chambers DA, et al. Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventative Medicine. 2012; 43(3): 337-350. doi: 10.1016/j.amepre.2012.05.024 CrossRefGoogle Scholar
  12. 12.
    Michie S, Johnston M, Abraham C, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality and Safety in Health Care. 2005; 14: 26-33. doi:  10.1136/qshc.2004.011155 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Francis JJ, Stockton C, Eccles MP, et al. Evidence-based selection of theories for designing behaviour change interventions: Using methods based on theoretical construct domains to understand clinicians’ blood transfusion behaviour. British Journal of Health Psychology. 2009; 14(4): 625-646. doi: 10.1348/135910708X397025 CrossRefPubMedGoogle Scholar
  14. 14.
    Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science. 2009; 4(50). doi:  10.1186/1748-5908-4-50
  15. 15.
    Ajzen I, Fishbein M. The prediction of behavior from attitudinal and normative variables. Journal of Experimental Social Psychology. 1970; 6(4), 466-487. doi: 10.1016/0022-1031(70)90057-0 CrossRefGoogle Scholar
  16. 16.
    Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology. 2001; 40(4): 471-499. doi: 10.1348/014466601164939 CrossRefPubMedGoogle Scholar
  17. 17.
    Fishbein M, Ajzen I. Belief, attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley; 1975.Google Scholar
  18. 18.
    Perkins MB, Jensen PS, Jaccard J, et al. Applying theory-driven approaches to understanding and modifying clinicians’ behavior: What do we know? Psychiatric Services. 2007; 58(3): 342-348. doi: 10.1176/ CrossRefPubMedGoogle Scholar
  19. 19.
    Klaybor GR. An application of the Theory of Planned Behavior on clinical social workers’ utilization of the DSM-IV: An exploratory. Dissertation Abstracts International. 1998; 59(7-A): 2720. UMI No. AAM9841117Google Scholar
  20. 20.
    Meissen GJ, Mason WC, Gleason DF. Understanding the attitudes and intentions of future professionals toward self-help. American Journal of Community Psychology. 1991; 19(5): 699-714. doi: 10.1007/BF00938040 CrossRefPubMedGoogle Scholar
  21. 21.
    Jensen-Doss A, Hawley KM, Lopez M, et al. Using evidence-based treatments: The experiences of youth providers working under a mandate. Professional Psychology: Research and Practice. 2009; 40(4): 417-424. doi: 10.1037/a0014690 CrossRefGoogle Scholar
  22. 22.
    Beidas RS, Kendall PC. Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice. 2010; 17(1): 1-30. doi: 10.1111/j.1468-2850.2009.01187.x Google Scholar
  23. 23.
    Jensen-Doss A, Hawley KM. Understanding clinicians’ diagnostic practices: Attitudes toward the utility of diagnosis and standardized diagnostic tools. Administration and Policy in Mental Health and Mental Health Services Research. 2011; 38(6): 476-485. doi: 10.1007/s10488-011-0334-3 CrossRefPubMedGoogle Scholar
  24. 24.
    Nelson TD, Steele RG. Predictors of practitioner self-reported use of evidence-based practices: Practitioner training, clinical setting, and attitudes toward research. Administration and Policy in Mental Health and Mental Health Services Research. 2007; 34(4): 319-330. doi: 10.1007/s10488-006-0111-x CrossRefPubMedGoogle Scholar
  25. 25.
    Aarons GA, Glisson C, Hoagwood K, et al. Psychometric properties and U.S. national norms of the Evidence-Based Practice Attitude Scale (EBPAS). Psychological Assessment. 2010; 22(2): 356-365. doi: 10.1037/a0019188 CrossRefPubMedGoogle Scholar
  26. 26.
    Francis JJ, Eccles MP, Johnston M, et al. Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers. Retrieved from University of Newcastle, Center for Health Services Research website: Published 2004. Accessed July 22, 2015.
  27. 27.
    Fogg CJ, Mawn BE, Porell F. Development of the Fogg Intent-to-Screen for HIV (ITS HIV) questionnaire. Research in Nursing & Health. 2011; 34(1): 73-84. doi: 10.1002/nur.20412 CrossRefGoogle Scholar
  28. 28.
    González ST, López MCN, Marcos YQ, et al. Development and validation of the theory of planned behavior questionnaire in physical activity. The Spanish Journal of Psychology. 2012; 15(2): 801-816.CrossRefGoogle Scholar
  29. 29.
    Ebel RL, Frisbie DA. Essentials of educational measurement. Oxford, England: Prentice-Hall; 1991.Google Scholar
  30. 30.
