Background
Methods
Selection of the framework
Enhancing the TDF framework
Results
Suggested adaptation for “social/professional role” and “identity”
Overarching intersectionality considerations when applied to the TDF
Consideration | Example |
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Though many TDF domains focus on the individual, individuals are impacted by systems and structures of power. | Self-efficacy (i.e. one’s belief in their capability to exercise control over one’s own behaviour; beliefs about capabilities TDF domain) is associated with better health outcomes [39]. Self-efficacy varies across social identity categories (e.g. Black women have lower levels of self-efficacy than black men, Caucasian women and Caucasian men) [39]. This may be a reflection of power structures in society related to both race and gender. Thus, while self-efficacy is often viewed as a psychological factor, there are social structural factors that can influence individuals’ perceived capabilities. Interventions to enhance self-efficacy may need to consider how some groups have been historically marginalized and disempowered and that their position in society may influence whether they feel they can take action to prevent or control their own health conditions. |
Reflect on how the TDF domains intersect with each other. | An individual’s intersecting social identity categories and professional role may be related to their experience of social influences. For example, a racialized Personal Support Worker may feel unable to speak up if they disagree with a Caucasian team member who is also a Registered Nurse. |
Do those developing/delivering the intervention/policy reflect the diversity of those who will be impacted by it? | Reflect on whether everyone who could be on the team has been asked if and how they would like to be involved. Think about how different perspectives that represent a range of intersecting categories have been examined. Consider whether you team reflects the makeup of the patient, community, and health care providers that experiences the project topic. |
Have those impacted by the intervention/policy been involved in its development? | Consider the patient, healthcare provider, and community population affected by the project topic area. Develop a plan to get them involved. Include multiple individuals to represent a particular group (e.g. five patient partners instead of one). |
Theoretical Domain | Definition of domaina | Intersectionality Prompts |
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Identity | One’s self concept, including one’s perception of relevant intersecting and interacting social categories. | Tell me a little bit about who you are as a person. What categories (e.g., race, gender) are important for someone else to know when they are exploring enhancing the way that you work? How do you think these factors affect you doing [target behavior]? Prompt: some people talk about their language/accent, gender, where they live, who they know, etc. [list categories described by respondent] How do these categories intersect to define you? Do you feel these categories influence others’ perceptions of you? If yes, how does this shape how you engage with [target behavior]? Are there any categories (e.g., gender) that you feel influence [target behaviour]? How do you think they intersect to influence [target behaviour] for you? Are there social identity categories that you have observed as important for influencing others’ engaging in [target behavior]? |
Social/Professional Role | A coherent set or expectation of behaviours and displayed personal qualities of an individual in a social or work setting | Do you believe there are intersecting categories that influence your social or professional role? Do you think they influence in a positive, neutral, or negative way? How do you think your intersecting categories influence your role? How do you think your intersecting categories influence your sense of belonging with your team at work? Do you think your intersecting categories influence their beliefs on whether you should or should not perform [target behaviour]? |
Emotion | A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event | How do you think the intersection of [categories listed by participant] (e.g., intersection of occupation and ethnicity) relates to the feelings you have toward [target behaviour]? |
Reinforcement | Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus | Are there rewards for engaging in [target behaviour] that are relevant to the groups you belong to/identify with (e.g., financial awards for female junior scientists)? Are these rewards important to you? Are there incentives not to do [target behaviour] that relate to the groups you belong to or identify with (e.g., engaging in behaviour will reinforce negative gender stereotypes about leadership)? |
Knowledge | An awareness of the existence of something | Do you think there is enough evidence for [target behaviour]? How might the intersection of [categories listed by participant] (e.g., intersection of education, age, socioeconomic status) influence whether you think there is enough evidence or not? Where and how did you learn about [target behaviour]? How might the intersection of [categories listed by participant] (e.g., intersection of ethnicity and religion) impact your knowledge about [target behaviour]? From your perspective, what knowledge is required to change or improve [target behaviour]? |
Skills | An ability or proficiency acquired through practice | What, if anything, about the intersection of the categories you belong to or identify with makes it easy or hard to [target behaviour]? How have your life experiences shaped the social skills required to engage in [target behaviour]? How might structures of power (e.g., racism) impact your access to acquiring skills required for [target behaviour]? Do you think your intersecting categories make it harder or easier to physically do [target behaviour] compared to other people? Why? Have you attended or engaged in any training to do [target behaviour]? If not, why not? In what ways might your intersecting categories influenced whether you attended or how you experienced training related to [target behaviour]? Are there considerations for future training you feel are important based on your experience? |
Memory, Attention, Decision Processes | The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives | When was a time you forgot to do [target behaviour]? Are there any pieces about your life or personal story related to your intersecting categories that played a role? When was a time you actively decided to do or not to do [target behaviour]? Are there any pieces about your life or personal story that played a role in the decision to do or to not do [target behaviour]? If so, what are they? How and why did they influence your decision? |
Behavioral Regulation | Anything aimed at managing or changing objectively observed or measured actions | Are there any specific traditions, practices, or resources from your socio-cultural background that do or would help you make [target behaviour] a habit? |
