ArticleFrontiers in health services2026
The theory behind the strategies: interpreting the expert recommendations for implementing change taxonomy through four behavioural lenses.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Implementation strategies are essential for promoting the uptake of evidence-based practices, yet they are often applied without explicit attention to their theoretical foundations. The Expert Recommendations for Implementing Change (ERIC) taxonomy identifies nine strategy categories, but work on exploring the assumptions underlying how these strategies bring about behaviour change is limited. This study aimed to clarify the theoretical bases of ERIC strategies to strengthen conceptual understanding and guide strategy selection. Methods: We conducted a conceptual analysis of the nine ERIC strategy categories and examined how each aligns with four major perspectives on behaviour change: behaviourism, social cognitivism, dual-process models, and culture. We identified the implicit assumptions about change processes for each category and interpreted these through the four lenses to compare convergences and divergences in their explanatory mechanisms. Results: Each theoretical perspective highlighted distinct yet complementary pathways through which implementation strategies operate. Behaviourism emphasized reinforcement and environmental cues; social cognitivism focused on self-efficacy, motivation, and social learning; dual-process models distinguished between automatic and reflective cognitive systems; and cultural perspectives underscored the influence of shared norms and values. Mapping ERIC categories through these perspectives revealed overlaps and tensions, such as between extrinsic reinforcement and intrinsic motivation, or between individual-level processes and collective cultural alignment. Conclusions: Implementation strategies are not theory-neutral but rest on implicit assumptions about how behaviour changes. Clarifying these assumptions reveals why strategies vary in effectiveness across contexts and provides a foundation for more deliberate, theory-informed strategy selection and evaluation. Integrating behavioural, cognitive, and cultural perspectives offers a multidimensional understanding of change processes, enabling researchers and practitioners to design strategies that are contextually aligned, theoretically coherent, and more likely to produce sustainable outcomes.
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