    Haynes SN, Richard DCS, Kubany ES. Content validity in psychological assessment: A functional approach to concepts and methods. Psychological Assessment. 1995; 7(3): 238-247. doi: 10.1037/1040-3590.7.3.238 CrossRefGoogle Scholar
  31. 31.
    Messick S. Validity of psychological assessment: Validation of inferences from persons’ responses and performances as scientific inquiry into score meaning. American Psychologist. 1995; 50(9): 741-749. doi: 10.1037/0003-066X.50.9.741
  32. 32.
    Patton M. Qualitative Research & Evaluation Methods (3rd ed). Thousand Oaks, CA: Sage Publications; 2002.Google Scholar
  33. 33.
    Francis JJ, Johnston M, Robertson C, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychology & Health. 2010; 25(10): 1229-1245. doi: 10.1080/08870440903194015 CrossRefGoogle Scholar
  34. 34.
    DeVellis RF. Applied social research methods series, Vol. 26. Scale development: Theory and applications. Thousand Oaks, CA: Sage Publications; 1991.Google Scholar
  35. 35.
    Stice E, Telch CF, Rizvi S L. Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment. 2000; 12(2): 123-131. doi: 10.1037/1040-3590.12.2.123 CrossRefPubMedGoogle Scholar
  36. 36.
    Shafran R, Clark DM, Fairburn CG, et al. Mind the gap: Improving the dissemination of CBT. Behaviour Research and Therapy. 2009; 47(11): 902-909. doi: 10.1016/j.brat.2009.07.003 CrossRefPubMedGoogle Scholar
  37. 37.
    Borntrager CF, Chorpita BF, Higa-McMillan, C, et al. Provider attitudes toward evidence-based practices: Are the concerns with the evidence or with the manuals? Psychiatric Services. 2009; 60(5): 677-681. doi: 10.1176/ CrossRefPubMedGoogle Scholar
  38. 38.
    Nakamura BJ, Selbo-Bruns A, Okamura K, et al. Developing a systematic evaluation approach for training programs within a train-the-trainer model for youth cognitive behavior therapy. Behaviour Research and Therapy. 2014; 5310-19. doi: 10.1016/j.brat.2013.12.001
  39. 39.
    Santucci LC, McHugh RK, Barlow DH. Direct-to-consumer marketing of evidence-based psychological interventions: Introduction. Behavior Therapy. 2012; 43(2): 231-235. doi: 10.1016/j.beth.2011.07.003 CrossRefPubMedGoogle Scholar
  40. 40.
    Kazdin AE, Blase SL. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives in Psychological Science. 2011; 6(1): 21-37. doi: 10.1177/1745691610393527 CrossRefGoogle Scholar
  41. 41.
    Beck JG, Castonguay LG, Chronis‐Tuscano A, et al. Principles for training in evidence‐based psychology: Recommendations for the graduate curricula in clinical psychology. Clinical Psychology: Science and Practice. 2014; 21(4): 410-424. doi: 10.1111/cpsp.12079 Google Scholar
  42. 42.
    Carmel A, Rose ML, Fruzzetti AE. Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system. Administration and Policy in Mental Health and Mental Health Services Research. 2014; 41(5): 608-614. doi: 10.1007/s10488-013-0504-6 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Hicks TB, Shahidullah JD, Carlson JS, et al. Nationally Certified School Psychologists’ use and reported barriers to using evidence-based interventions in schools: The influence of graduate program training and education. School Psychology Quarterly. 2014; 29(4): 469-487. doi: 10.1037/spq0000059 CrossRefPubMedGoogle Scholar
  44. 44.
    Bearman SK, Wadkins M, Bailin A, et al. Pre-practicum training in professional psychology to close the research–practice gap: Changing attitudes toward evidence-based practice. Training and Education in Professional Psychology. 2015; 9(1): 13-20. doi: 10.1037/tep0000052 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Hawaii Departments of Education and Health. Interagency performance standards and practice guidelines. Honolulu, HI: Hawaii Department of Health Child and Adolescent Mental Health Division; 2002.Google Scholar
  46. 46.
    Chorpita BF, Regan J. Dissemination of effective mental health treatment procedures: Maximizing the return on a significant investment. Behaviour Research and Therapy. 2009; 47(11): 990-993. doi: 10.1016/j.brat.2009.07.002 CrossRefPubMedGoogle Scholar

Copyright information

© National Council for Behavioral Health 2016

Authors and Affiliations

  • Alexandra M. Burgess
    • 1
    Email author
  • Jaime Chang
    • 2
  • Brad J. Nakamura
    • 2
  • Sonia Izmirian
    • 2
  • Kelsie H. Okamura
    • 2
  1. 1.Smith College, Bass Hall 303NorthamptonUSA
  2. 2.University of Hawaii at ManoaHonoluluUSA

Personalised recommendations