Social Influences | Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviours | How do the social groups you belong to/identify with influence [target behaviour]? Do you think the intersecting categories of others influence their beliefs related to [target behaviour]? How? What do you think are other peoples’ perceptions of you doing [target behaviour]? Do you think they think it is important to do or not to? Do you feel pressure by the social groups you belong to/identify with to do or not do [target behaviour]? How might these feelings or pressure intersect? What are others’ expectations about [target behaviour]? How do their expectations intersect with your expectations about [target behaviour]? How might others’ intersecting categories influence their expectations about your engagement in [target behaviour]? Do particular social groups of other people influence your expectations of yourself related to [target behaviour]? Do you feel you have power within the social groups you belong/to identify with? How may this feeling of power or lack of power influence [target behaviour]? How might internalized oppression (e.g., internalized racism) impact [target behaviour]? Are there social groups that you do not belong to/identify with that may influence [target behaviour]? How do the people in your life talk about [target behaviour]? What intersectional categories do they belong to? What do they say about [target behaviour]? |
Environmental Context and Resources | Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour | How do your intersecting categories influence your access to the resources you need to do [target behaviour]? Have the groups you belong to/identify with experienced specific benefits or challenges in your current context? How might these benefits or challenges intersect and influence [target behaviour]? (e.g., Have you faced racism, ableism, or structures operating in society that create inequalities and reinforce exclusion) Have you experienced benefits based on the groups you belong to/identify with (e.g., others identify your professional role based on your gender)? How does where you live and work impact your experience of [target behaviour]? How does your level of education impact your experience of [target behaviour]? |
Optimism | The expectation, hope or confidence that things will happen for the best or that desired goals will be attained | How does who you are as a person (e.g., intersection of gender and age) make you hopeful about doing [target behaviour]? How does the intersection of [categories listed by participant] (e.g., intersection of education and socioeconomic status) make you pessimistic about doing [target behaviour]? |
Beliefs about Consequences | Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation | What do you think the impact is of doing [target behaviour]? What, if any, of your intersecting categories do you think influences your belief that doing [target behaviour] will [outcome stated by participant, e.g. improve healing]? Why or in what ways? If you haven’t engaged in [target behaviour], can you describe what you think would happen if you did [target behaviour]? How did you come to this description? How might your intersecting categories influence this description? |
Beliefs about Capabilities | Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use | What about who you are as a person (e.g., intersection of education and gender) makes it easy or difficult for you to engage in [target behaviour]? What about who you are as a person (e.g., intersection of your home in the community and age) makes you more or less confident to make this change? Why? How might experiences of discrimination or oppression based on intersecting categories impact beliefs about your capabilities to do [target behaviour], either for yourself or for others? |
Intentions | A conscious decision to perform a behaviour or a resolve to act in a certain way | How motivated are you to do [target behaviour]? What about who you are as a person (e.g., intersection of education and age) makes you motivated or not motivated? How does who you are as a person (e.g. intersection of gender and age) influence whether you have a plan to do [target behaviour]? |
Goals | Mental representations of outcomes or end states that an individual wants to achieve | How much of a priority is engaging in [target behaviour] for you? What about who you are as a person (e.g., intersection of socioeconomic status and gender) influences whether or not you want to engage in [target behaviour] relative to your other priorities? |
Case example: mobilization of vulnerable elders (MOVE)
Questions to ask | Mobilization of Vulnerable Elders (MOVE) case example | Your KT Project |
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What barriers to behaviour change did you identity? These can be identified through knowledge syntheses, conversations with stakeholders, interviews/focus groups, surveys, and observations. | Belief that mobilizing patients will lead to more falls. | |
Who is changing their behaviour?a | Unit 2A nurses | |
What does an intersectional approach tell us about these barriers? Think through how you can identify barriers and their related context. | The education system (e.g., undergraduate nursing education) and organizational context (e.g., falls prevention policies at the hospital) support the belief that mobilizing patients will lead to patients falling. Middle-aged female nurses, who have historically held roles as caregivers to aging relatives, share stories of how mobilizing family members has led to falls. | |
What facilitators to knowledge use did you identify? | Nurses’ desire to improve patient outcomes. Nurses’ desire to be in compliance with hospital’s falls prevention policies. | |
What does an intersectional approach tell us about these facilitators? | Nurses’ motivation to provide quality care is driven by the intersection of their professional role, individual values, and societal norms. Nurses’ role as paid employees of the organization impacts their desire to comply with existing organizational mandates (e.g., falls prevention initiatives). |
Questions to ask | Mobilization of Vulnerable Elders (MOVE) case example | Your KT Project |
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What is the current practice? | Patients’ mobility is not assessed upon admission or within 24 hours of admission. Mobility may be assessed at a later point for specific clinical cases. | |
What is the behaviour you want to change? | Assessing mobility within 24 hours of a patient’s admission. | |
How will the current practice be changed: • Stopped • Replaced • Modified • Added to | The current practice will be modified. | |
Who is changing their behaviour?a | Nurses | |
What are key intersecting categories as identified by those expected to change their behaviour? Note that the number of intersecting categories to consider will depend on the project. For more information on exploring intersecting categories, please visit the Intersectionality Guide [26]. |